The Center for Cardiothoracic Simulation at the University of North Carolina at Chapel Hill has developed two simulators which allow for a full operative experience with cardiac surgery and with lung surgery (both open and thoracoscopic) without the use of live animals.
The lifelike simulators, which use porcine organs, are used in cardiothoracic surgery education and training at the local and national levels. The simulators use organs that have been re-animated using hydraulics, reperfusion, and computer orchestration, and are then placed in a human equivalent model.
The simulators are:
Ramphal Cardiac Surgery Simulator (RCSS)
The RCSS was invented by Dr. Paul Ramphal and colleagues at the University of the West Indies Mona in 2001 and published in the European Journal of Cardiothoracic Surgery in 2005 (Euro J Cardiothorac Surg 27(5):910-916, 2005). It lay dormant until January 2008, when it was reactivated at the CCTS at UNC under sponsorship of the American Board of Thoracic Surgery and the University of North Carolina.
The model uses a porcine heart that is prepared with an intraventricular balloon in each ventricle. The balloons are inflated by a computer controlled activator. The computer program is able to simulate the beating heart, various cardiac arrhythmias, hypo- and hypertensive states, cardiac arrest, and even placement of an intra-aortic balloon pump. The model is perfused with a washable blood substitute. When placed in a replica of the pericardial well in a mannequin, the RCSS is capable of duplicating most aspects of cardiac surgery including all aspects of cardiopulmonary bypass, coronary artery bypass grafting both on and off bypass, aortic valve replacement, heart transplantation, and aortic root reconstruction. The computer protocols also make experience with adverse events such as accidental instillation of air into the pump circuit, aortic dissection, and sudden ventricular fibrillation after discontinuation of cardiopulmonary bypass possible.
The model has been used in the training of more than 140 cardiothoracic surgery residents in the United States at the Thoracic Surgery Directors Association (TSDA) Resident Boot Camps (intensive training sessions for physicians who are beginning their residency training in cardiothoracic surgery) and the Resident Technology Symposia and has been shown to be a very effective training tool.
UNC Thoracic Surgery Simulator
A similar strategy has been used to develop the UNC Thoracic Surgery Simulator, which is capable of simulating open chest procedures and thoracoscopic chest procedures. It can be used to simulate left hilar dissection, left upper and lower lobectomies, thoracoscopic wedge resections, pleural biopsy, pericardial window, and thoracoscopic lobectomy.
The UNC Thoracic Simulator uses a porcine heart, lung, descending aorta, esophagus and trachea block. Only the left lung is used for anatomic lobectomy as the porcine right sided anatomy has an extra bronchus. The block is prepared by filling the descending aorta with silicone to prevent leakage and stiffen the vessel to resemble the perfused aorta. Perfusion of the pulmonary artery and the pulmonary veins separately with the blood substitute is necessary to distend them without causing the lung to become edematous. The block is placed on a moving platform which simulates mediastinal movement during one lung anesthesia. The heart is activated by inflation of a right intraventricular balloon. The preparation is housed in one of two mannequins, one with a thoracotomy incision made and one with thoracoscopy ports depending on whether the simulation involves thoracotomy or thoracoscopy. The thoracoscopic simulator has been found to be more representative of operating on the human than a live pig since the simulator thorax has human dimensions. This simulator has also been extensively used at the TSDA Boot Camp and the Resident Technology Symposium.
We plan to add thoracic esophageal surgery, including repair of perforation and performance of esophagogastric anastomosis. The model would also lend itself readily to open thoracic aorta surgery.
Three videos of UNC's cardiac surgery simulator and lung surgery simulators can be seen below. Requires Flash.
Ramphal Cardiac Surgery Simulator:
UNC Lung Surgery Simulator:
UNC Lung Surgery Simulator: