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Wippel D, Westreicher W, Gummerer M, Kluckner M, Ouaret M, Lamprecht F, Grams A, Gratl A, Wipper S. Comparing the Efficacy of Endovascular Simulation Training in different Training Formats: a randomized controlled trial. Ann Vasc Surg 2024:S0890-5096(24)00415-1. [PMID: 39013489 DOI: 10.1016/j.avsg.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION High-fidelity endovascular simulators have demonstrated significant potential in enhancing interventionalists' performance metrics, including procedure time, fluoroscopy time, and contrast volume usage. However, it is less clear whether trainee performance, when assessed using both multidimensional global and procedure-specific rating scales, improves in a manner consistent with these metric parameters. This study aimed to determine whether the structure of the training - conducted in block sessions or weekly intervals - impacts the effectiveness of the training. METHODS 20 students were enrolled in this prospective, randomized, controlled, single-center trial. They were randomly divided into block and weekly training groups, each undergoing 6 hours of supervised endovascular training on a Mentice simulator over a span of 3 weeks. At the outset and conclusion of their training, students performed a predefined peripheral endovascular intervention, which was assessed by an experienced interventionalist. Furthermore, participants were prompted to complete a survey at both the beginning and the end of the study. RESULTS Both groups exhibited significant improvements in procedure time, fluoroscopy time, contrast volume usage, global rating scale scores, and performance-specific rating scale scores. However, no significant difference was observed between the two groups. The simulator training notably boosted the trainee's self-confidence. CONCLUSION Simulator training not only enhances metric performance parameters, but also improves performance as assessed by both global rating scale and procedure-specific rating scale. Whether the training is conducted in block sessions or weekly intervals did not affect its efficacy. As such, the training format can be tailored to best fit the specific circumstances and setting.
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Affiliation(s)
- David Wippel
- Department of Vascular Surgery, Medical University Innsbruck
| | | | - Maria Gummerer
- Department of Vascular Surgery, Medical University Innsbruck
| | | | - Miar Ouaret
- Department of Radiology, Medical University of Innsbruck
| | | | - Astrid Grams
- Department of Radiology, Medical University of Innsbruck
| | - Alexandra Gratl
- Department of Vascular Surgery, Medical University Innsbruck.
| | - Sabine Wipper
- Department of Vascular Surgery, Medical University Innsbruck
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Rouby AF, Neumann N, Vento V, Lejay A, Kuntz S, Bourcier T, Oulehri W, Bismuth J, Chakfé N. Fundamental Technical Skills of Endovascular Surgery: A Preliminary Study on Its Impact on Skills and Stress during Procedures. Ann Vasc Surg 2024; 108:84-91. [PMID: 38942373 DOI: 10.1016/j.avsg.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Our objective is twofold: determining if simulation allows residents to reach proficient surgeons' performance concerning fundamental technical skills of endovascular surgery (FEVS) while investigating effects of the program on surgeons' stress. METHODS Using a FEVS training simulator, 8 endovascular FEVS were performed by vascular surgery residents (simulator-naive or simulator-experienced residents [SER]) and seniors. Total time needed to complete the 8 tasks, called total completion time (TCT), was the main evaluation criterion. Analgesia Nociception Index (ANI) was monitored during simulation. Likert scale questionnaire was filled out after each simulation. RESULTS For each task, TCT was significantly lower for SER and seniors than simulator-naive residents (P = 0.0163). After only 5 simulations, SER were able to reach and even exceed the seniors' level in terms of TCT, with a median time of 10.8 min for SER and 11.9 min for seniors, and wire's movements with a median distance during cannulation of 4.44 m for SER and 4.17 m for seniors. Seniors remained better than SER in terms of precise wire manipulation (wire movement after cannulation), 4.17 m against 4.44 m (3.72-5.96), respectively. Based on the Likert scale stress analysis, seniors felt less stressed than both residents' groups (P = 0.0618). Seniors' initial ANI and mean ANI over the session were significantly lower than those of the residents, P = 0.0358 and P = 0.0250, respectively. CONCLUSIONS We showed that 5 simulation sessions allowed residents to reach experienced surgeons' capacities on FEVS concerning TCT. Subjectively, seniors felt less stressed than residents, contrary to the results of our objective measures of stress.
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Affiliation(s)
- Anne-Florence Rouby
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France
| | | | - Vincenzo Vento
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France
| | - Anne Lejay
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France
| | - Salomé Kuntz
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France
| | - Tristan Bourcier
- GEPROMED, Strasbourg, France; Department of Ophthalmology, University Hospital of Strasbourg, Strasbourg, France
| | - Walid Oulehri
- GEPROMED, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France; Department of Anaesthesiology and Intensive Care, University of Strasbourg, Strasbourg, France
| | - Jean Bismuth
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Nabil Chakfé
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France; Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France.
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Foresti R, Fornasari A, Bianchini Massoni C, Mersanne A, Martini C, Cabrini E, Freyrie A, Perini P. Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training. Bioengineering (Basel) 2024; 11:197. [PMID: 38391683 PMCID: PMC10886183 DOI: 10.3390/bioengineering11020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.
