Background Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator’s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post–cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform.
External chest compressions are often ineffective for patients arresting after cardiac surgery, for whom emergency resternotomy may be required. A single-blinded randomized controlled trial (RCT) was performed, with participants being randomized to a virtual reality (VR) Cardiac Surgical Unit Advanced Life Support (CSU-ALS) simulator training arm or a conventional classroom CSU-ALS training arm. Twenty-eight cardiothoracic surgery (CTS) residents were included and subsequently assessed in a moulage scenario in groups of two, either participating as a leader or surgeon. The primary binary outcomes were two time targets: (1) delivering three stacked shocks within 1 min and (2) resternotomy within 5 min. Secondary outcomes were the number of protocol mistakes made and a questionnaire after the VR simulator. The conventional training group administered stacked shocks within 1 min in 43% (n = 6) of cases, and none in the VR group reached this target, missing it by an average of 25 s. The resternotomy time target was reached in 100% of the cases (n = 14) in the conventional training group and in 83% of the cases (n = 10) in the VR group. The VR group made 11 mistakes in total versus 15 for those who underwent conventional training. Participants reported that the VR simulator was useful and easy to use. The results show that the VR simulator can provide adequate CSU-ALS training. Moreover, VR training results in fewer mistakes suggesting that repetitive practice in an immersive environment improves skills.
We present a stepwise approach to performing a laparoscopic right hemicolectomy along with D2 excision. The video illustrates a modular approach for set up and resection, performed on a 60‐year‐old male patient, with a cancer in the ascending colon. The procedure is divided into its key steps, which include patient position, port placement and anatomical exposure, medial to lateral dissection with vessel control, sub‐ileal dissection, lateral mobilization, hepatic flexure mobilization and extraction with extracorporeal anastomosis. The key regional anatomy is highlighted alongside diagrams illustrating standard anatomy and common anatomical variants. We believe this video provides a valuable resource for trainee surgeons to expand their understanding regarding steps of the procedure and associated anatomy.
BACKGROUND Cardiac arrest after cardiac surgery commonly has a reversible cause, where often emergency re-sternotomy is required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of CPR and emergency re-sternotomy procedures after cardiac surgery, the CardioPulmonary resuscitation VR-simulator (CPVR-sim). In this prospective study, we researched face validity and content validity of this CPVR-sim. OBJECTIVE We designed a prospective study to assess the feasibility and to establish the face and content validity of CPVR-sim in a group of novices and experts in performing CPR and emergency re-sternotomies in patients after cardiac surgery. METHODS Thirty clinicians (staff cardiothoracic surgeons, physicians, surgical residents, and nurse practitioners) participated as either an expert or novice, based on experience with emergency re-sternotomy. All performed the simulation and completed the questionnaire rating the simulator’s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. RESULTS Responses towards face validity and content validity were predominantly positive in both groups. Most participants felt actively involved (97%), in charge of the situation (73%), it was easy to learn how to interact with the software (80%), and the software responded well (70%). Almost all expert-participants preferred VR training as a substitute to conventional (100%) and digital (60% agreed and 40% was neutral) training. Moreover, 86% of the expert-participants would recommend VR training to other colleagues, and 93% found that CPVR-sim is a useful method to train infrequent CPR-cases after cardiac surgery. CONCLUSIONS We developed a proof-of-concept of a VR simulation for CPR training after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of CPVR-sim, we present a first step towards a cardiothoracic surgery VR training platform.
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