CREST Trial: Endoscopic vein harvesting Structured vs Current Training
Research type
Research Study
Full title
A multicentre Cluster Randomised pilot study comparing current Endoscopic (keyhole) vein harvesting training with Structured Training - The CREST trial.
IRAS ID
310749
Contact name
Bhuvaneswari Krishnamoorthy
Contact email
Sponsor organisation
Manchester University NHS Foundation Trust
ISRCTN Number
ISRCTN27493194
Duration of Study in the UK
1 years, 8 months, 21 days
Research summary
Coronary Artery Bypass Graft (CABG) surgery is a commonly performed surgical procedure for coronary artery disease. 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. 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 Manchester Endoscopic Learning Tool (MELT) is 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%. The first two phases of the MELT are skill-based e-learning and the second two phases are learning in clinical settings with patients. The training programme will seek to optimise patient outcomes, improved cost effectiveness and reduction of variation in global training practices. This will ensure that practitioners are delivering good surgical techniques under minimally stressful conditions so that patients directly benefit from a structured training programme.Results Summary:
: Lay Summary: 1(all aspects of the study) A feasibility study comparing current Endoscopic vein harvesting training with a structured training programme Bhuvaneswari Krishnamoorthy, Sam Raaj, Rick Air, Cristina Ruiz Segria, Jaydeep Sarma, James Barnard, Azita Rajai, Rajamiyer Venkateswaran.This study looked at two different ways of training practitioners to perform a keyhole technique called Endoscopic Vein Harvesting (EVH), which is used in heart bypass surgery. EVH is less invasive than traditional methods and results in fewer complications and better patient outcomes.
Researchers compared the current standard training, which is short and inconsistent, with a new, more structured training programme. This structured training included classroom learning, practice on simulators, watching surgical videos, and closely supervised practice on real patients.
Four surgical trainees took part: two followed the structured programme, and two followed the usual current training. The structured training lasted four weeks, while the standard training stretched over 2 weeks or several months with long gaps in between. After training, the structured group successfully completed all their surgeries, while the standard group struggled and eventually dropped out due to stress and low confidence.
Veins removed by the structured group showed better quality under the microscope. Patients treated by this group also had fewer complications. After the study, the structured trainees went on to perform hundreds of successful procedures.
In summary, the structured training programme improved surgical skill, confidence, and patient safety highlighting the need for better training in this important surgical technique.
Lay summary 2: Histology results
A Feasibility Study Comparing Histological Damage in Long Saphenous Vein Harvesting Using Endoscopic Vessel Harvesting During the Learning Curve Period Sam Raaj, Rick Air, Cristina Ruiz Segria, Setemi Olufemi, Azita Rajai, Bhuvaneswari Krishnamoorthy
In heart bypass surgery, veins are removed from a patient’s leg and used to reroute blood around blocked arteries. One common method for removing these veins is called Endoscopic Vessel Harvesting (EVH), a less invasive “keyhole” technique. However, how well the vein is handled during removal can affect its quality and how well it works in the body later.
This study looked at how much microscopic damage occurred in veins removed by surgical trainees learning EVH. The researchers compared two types of training: a structured training programme with step-by-step guidance and simulation practice, and conventional training, which is shorter and less hands-on.
Four trainees participated: two in each training group. The structured training group completed all 20 planned surgeries, while the conventional trainees struggled and dropped out early due to stress.
Veins removed by the structured trainees had healthier inner linings, with fewer signs of injury, muscle damage, or swelling when viewed under a microscope. In contrast, veins removed by the conventional group showed more signs of stress and trauma.
REC name
North West - Greater Manchester South Research Ethics Committee
REC reference
22/NW/0010
Date of REC Opinion
24 Jan 2022
REC opinion
Favourable Opinion