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Affiliation(s)
- Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Arianna Mersanne
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Diagnostic Department, University-Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
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Hartung V, Augustin AM, Grunz JP, Huflage H, Hennes JL, Kleefeldt F, Ergün S, Peter D, Lichthardt S, Bley TA, Gruschwitz P. Training for endovascular therapy of acute arterial disease and procedure-related complication: An extracorporeally-perfused human cadaver model study. PLoS One 2024; 19:e0297800. [PMID: 38330071 PMCID: PMC10852297 DOI: 10.1371/journal.pone.0297800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the usability of a recently developed extracorporeally-perfused cadaver model for training the angiographic management of acute arterial diseases and periprocedural complications that may occur during endovascular therapy of the lower extremity arterial runoff. MATERIALS AND METHODS Continuous extracorporeal perfusion was established in three fresh-frozen body donors via inguinal and infragenicular access. Using digital subtraction angiography for guidance, both arterial embolization (e.g., embolization using coils, vascular plugs, particles, and liquid embolic agents) and endovascular recanalization procedures (e.g., manual aspiration or balloon-assisted embolectomy) as well as various embolism protection devices were tested. Furthermore, the management of complications during percutaneous transluminal angioplasty, such as vessel dissection and rupture, were exercised by implantation of endovascular dissection repair system or covered stents. Interventions were performed by two board-certified interventional radiologists and one resident with only limited angiographic experience. RESULTS Stable extracorporeal perfusion was successfully established on both thighs of all three body donors. Digital subtraction angiography could be performed reliably and resulted in realistic artery depiction. The model allowed for repeatable training of endovascular recanalization and arterial embolization procedures with typical tactile feedback in a controlled environment. Furthermore, the handling of more complex angiographic devices could be exercised. Whereas procedural success was be ascertained for most endovascular interventions, thrombectomies procedures were not feasible in some cases due to the lack of inherent coagulation. CONCLUSION The presented perfusion model is suitable for practicing time-critical endovascular interventions in the lower extremity runoff under realistic but controlled conditions.
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Affiliation(s)
- Viktor Hartung
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Lucca Hennes
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Florian Kleefeldt
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Dominik Peter
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Sven Lichthardt
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Khilnani TK, Kesselman A, D'Angelo D, RoyChoudhury A, Lamparello NA. Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency. Acad Radiol 2023; 30:2067-2078. [PMID: 36849334 DOI: 10.1016/j.acra.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/27/2023]
Abstract
RATIONALE AND OBJECTIVES Endovascular simulation is a validated training method, allowing residents to improve technical skills with interventional equipment in a risk-free environment. The purpose of this study was to assess the utility and efficacy of supplementing the IR/DR Integrated Residency training program with a dedicated 2-year endovascular simulation curriculum. MATERIALS AND METHODS Trainees participated in a 2-year curriculum that included the completion of 8 modules using a high-fidelity endovascular simulator (Mentice AB, Gothenberg, Sweden). Procedural modules included IVC filter placement, transarterial chemoembolization, trauma embolization, uterine artery embolization, prostate artery embolization, and peripheral arterial disease interventions. Each quarter, two trainees were filmed while completing an assigned module. Sessions led by IR faculty were held with film footage review and didactics on the assigned topic. Pre- and postcase surveys were collected to evaluate trainee comfort and confidence and assess the validity of the simulation. At the conclusion of the 2-year period, a postcurriculum survey was sent to all trainees to determine how residents viewed the utility of the simulation sessions. RESULTS Eight residents participated in the pre- and postcase surveys. The simulation curriculum significantly increased trainee confidence for these 8 residents. A separate postcurriculum survey was completed by all 16 IR/DR residents. All 16 residents felt that simulation was a helpful addition to their education. A total of 87.5% of all residents felt that the sessions improved their confidence in the IR procedure room. A total of 75% of all residents believe that the simulation curriculum should be incorporated into the IR residency program. CONCLUSION Adoption of a 2-year simulation curriculum can be considered for existing IR/DR training programs with access to high-fidelity endovascular simulators using the described approach.
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Affiliation(s)
- Tyler K Khilnani
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, 525 E 68th Street, New York City, NY 10021
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, 525 E 68th Street, New York City, NY 10021
| | - Nicole A Lamparello
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Fischer N, Marzi C, Meisenbacher K, Kisilenko A, Davitashvili T, Wagner M, Mathis-Ullrich F. A sensorized modular training platform to reduce vascular damage in endovascular surgery. Int J Comput Assist Radiol Surg 2023; 18:1687-1695. [PMID: 37193935 PMCID: PMC10491519 DOI: 10.1007/s11548-023-02935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Endovascular interventions require intense practice to develop sufficient dexterity in catheter handling within the human body. Therefore, we present a modular training platform, featuring 3D-printed vessel phantoms with patient-specific anatomy and integrated piezoresistive impact force sensing of instrument interaction at clinically relevant locations for feedback-based skill training to detect and reduce damage to the delicate vascular wall. METHODS The platform was fabricated and then evaluated in a user study by medical ([Formula: see text]) and non-medical ([Formula: see text]) users. The users had to navigate a set of guidewire and catheter through a parkour of 3 modules including an aneurismatic abdominal aorta, while impact force and completion time were recorded. Eventually, a questionnaire was conducted. RESULTS The platform allowed to perform more than 100 runs in which it proved capable to distinguish between users of different experience levels. Medical experts in the fields of vascular and visceral surgery had a strong performance assessment on the platform. It could be shown, that medical students could improve runtime and impact over 5 runs. The platform was well received and rated as promising for medical education despite the experience of higher friction compared to real human vessels. CONCLUSION We investigated an authentic patient-specific training platform with integrated sensor-based feedback functionality for individual skill training in endovascular surgery. The presented method for phantom manufacturing is easily applicable to arbitrary patient-individual imaging data. Further work shall address the implementation of smaller vessel branches, as well as real-time feedback and camera imaging for further improved training experience.
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Affiliation(s)
- Nikola Fischer
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany
| | - Christian Marzi
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna Kisilenko
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Tornike Davitashvili
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
- Center for the Tactile Internet with Human in the Loop (CeTI), Technical University Dresden, 01062, Dresden, Germany
| | - Franziska Mathis-Ullrich
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany.
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-University Erlangen-Nürnberg, 91052, Erlangen, Germany.
