Title: Can We Safely Teach Minimal Access Techniques In A Surgical Training Programme?
Abstract: Objective: New surgical techniques often preclude incorporation into training programmes due to increased complexity and concerns for patient safety during the learning curve. Conventional aortic valve replacement is undertaken with a full median sternotomy. Partial sternotomy (mini-AVR) reduces the surgical morbidity and offers significant functional and cosmetic benefits. Training is challenging due to the inherent difficulties of limited surgical exposure. We examined the outcomes of minimally invasive operations undertaken by trainees at our centre. Methods: Operative records of patients who had undergone mini-AVR between 2006-2018 were retrieved. Patient/operative details, and outcomes were evaluated. We used descriptive statistics and unpaired t-test to compare trainee and consultant performance. Results: 251 patients underwent mini-AVR in the study period, of which 51 were performed by trainees. The patients were divided into two groups. Group I operated by Surgical Trainees and Group II by Consultant Surgeon. Group I was significantly younger (65.9 vs 70.2 years, p=0.001). Significantly longer cross-clamp (92 vs 70 mins, p=0.001), and cardiopulmonary bypass times (110 vs 90 mins, p=0.008) were noted in Group I. Other outcomes between the two groups were similar: all-cause 30-day mortality (0% vs 1.1%), re-exploration, renal failure, neurological events, permanent pacemaker insertion, with no significant differences. Chronological evaluation of cross-clamp and bypass times reveal a cyclical pattern of increasing and decreasing operative times as trainees start and finish their rotations over 10 years. Overall operative times for both consultant and trainees are also shown to have reduced over the study period (Figure 1), suggesting the learning curve is shorter for subsequent trainees. Conclusions: We demonstrate that training the next generation of cardiac surgeons in the latest techniques can be undertaken safely with appropriate patient selection.