In situ and patient-specific simulation-based training for low volume high complex cardio-thoracic surgery: The Twente practice

<div class="WACEditing EditMode EditingSurfaceBody FireFox WACViewPanel_DisableLegacyKeyCodeAndCharCode usehover" style="overflow: hidden; visibility: visible; direction: ltr;"><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: left; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Introduction </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Low-volume and high-complex cardio-thoracic surgery​ procedures such as minimally-invasive removal of small lung tumours (segmentectomy) or septal myectomies for hypertrophic obstructive cardiomyopathies have long learning curves and a high risk for complications. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Simulation-based practice might reduce these long learning curves​, tailors towards surgery without surprises, and may reduce complications and improves quality of life. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">​With increasing 3D-technology opportunities, we aim to simulate these complex patient cases before the actual procedure and hypothesize this to improve understanding of patients’ anatomy, increase confidence and ultimately improve patient consultation and outcomes as novel institutional practice. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Description </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Magnetic resonance or computer tomography imaging (MRI/CT) is used to visualize relevant intrathoracic structures which is segmented into 3D virtual reconstructions. A technical medical doctor analyses relevant anatomical structures, determines a treatment plan, discussed subsequently with the patient and treating cardio-thoracic surgeon to prepare a patient case just-in-time. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Over 35 septal myectomies were simulated, and matured from a virtual model to a 3D-printed model with a silicone inlay where the surgeon might resect excessive heart tissue. Dyspnoea was reduced by these procedures as determined by NYHA-assessment. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">For 14 consecutive lung segmentectomies, surgeons felt 96% confident in the treatment plan after 3D-planning. Moreover, in 32% of cases, initial surgical plan changed by using 3D-visualization simulation. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Discussion </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Next to novices, experts also benefit from patient-specific, in-situ planning for clinical practice. Although patients and surgeons feel more informed (Kirkpatrick Level 2), this effect was not yet assessed quantitatively. Patient outcomes are satisfactory and will be compared to former practice in the near future. </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">Conclusion </div><div class="OutlineElement Ltr SCXW201806332 BCX2" style="direction: ltr;"><p class="Paragraph SCXW201806332 BCX2" style="font-weight: normal; font-style: normal; vertical-align: baseline; background-color: transparent; color: windowtext; text-align: justify; margin: 0px 0px 10.6667px; padding-left: 0px; padding-right: 0px; text-indent: 0px;">With in-house expertise we developed an institutional approach to simulation-based practice for low-volume and high-complex cardio-thoracic surgery. In situ and just-in-time simulation-based practice paves the way for a new paradigm in cardio-thoracic surgery: See one, simulate one, do one, teach one​. </div></div>