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Siddiqui NA, Javed A, Pirzada A. A systematic review of simulation training for lower extremity bypass procedures. Vascular 2023:17085381231192689. [PMID: 37494569 DOI: 10.1177/17085381231192689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Simulation is used across surgical specialties for skill enhancement. The choice and assessment method of a simulator varies across literature. In the age of endovascular approach, trainees have limited exposure to open lower limb bypass procedures which needs attention. This review aims to assess the utility of simulation training in lower limb bypass surgery using Kirkpatrick's model. METHODS Using PRISMA statement, we included all the studies done on simulators in lower limb bypass surgical procedures for this systematic review. The primary outcome was to assess the effectiveness of different types of simulation used for lower limb bypass surgery using the Kirkpatrick's model for training evaluation. RESULTS An initial search identified 295 articles out of which 7 articles were found to be eligible for this systematic review. A variety of simulators were used including cadavers and synthetic models. Most studies (n=5) found the use of simulation as an effective tool in achieving technical competence. All the five studies we found at level 2 on Kirpatrick's model evaluation. CONCLUSION Most of the existing studies are at level 2 of Kirkpatrick's model which reflects learning changes in trainees after simulation. Feedback mechanism needs to be evolved where the improvement after simulation training can be gauged by its replication in clinical practice and improved patient care practices corresponding to the highest level of Kirkpatrick's model.
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Affiliation(s)
| | - Aden Javed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ammar Pirzada
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Maguire SC, O'Callaghan AP, Traynor O, Strawbridge JD, Kavanagh DO. A National Needs Assessment in Simulation Based Training in Vascular Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1039-1045. [PMID: 37271598 DOI: 10.1016/j.jsurg.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this research was to ascertain the highest need areas for vascular simulation, in order to tailor training for the highest impact. DESIGN, PARTICIPANTS AND SETTING A needs assessment was conducted according to best practices using the Delphi method. All consultant vascular surgeons/trainers in the training jurisdiction (n=33) were approached through an independent intermediary to contribute and generate a prioritized list of procedures for training. The research team were blinded to participant identities. Three rounds were conducted according to the Delphi process and scored according to the Copenhagen Needs Assessment Formula (CAMES-NAF). RESULTS A final list of 34 vascular procedures was selected and prioritized by surgical trainers. Principles of arterial repair and endarterectomy/patching were considered the highest priority. Complex major interventions such as open abdominal aortic aneurysm (AAA) repair, carotid endarterectomy, and endovascular aortic repair (EVAR) consistently ranked higher than rarer, such as first rib resection and more basic procedures, such as foam injection for varicose veins. Major lower limb amputations typically ranked lower overall compared to arterial interventions. Surgical trainers generally agreed with the ranking according to the CAMES-NAF. There was some disagreement for a select few procedures such as iliac stenting (which rose 13 places) and open radial artery exposure (which fell 6 places) on subsequent iterations. CONCLUSIONS Core operative principles and common major operative cases should remain the priority for vascular technical skills training. Other procedures which may be less invasive, but have the potential for major complications should also not be overlooked. In designing simulators the main focus should center on specific skill acquisition for commonly performed major procedures and management of the recognized potential complications. Lower limb amputations are considered adequately taught in clinical practice, or are too challenging to simulate in simulator models apart from cadaveric models.
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Affiliation(s)
- Seán C Maguire
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland.
| | - Adrian P O'Callaghan
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Judith D Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
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Gomaa AR, Grafton-Clarke C, Saratzis A, Davies RSM. The role of high-fidelity simulation in the acquisition of endovascular surgical skills: a systematic review. Ann Vasc Surg 2023:S0890-5096(23)00125-5. [PMID: 36906131 DOI: 10.1016/j.avsg.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION The widespread introduction of minimally invasive endovascular techniques in cardiovascular surgery has necessitated a transition in the psychomotor skillset of trainees and surgeons. Simulation has previously been used in surgical training; however, there is limited high quality evidence regarding the role of simulation-based training on the acquisition of endovascular skills. This systematic review aimed to systematically appraise the currently available evidence regarding endovascular high-fidelity simulation interventions, to describe the overarching strategies used, the learning outcomes addressed, the choice of assessment methodology, and the impact of education on learner performance. METHODS A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using relevant keywords to identify studies evaluating simulation in the acquisition of endovascular surgical skills. References of review articles were screened for additional studies. RESULTS A total of 1081 studies were identified (474 after removal of duplicates). There was marked heterogeneity in methodologies and reporting of outcomes. Quantitative analysis was deemed inappropriate due to the risk of serious confounding and bias. Instead, a descriptive synthesis was performed, summarising key findings and quality components. Eighteen studies were included in the synthesis (15 observational, 2 case-control and 1 randomised control studies). Most studies measured procedure time, contrast usage, and fluoroscopy time. Other metrics were recorded to a lesser extent. Significant reductions were noted in both procedure and fluoroscopy times with the introduction of simulation-based endovascular training. CONCLUSION The evidence regarding the use of high-fidelity simulation in endovascular training is very heterogeneous. The current literature suggests simulation-based training leads to improvements in performance, mostly in terms of procedure and fluoroscopy time. High-quality randomised control trials are needed to establish the clinical benefits of simulation training, sustainability of improvements, transferability of skills and its cost-effectiveness.
