A coronary artery bypass grafting procedure is being performed on the cardiac surgery simulator. - Contributed

Researchers at the University of the West Indies, Mona, have deve-loped the cardiac surgery training simulator which allows surgeons and trainees to practise complex surgical procedures under realistic conditions, using a pig's heart, which beats under computer control.

Lecturer in the Department of Mathematics and Computer Science, Dr Daniel Coore, deve-loped the simulator in collabo-ration with Drs Paul Ramphal and Michael Craven. He explained: "A real pig's heart is placed inside a mock chest cavity with balloons inserted into the heart. The heart is animated by a pneumatic pump which is controlled by a computer. The computer allows the heart to 'beat' fast or slowly and arbitrarily 'creates' various conditions that might arise during the course of a surgical procedure." Coore said that the cardiac surgery training simulator provides "a realistic environment for training" as participants are able to work with an authentic organ.

Practising the procedures

Currently, cardiac surgeons are trained by observing experts in the operating room and by practising the procedures on animals, typically a pig, because the pig's heart is so much like a human's. In some institutions, residents use synthetic models of the arteries and veins to practise stitching them together, which is one of the most commonly performed procedures in heart surgery. According to Coore, the problem with these modalities of training is that it takes a lot of time before a resident receives enough exposure and gains sufficient experience to actually perform these procedures on a human being.

He explains: "Our simulator solves the problem of allowing surgeons to train in realistic conditions without putting anyone at risk. We do so by providing an environment that is almost identical to the operating room environment, but without involving a human patient. The analogy is with pilots who learn to fly a plane by first training in a flight simulator. They learn the basics there, and then the more advanced and even esoteric manoeuvres. They can master even more difficult situations in the simulator, so that if these situations ever arise in a real-life situation, the trainee would have had the experience (vicariously) to handle it."

The simulator is particularly useful because of new regulations that have been introduced in both the United States and Europe that put upper limits on the time that medical personnel may work per week. Coore points out that as a consequence, either residency programmes will take longer to complete, residents will not be able to cover as much material, or educators will have to find innovative ways of training residents that minimise the compromise between those two extremes.

The cardiac surgery simulator provides educators with an opportunity to find many innovative ways of training cardiac surgeons. According to Coore, while simulation is already being used in various medical pro-grammes, simulator technology to assist with cardiac surgery training is still relatively young, so there is enormous potential for growth and development.

"Residents who have had an opportunity to use it have unani-mously endorsed it. None of them believed that they could be trained purely on the simulator, but all of them thought that training on it was a fantastic substitute for the real thing," he said.

The cardiac surgery simulator in the process of being reconstructed. In the fore-ground is the mock chest cavity (without a heart), behind it, to the left, are the computer and electronic controls, and adjacent to them are the fluid pumps and controls. - Contributed

The simulator was, in fact, the brainchild of cardiac surgeon Paul Ramphal, in collaboration with lecturers, Drs Coore and Michael Craven.