# Construction and Surgical Training of Coronary Anastomosis on a Low-Cost Portable Simulator: Experience in a Peruvian Multicenter Study

## TL;DR

A low-cost, portable simulator was developed and tested to train cardiothoracic surgery residents in coronary anastomosis, showing improved skills and performance.

## Contribution

A portable and affordable simulator for coronary anastomosis training was developed and validated across multiple centers in Peru.

## Key findings

- Junior residents showed significant improvement in specific anastomosis skills using the simulator.
- Senior residents outperformed junior residents in anastomosis time for all types of anastomoses.
- The simulator effectively transfers skills to real surgical settings.

## Abstract

The operating room is no longer the ideal place for early surgica training of
cardiothoracic surgery residents, forcing the search for simulation-based
learning options. The study’s aim was the construction and surgicaltraining
of coronary anastomosis in a portable, low-cost, homemade simulator.

This is an observational, analytical, and multicenter study. The simulator
was built with common materials and was evaluated with the Objective
Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and
senior residents from nine national cardiothoracic surgery centers were
considered for 90 days. Operative skill acquisition and time in the creation
of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E)
coronary anastomoses were evaluated. All sessions were recorded and
evaluated by a single senior cardiothoracic surgeon during two time
periods.

One hundred and forty residents were assessed in 270 sessions. In junior
residents, a significant improvement in final scores was identified in S-T-S
(use of Castroviejo needle holder, needle angles, and needle transfer)
(P<0.05). In seniors, a significant improvement was
identified in S-T-S (graft orientation, appropriate spacing, use of forceps,
angles, and needle transfer) anastomoses (P<0.05). A
significant improvement in the final anastomosis time of senior residents
over junior residents was identified in S-T-S (8.11 vs.
11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E
(6.56 vs. 9.68 minutes) (P=0.039).

Our portable and low-cost coronary anastomosis simulator is effective in
improving operative skills in cardiothoracic surgery residents; therefore,
skills acquired through simulation-based training transfer have a positive
impact on the surgical environment.