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Affiliation(s)
- Abdul-Rahman Gomaa
- Human Anatomy Resource Centre (HARC), University of Liverpool, Liverpool, UK.
| | | | - Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert S M Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Su P, Zhu Z, He J, He R, Feng H, Du P, Lönn L, Konge L, Yin F. Focus on Radiation Protection Improves Both Correct Behavior and Procedural Performance During Simulation-Based Training - A Randomized Comparison. Ann Vasc Surg 2023; 89:302-311. [PMID: 36334895 DOI: 10.1016/j.avsg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND To explore whether simulation-based endovascular training with focus on radiation safety could improve correct behavior without jeopardizing the learning of procedural skills. METHODS Twenty-four residents without previous endovascular experience completed 10 clinical scenarios on a virtual-reality endovascular simulator with software for peripheral endovascular interventions. Participants were randomized to receive feedback (n = 12) or not (n = 12) on radiation protection (RP) performance after each case. Expert assessments were done at the first, second, fourth, seventh, and 10th case on RP and endovascular skills (ES). Automatic simulator metrics on procedure time, contrast dose, handling errors, and estimated radiation exposure to patient and operator were registered. Outcome metrics were analyzed by two-way mixed analysis of variance pairwise comparisons with independent t-tests. Correlations were explored using Pearson's r for internal consistency reliability. RESULTS The RP performance was similar in both groups at their first attempt (P = 0.61), but the feedback group significantly outperformed the control group over time (P < 0.001 for all comparisons). The feedback group was however slower to learn the ES at start (P = 0.047 at second performance), but after 7 attempts no difference was shown (P = 0.59). The feedback group used more time (19.5 vs. 15.3 min; P = 0.007) but less contrast (60 vs. 100 mL; P < 0.001). The number of errors was the same in both groups, but all metrics regarding radiation exposure favored the feedback group (P-values from 0.001 to 0.008). CONCLUSIONS Simulation-based training (SBT) is effective to acquire basic endovascular intervention skills and concurrently learn RP behavior when feedback on radiation culture is provided.
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Affiliation(s)
- Peizhu Su
- Department of Gastroenterology, The First People's Hospital of Foshan, Foshan, Guangdong, China; Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China
| | - Zhengrong Zhu
- Department of Vascular and Thyroid Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiawei He
- Department of Radiology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Rong He
- Department of Radiology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Huahai Feng
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Pu Du
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.
| | - Fang Yin
- Department of Post-graduate Education, The First People's Hospital of Foshan, Foshan, Guangdong, China
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11
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Innovation, disruptive Technologien und Transformation in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Haiser A, Aydin A, Kunduzi B, Ahmed K, Dasgupta P. A Systematic Review of Simulation-Based Training in Vascular Surgery. J Surg Res 2022; 279:409-419. [PMID: 35839575 PMCID: PMC9483723 DOI: 10.1016/j.jss.2022.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
Introduction Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. Methods PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes. Results Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Conclusions Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.
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Affiliation(s)
- Alexander Haiser
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
| | - Basir Kunduzi
- Department of Transplant Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
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13
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Dreyfus R, Boehler Q, Nelson BJ. A Simulation Framework for Magnetic Continuum Robots. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3187249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roland Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, Zürich, Switzerland
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Gratl A, Lobenwein D, Gummerer M, Wipper S. Die Etablierung eines neuen Forschungskonzepts an einem universitären Standort. GEFÄSSCHIRURGIE 2022; 27:239-245. [PMID: 35702688 PMCID: PMC9185131 DOI: 10.1007/s00772-022-00900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
Neben der klinischen Tätigkeit haben an einem universitären Standort Forschung und Lehre einen großen Stellenwert. Durch die Etablierung eines neuen Forschungslabors an der Universitätsklinik für Gefäßchirurgie der Medizinischen Universität Innsbruck wurden die infrastrukturellen Voraussetzungen zur Gestaltung eines neuen Forschungsschwerpunkts geschaffen. Die Kooperation mit nationalen und internationalen Partnern war für diesen Prozess essenziell. Nicht nur in der Planung und Ausstattung der Räumlichkeiten, sondern auch in der Entwicklung von Studienprotokollen und zur kritischen Diskussion von Ergebnissen ist der Aufbau eines Netzwerkes von großer Bedeutung. Durch die Etablierung der experimentellen Gefäßchirurgie Innsbruck ist nun die Realisierung von Projekten der Grundlagenforschung und der translationalen Forschung an diesem universitären Standort möglich. Zudem spielt die Lehrforschung eine immer größere Rolle, insbesondere um die Ausbildungsstruktur möglichst praxisnah zu gestalten, Nachwuchs anzuwerben und die immer komplexer werdenden Techniken auch praxisnah zu vermitteln.
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Affiliation(s)
- Alexandra Gratl
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Daniela Lobenwein
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Maria Gummerer
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Sabine Wipper
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
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15
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Crinnion W, Jackson B, Sood A, Lynch J, Bergeles C, Liu H, Rhode K, Mendes Pereira V, Booth TC. Robotics in neurointerventional surgery: a systematic review of the literature. J Neurointerv Surg 2022; 14:539-545. [PMID: 34799439 PMCID: PMC9120401 DOI: 10.1136/neurintsurg-2021-018096] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Robotically performed neurointerventional surgery has the potential to reduce occupational hazards to staff, perform intervention with greater precision, and could be a viable solution for teleoperated neurointerventional procedures. OBJECTIVE To determine the indication, robotic systems used, efficacy, safety, and the degree of manual assistance required for robotically performed neurointervention. METHODS We conducted a systematic review of the literature up to, and including, articles published on April 12, 2021. Medline, PubMed, Embase, and Cochrane register databases were searched using medical subject heading terms to identify reports of robotically performed neurointervention, including diagnostic cerebral angiography and carotid artery intervention. RESULTS A total of 8 articles treating 81 patients were included. Only one case report used a robotic system for intracranial intervention, the remaining indications being cerebral angiography and carotid artery intervention. Only one study performed a comparison of robotic and manual procedures. Across all studies, the technical success rate was 96% and the clinical success rate was 100%. All cases required a degree of manual assistance. No studies had clearly defined patient selection criteria, reference standards, or index tests, preventing meaningful statistical analysis. CONCLUSIONS Given the clinical success, it is plausible that robotically performed neurointerventional procedures will eventually benefit patients and reduce occupational hazards for staff; however, there is no high-level efficacy and safety evidence to support this assertion. Limitations of current robotic systems and the challenges that must be overcome to realize the potential for remote teleoperated neurointervention require further investigation.
