Centre for Applied Health Research

A Feasibility Study Comparing Current Keyhole Vein Removal Training with a Structured Training Programme

Coronary artery bypass graft surgery (CABG) is a commonly performed surgical procedure for coronary artery disease. Currently, 20,000 bypass surgeries are carried out each year in the UK involving 290 surgical nurse practitioners and many more surgical trainee doctors who perform vein harvesting. A blood vessel (vein) from the leg is removed and used to bypass the blocked coronary arteries. The new vein takes over the job of supplying blood to the heart muscles and patients need to live with their vein graft for many years (typically 10 to 15 years). If the vein is mishandled or damaged during removal, it can become blocked. This can affect the patient’s quality of life and cause repeated chest pain. Harvesting veins using keyhole surgery has been shown to reduce wound complications and improve patient satisfaction compared to traditional open vein harvesting.

Current training for keyhole vein removal in cardiac surgery typically involves a limited number of practice sessions on a leg model and one week’s training in the operating room, provided by a commercial trainer. However, a structured training programme is required for this procedure, to make sure vein quality is better and to minimise problems for patients. Currently, during training, patients are used as “Guinea pigs” by trainees.

A recent survey of 151 health care professionals in 15 European countries found that 99% of specialists would like to have a structured keyhole training programme. The study main investigator previously developed the Manchester Endoscopic Learning Tool (MELT), a structured training programme that consists of four sections (introducing the trainees to the theory, surgical video, gradual introduction to clinical practice and vein harvesting), with a minimum pass mark of 80% for each section. The first two phases of the MELT are skill-based e-learning and the second two phases are learning in clinical settings with patients.

Primary aim of this study is to find out whether the structured comprehensive keyhole removal training programme will improve the quality of vein tube by improving the operator’s skills and confidence.

Prof. Bhuvaneswari Krishnamoorthy from the University of Salford is the main contact for this study.

How will we do this?

Trainees:

  • Full training will be provided by the chief investigator for one arm of the study and another arm of the study participants will be taught by the current company trainer.
  • Various questionnaires need to be completed on different stage of the training and after
  • training of the keyhole vein removal method.
  • Trainees will be asked to provide 1cm x 3 vein pieces from the vein removed for surgery. 20 patients will be recruited post training not during keyhole training.

Patients:

  • As part of standard care, patient will be admitted to hospital for their heart bypass surgery (CABG). During the operation their leg veins will be taken out for bypassing the blocked arteries in the heart, which is a routine procedure during bypass surgery.
  • The hospital will have been allocated randomly for one of the two methods of training for vein removal and the removed vein will be used for CABG with a small sample of this vein will be taken to laboratory for further cell studies. Hospital may receive current standard training from the keyhole method company or structured training method.
  • If they agree to take part one of the trainees will remove their leg vein and we will follow up as part of aftercare progress through their medical notes, a series of questionnaires over the telephone and we will ask them to come back for a CT coronary angiogram between 6 to 9 months.
  • The samples taken from their vein (1cm) will be taken to the laboratory. We will look at how cells that make up the vein have reacted to the different vein removal techniques which we have used. All the samples will be coded with a unique reference number that will not include any of their personal data.
  • Patient will be telephone interviewed by one of the researchers from the hospital on 1, 3, 6, 9 and 12 months using standard questionnaire regarding the progress after cardiac operation.

Study start date: March 2022.

Study end date: September 2024, study completed earlier due to COVID pandemic, in the process of analysis and write up for another 6 to 1 year depends upon the patient follow up completion.

Funder: NIHR postdoctoral fellowship

Team

Prof. Bhuvaneswari Krishnamoorthy

Prof. Rajamiyer Venkateswaran

Mr. Rick Air

Prof. Enoch Akowuah

Mrs. Cristina Ruiz Segria

Mrs. Azita Rajai

Dr. Alexandra Thompson

Prof. Sally Spencer

Publications