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Ann Thorac Surg. 2019 Nov;108(5):1551-1554. doi: 10.1016/j.athoracsur.2019.04.084. Epub 2019 Jun 14.

Surgeon as Programmer: Overcoming Obstacles to the Use of Modern Internet Technology for Cardiothoracic Surgery.

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Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California. Electronic address:
Department of Orthopaedics, University of Miami, Miami, Florida.
Section of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.



Leveraging Internet technologies for academic activities can be complex and expensive, costing tens of thousands of dollars. This report describes an experience in eliminating financial barriers and realizing the potential for a new paradigm in applications for surgical education and practice.


After developing multiple surgical smartphone applications (apps), the report describes the acquisition of skill sets and resources to create state-of-the-art tools. Learning these techniques is nontrivial but is attainable and clearly defined. The report then discusses the trivial costs associated with complex software development, thereby opening new doors to creative uses of technology.


Acquisition of coding skills for smartphones took approximately 100 hours. For a simple app without data storage, EuroSCORE (European System for Cardiac Operative Risk Evaluation), total programming time was 25 hours with no additional costs. The more complex autonomy evaluation app, Zwisch Me, was used to evaluate more than 1260 cases from 15 cardiothoracic surgery training programs between January 2016 and August 2018 by using smartphone apps for data collection and a Web dashboard for data reporting. During the first year, all enrollment and data reporting was done manually, at a cost of $124. Automating user enrollment and data reporting increased costs by roughly $240, for an annual expense of $364. Total programming time for this app was approximately 120 hours.


Mobile software is underused in the academic surgical arena. The historically large financial barriers to adoption can be overcome by acquisition of coding skills by surgical team members. Direct physician involvement will spawn previously undreamed-of creative applications to enhance practice and education.

[Indexed for MEDLINE]

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