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Affiliation(s)
- William Crinnion
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Ben Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Avnish Sood
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jeremy Lynch
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Hongbin Liu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Thomas C Booth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
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Badrou A, Tardif N, Chaudet P, Lescanne N, Szewczyk J, Blanc R, Hamila N, Gravouil A, Bel-Brunon A. Simulation of multi-curve active catheterization for endovascular navigation to complex targets. J Biomech 2022; 140:111147. [DOI: 10.1016/j.jbiomech.2022.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Debucquois A, Vento V, Neumann N, Mertz L, Lejay A, Rouby AF, Bourcier T, Lee JT, Chakfe N, Berard X, Bonnin E, Camin A, Chenesseau B, Cochennec F, Corpateaux JM, Deglise S, Delay C, Deltatto B, Duprey A, Gaudric J, Georg Y, Ghariani Z, Jean-Baptiste E, Hertault A, Meteyer V, Roussin M, Saucy F, Schneider F, Steinmetz L, Thaveau F. X-Ray Exposure Time in Dedicated Academic Simulation Programs Is Realistic To Patient Procedures. EJVES Vasc Forum 2022; 55:5-8. [PMID: 35252939 PMCID: PMC8888963 DOI: 10.1016/j.ejvsvf.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/20/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To ascertain whether simulated endovascular procedures are comparable to real life operating room (OR) procedures, particularly with regard to irradiation time. Methods This was a retrospective study comparing simulation with clinical data. Fluoroscopy time and overall operation time were compared between simulated abdominal aortic endovascular repair (EVAR) and iliac procedures that were performed, respectively, from 2016 to 2019 and from 2015 to 2019, and clinical EVAR and iliac procedures performed in the OR between January 2018 and November 2021. Results Within the defined periods, 171 simulated procedures (91 EVAR, 80 iliac) and 199 clinical procedures (111 EVAR, 88 iliac) were performed. For both EVAR and iliac procedures, median total procedure time was much longer during real surgery (p < .001). However, median total fluoroscopy time remained the same, whether the procedure was real surgery or performed on the simulator, for iliac procedures (8.47 minutes in the OR, 8.35 minutes on the simulator, p = .61) and for EVAR procedures (14.80 minutes in the OR, 15.00 minutes on the simulator p = .474). Conclusion Simulated endovascular procedures are comparable with real life OR procedures, particularly with regard to irradiation time when integrated in a dedicated curriculum. Simulation is a necessary tool for trainee education in vascular surgery. Simulation training must reflect real situations in the operating room. Xray exposure must be as low as possible. Radiation safety must be taught in simulation. Xray exposure time in academic simulation programs was realistic to real life.
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19
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Low-cost digital tool kit for planning and sizing with 3D printing of abdominal aortic aneurysms for endovascular aortic repair: A Latinoamerican experience. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Letter to the Editor: The Role of Modern Simulation Techniques in Neurovascular Surgery Training. World Neurosurg 2021; 148:233. [PMID: 33770840 DOI: 10.1016/j.wneu.2021.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022]
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21
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Bartal G, Vano E, Paulo G. Get Protected! Recommendations for Staff in IR. Cardiovasc Intervent Radiol 2021; 44:871-876. [PMID: 33837456 PMCID: PMC8034513 DOI: 10.1007/s00270-021-02828-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Purpose Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. Methods Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. Results The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. Conclusion The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
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Affiliation(s)
| | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, ESTESC - Coimbra Health School, Instituto Politécnico de Coimbra, Coimbra, Portugal
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22
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Souza JRF, Barros Filho EMD, JucÁ CEB, Rolim JPML. Endovascular technique simulator for Neuroradiology learning. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:535-540. [PMID: 32627807 DOI: 10.1590/0004-282x20200028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vascular cerebral infarction (or stroke) is recognized as the third leading cause of death worldwide, and acute arterial occlusion comprises the main mechanism underlying ischemic stroke. Cerebrovascular diseases are treated by intracranial endovascular interventions employing minimally invasive intravascular techniques, such as neuroimaging. Conducting practical training in this area is a necessary task since patient safety is a considerably significant factor. There has been a steady increase in scientific research focused on validating endovascular simulation as a tool for training interventionists in endovascular procedures. Current literature confirms the idea that there is a beneficial role of simulation in endovascular training and skill acquisition and technique improvement. OBJECTIVE To develop an endovascular technique simulator for learning Neuroradiology. METHODS The methodology consisted of developing a simulator using 3D printing technology. RESULTS A literature search was carried out, commencing in August 2017, through consultation of the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) databases, using the PubMed and BIREME websites, respectively. Meetings were held between the neuroradiologist specialist and programmers to develop the simulator, which was carried out in three phases: design of the arterial system, design of the prototype of the arterial system in computer graphics, and confection of the arterial system simulator in 3D. CONCLUSION The simulator is ready for testing by residents and can enable the student to learn through simulations that reproduce, as realistically as possible, the situation to be subsequently experienced using a concrete tool.
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Lawaetz J, Skovbo Kristensen JS, Nayahangan LJ, Van Herzeele I, Konge L, Eiberg JP. Simulation Based Training and Assessment in Open Vascular Surgery: A Systematic Review. Eur J Vasc Endovasc Surg 2020; 61:502-509. [PMID: 33309171 DOI: 10.1016/j.ejvs.2020.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/30/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature and give evidence based recommendations for future initiatives for simulation based training (SBT) and assessment in open vascular surgery. DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS A systematic review of PubMed, Embase, and the Cochrane Library was performed, with the last search on 31 March 2020, to identify studies describing SBT and assessment in open vascular surgery. Kirkpatrick's levels for efficacy of training were evaluated. Validity evidence for assessment tools was evaluated according to the recommended contemporary framework by Messick. RESULTS Of 2 844 studies, 51 were included for data extraction. A high degree of heterogeneity in reporting standards and varying types of simulation was found. Vascular anastomosis was the most frequently simulated technical skill (43%). Assessment was mostly carried out using the Objective Structured Assessment of Technical Skills (55%). Validity evidence for assessment tools was found using outdated frameworks, and only one study used Messick's framework. Self directed training is valuable, the low trainer to trainee ratio is important to maximise efficiency, and experienced vascular surgeons are the most effective trainers. CONCLUSION Carefully designed and structured SBT is effective and can improve technical skills, especially in less experienced trainees. However, the supporting evidence lacks homogeneity in the reporting standards and types of simulations. Pass/fail standards that support proficiency based learning and studies investigating skills transfer should be the focus in future studies. Validity evidence of assessment tools needs to be addressed using contemporary frameworks.
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Affiliation(s)
- Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Leizl J Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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The Role of Simulators in Interdisciplinary Medical Work. MULTIMODAL TECHNOLOGIES AND INTERACTION 2020. [DOI: 10.3390/mti4040090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article reports from a project introducing a virtual reality simulator with patient-specific input for endovascular aneurysm repair (EVAR) into a surgical environment at a university hospital in Norway during 2016–2019. The project includes acquisition of the simulator, training of personnel, and a mapping of the effects. We followed the process, adopting ethnographic methods including participation in the operating room, simulated patient-specific rehearsals, preparations of the rehearsals, meetings with the simulator company, scientific meetings and scientific work related to the clinical trials (the second author led the clinical trial), in addition to open-ended interviews with vascular surgeons and interventional radiologists. We used the concepts of boundary work and sensework as conceptual lenses through which we studied the introduction of the simulator and how it influenced the nature of work and the professional relationship between the vascular surgeons and the interventional radiologists. We found that the simulator facilitated professional integration, at the same time as it served as a material resource for professional identity development. This study is the first to our knowledge that investigates the role of simulators for professional identity and relationship among surgeons and radiologists. Further studies of simulators in similar and different social contexts may contribute to deeper and more generic understanding of the way simulators influence our working life.
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25
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Falconer R, Semple CM, Walker KG, Cleland J, Watson AJM. Simulation for technical skill acquisition in open vascular surgery. J Vasc Surg 2020; 73:1821-1827.e2. [PMID: 33248120 DOI: 10.1016/j.jvs.2020.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Simulation has an increasingly prominent role in modern vascular surgery training. However, it is important to understand how simulation is most effectively delivered to best use the time and resources available. The aim of this narrative review is therefore to critically appraise open technical skill acquisition in the operating room environment and provide recommendations for the future development of evidence-based simulation for open vascular surgery. METHODS A systematic search strategy was used to retrieve relevant studies from PubMed, Medline, Web of Science, EMBASE, and the Cochrane databases in July 2019. Included papers were independently screened by two reviewers. Data were subsequently extracted using a standardized proforma and thematically analyzed. RESULTS Thirteen studies were included. All demonstrated that simulation is effective in improving confidence and/or competence in performing open technical skills when assessed by previously validated metrics. However, not all participants or course schedules achieved equal benefit, with distributed practice for junior trainees over several weeks achieving a greater improvement in technical skill compared with senior trainees or longer course schedules for some tasks. CONCLUSIONS Simulation can be an effective adjunct to traditional operative experience for technical skill acquisition in open vascular surgery. Future work should focus on developing models to address a wider range of training needs, as well as further defining the optimum schedule for the style, content, and timing of simulation for specific learner groups.
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Affiliation(s)
| | - Cariona M Semple
- Department of Vascular Surgery, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Kenneth G Walker
- NHS Education for Scotland, Inverness, United Kingdom; Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
| | - Jennifer Cleland
- Medical Education Research & Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angus J M Watson
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
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Feasibility of an endovascular training and research environment with exchangeable patient specific 3D printed vascular anatomy. Ann Anat 2020; 231:151519. [DOI: 10.1016/j.aanat.2020.151519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/18/2022]
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Jaschke W, Bartal G, Martin CJ, Vano E. Unintended and Accidental Exposures, Significant Dose Events and Trigger Levels in Interventional Radiology. Cardiovasc Intervent Radiol 2020; 43:1114-1121. [PMID: 32435834 PMCID: PMC7369256 DOI: 10.1007/s00270-020-02517-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists. Also, the number of complex interventional procedures has increased. In the late nineties, first reports of skin injuries appeared in the literature. The medical community responded through increased awareness for radiation protection and public authorities by recommendations and legislation, for example, the European Basic Safety Standards (EU-BSS) which were published in 2014, or the international Basic Safety Standards (BSS). Implementation of the EU-BSS requires concerted action from interventionalists, radiographers, medical physics experts and competent national authorities. Interventionalists should play an important role in this project since implementation of the EU-BSS will affect their daily practice. This paper discusses some important issues of the EU-BSS such as unintended and accidental radiation exposures of patients, the meaning of significant dose events and how to deal with patients who were exposed to a substantial radiation dose with the risk of tissue injuries. In addition, this paper provides practical advice on how to implement alert and trigger levels in daily practice of FGIs in order to increase patient safety.
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Affiliation(s)
- Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | | | - Colin J Martin
- Department of Clinical Physics and Bio-Engineering, Gartnavel Royal Hospital, University of Glasgow, Glasgow, G12 0XH, UK
| | - Eliseo Vano
- Department of Radiology, Medical Physics, Faculty of Medicine, Complutense University, 28040, Madrid, Spain
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Böckler D, Geisbüsch P, Hatzl J, Uhl C. Erste Anwendungsoptionen von künstlicher Intelligenz und digitalen Systemen im gefäßchirurgischen Hybridoperationssaal der nahen Zukunft. GEFÄSSCHIRURGIE 2020. [DOI: 10.1007/s00772-020-00666-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yamaki VN, Cancelliere NM, Nicholson P, Rodrigues M, Radovanovic I, Sungur JM, Krings T, Pereira VM. Biomodex patient-specific brain aneurysm models: the value of simulation for first in-human experiences using new devices and robotics. J Neurointerv Surg 2020; 13:272-277. [PMID: 32601259 PMCID: PMC7892376 DOI: 10.1136/neurintsurg-2020-015990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
Background With the recent advent of advanced technologies in the field, treatment of neurovascular diseases using endovascular techniques is rapidly evolving. Here we describe our experience with pre-surgical simulation using the Biomodex EVIAS patient-specific 3D-printed models to plan aneurysm treatment using endovascular robotics and novel flow diverter devices. Methods Pre-procedural rehearsals with 3D-printed patient-specific models of eight cases harboring brain aneurysms were performed before the first in-human experiences. To assess the reliability of the experimental model, the characteristics of the aneurysms were compared between the patient and 3D models. The rehearsals were used to define the patient treatment plan, including technique, device sizing, and operative working projections. Results The study included eight patients with their respective EVIAS 3D aneurysm models. Pre-operative simulation was performed for the first in-human robotic-assisted neurovascular interventions (n=2) and new generation flow-diverter stents (n=6). Aneurysms were located in both the anterior (n=5) and posterior (n=3) circulation and were on average 11.0±6.5 mm in size. We found reliable reproduction of the aneurysm features and similar dimensions of the parent vessel anatomy between the 3D models and patient anatomy. Information learned from pre-surgical in vitro simulation are described in detail, including an improved patient treatment plan, which contributed to successful first in-world procedures with no intraprocedural complications. Conclusions Pre-procedural rehearsal using patient-specific 3D models provides precise procedure planning, which can potentially lead to greater operator confidence, decreased radiation dose and improvements in patient safety, particularly in first in-human experiences.
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Affiliation(s)
- Vitor Nagai Yamaki
- Division of Neurosurgery, Department of Neurology, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Patrick Nicholson
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marta Rodrigues
- Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Ivan Radovanovic
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Timo Krings
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Våpenstad C, Lamøy SM, Aasgaard F, Ødegård A, Haavik TK, Hernes TN, Stensæth KH, Søvik E. Operators believe patient-specific rehearsal improve individual and team performance. MINIM INVASIV THER 2020; 31:149-158. [PMID: 32491930 DOI: 10.1080/13645706.2020.1768407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rehearsing endovascular aortic aneurysm repair on patient-specific data is recent within virtual reality simulation and opens up new possibilities for operators to prepare for complex procedures. This study evaluated the feasibility of patient-specific rehearsal (PsR) and assessed operators' appraisal of the VIST-LAB simulator from Mentice. MATERIAL AND METHODS CT-data was segmented and uploaded to the simulator, and simulated for 30 elective EVAR patients. Operators were asked how they perceived the PsR on a Likert scale after the PsR (once) and after the following procedure (each time). RESULTS Patients were simulated and operated by 14 operators, always in pairs of one vascular surgeon and one interventional radiologist. The operators estimated that PsR improved individual and team performance (median 4), and recommended the use of PsR in general (median 4) and for difficult cases (median 5). The simulator realism got moderate scores (median 2-3). Inexperienced operators seemed to appreciate the PsR the most. CONCLUSIONS PsR was feasible and was evaluated by operators to improve individual and team performance. Inexperienced users were more positive towards PsR than experienced users. PsR realism and the ease of importing patient-specific data can still be improved, and further studies to quantify and precisely identify benefits are needed.
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Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health Research, SINTEF Digital AS, Trondheim, Norway.,The Central Norway Regional Health Authority, Trondheim, Norway.,The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siv Marit Lamøy
- Department of Radiology and Nuclear Medicine, St. Olavs Trondheim University Hospital, Trondheim, Norway
| | - Frode Aasgaard
- Department of Vascular Surgery, St. Olavs Trondheim University Hospital, Trondheim, Norway
| | - Asbjørn Ødegård
- Department of Radiology and Nuclear Medicine, St. Olavs Trondheim University Hospital, Trondheim, Norway
| | - Torgeir K Haavik
- Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Studio Apertura, NTNU Social Research, Trondheim, Norway
| | - Toril Nagelhus Hernes
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Knut Haakon Stensæth
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Trondheim University Hospital, Trondheim, Norway
| | - Edmund Søvik
- Department of Radiology and Nuclear Medicine, St. Olavs Trondheim University Hospital, Trondheim, Norway.,Medical Simulation Centre, Trondheim, Norway
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31
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Kreiser K, Gehling KG, Ströber L, Zimmer C, Kirschke JS. Simulation Training in Neuroangiography: Transfer to Reality. Cardiovasc Intervent Radiol 2020; 43:1184-1191. [PMID: 32394089 PMCID: PMC7369255 DOI: 10.1007/s00270-020-02479-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/02/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Endovascular simulation is an established and validated training method, but there is still no proof of direct patient's benefit, defined as lower complication rate. In this study, the impact of such a training was investigated for rehearsal of patient-specific cases as well as for a structured simulation curriculum to teach angiographer novices. MATERIALS AND METHODS A total of 40 patients undergoing a diagnostic neuroangiography were randomized in a training and control group. In all training group patients, the angiographer received a patient-anatomy-specific rehearsal on a high-fidelity simulator prior to the real angiography. Radiation exposure, total duration, fluoroscopy time and amount of contrast agent of the real angiography were recorded. Silent cerebral ischemia was counted by magnetic resonance diffusion-weighted imaging (DWI). Additionally, the first 30 diagnostic neuroangiographies of six novices were compared (ntotal = 180). Three novices had undergone a structured simulation curriculum; three had acquired angiographic skills without simulation. RESULTS No differences were found in the number of DWI lesions or in other quality measures of the angiographies performed with and without patient-specific rehearsal. A structured simulation curriculum for angiographer novices reduced fluoroscopy time significantly and radiation exposure. The curriculum had no influence on the total duration of the examination, the amount of contrast medium or the number of catheters used. CONCLUSION There was no measurable benefit of patient-anatomy-specific rehearsal for an unselected patient cohort. A structured simulation-based curriculum to teach angiographic skills resulted in a reduction of fluoroscopy time and radiation dose in the first real angiographies of novice angiographers. LEVEL OF EVIDENCE Level 4, part 1: randomized trial, part 2: historically controlled study.
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Affiliation(s)
- Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Kim G Gehling
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lea Ströber
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Rynio P, Falkowski A, Witowski J, Kazimierczak A, Wójcik Ł, Gutowski P. Simulation and Training of Needle Puncture Procedure with a Patient-Specific 3D Printed Gluteal Artery Model. J Clin Med 2020; 9:jcm9030686. [PMID: 32143426 PMCID: PMC7141337 DOI: 10.3390/jcm9030686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
The puncture of the gluteal artery (GA) is a rare and difficult procedure. Less experienced clinicians do not always have the opportunity to practice and prepare for it, which creates a need for novel training tools. We aimed to investigate the feasibility of developing a 3D-printed, patient-specific phantom of the GA and its surrounding tissues to determine the extent to which the model can be used as an aid in needle puncture planning, simulation, and training. Computed tomography angiography scans of a patient with an endoleak to an internal iliac artery aneurysm with no intravascular antegrade access were processed. The arterial system, including the superior GA with its division branches, and pelvic area bones were 3D printed. The 3D model was embedded in the buttocks-shaped, patient-specific mold and cast. The manufactured, life-sized phantom was used to simulate the GA puncture procedure and was validated by 13 endovascular specialists. The printed GA was visible in the fluoroscopy, allowing for a needle puncture procedure simulation. The contrast medium was administered, simulating a digital subtraction angiography. Participating doctors suggested that the model could make a significant impact on preprocedural planning and resident training programs. Although the results are promising, we recommend that further studies be used to adjust the design and assess its clinical value.
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Affiliation(s)
- Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
- Correspondence:
| | - Aleksander Falkowski
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland;
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
| | - Łukasz Wójcik
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
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Mafeld S, Musing ELS, Conway A, Kennedy S, Oreopoulos G, Rajan D. Avoiding and Managing Error in Interventional Radiology Practice: Tips and Tools. Can Assoc Radiol J 2020; 71:528-535. [PMID: 32100547 DOI: 10.1177/0846537119899215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
While there are limited data on error in interventional radiology (IR), the literature so far indicates that many errors in IR are potentially preventable. Yet, understanding the sources for error and implementing effective countermeasures can be challenging. Traditional methods for reducing error such as increased vigilance and new policies may be effective but can also contribute to an "error cycle." A hierarchy of effectiveness for patient safety interventions is outlined, and the characteristics of "high-reliability" organizations in other "high-risk" industries are examined for clues that could be implemented in IR. The evidence behind team error reduction strategies such as checklists is considered along with individual approaches such as "slowing down when you should." However, error in medicine is inevitable, and this article also seeks to outline an evidence-based approach to managing the psychological impact of being involved in medical error as a physician.
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Affiliation(s)
- Sebastian Mafeld
- Department of Medical Imaging, University Health Network, 33540Toronto General Hospital, Toronto, Ontario, Canada
| | - E L S Musing
- Chief Patient Safety Officer and VP Quality & Safety, University Health Network, Toronto, Ontario, Canada
| | - Aaron Conway
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sean Kennedy
- Department of Medical Imaging, University Health Network, 33540Toronto General Hospital, Toronto, Ontario, Canada
| | - George Oreopoulos
- Department of Medical Imaging, University Health Network, 33540Toronto General Hospital, Toronto, Ontario, Canada
| | - Dheeraj Rajan
- Department of Medical Imaging, University Health Network, 33540Toronto General Hospital, Toronto, Ontario, Canada
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Lerner DJ, Gifford SE, Olafsen N, Mileto A, Soloff E. Lumbar Puncture: Creation and Resident Acceptance of a Low-Cost, Durable, Reusable Fluoroscopic Phantom with a Fluid-Filled Spinal Canal for Training at an Academic Program. AJNR Am J Neuroradiol 2020; 41:548-550. [PMID: 32079597 DOI: 10.3174/ajnr.a6439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
Simulation-based medical training provides learners a method to develop technical skills without exposing patients to harm. Although fluoroscopic phantoms are already adopted in some areas of radiology, this has historically not been for lumbar puncture. Commercially available phantoms are expensive. We report a cost-effective, accessible solution by creation of an inexpensive phantom for resident training to perform fluoroscopically guided lumbar puncture, as well as instructions on how to make a phantom for residency education. An anthropomorphic ballistics-gel phantom that contains a plastic lumbar vertebral column and simulated CSF space was created. Radiology residents with minimum or no experience with fluoroscopically guided lumbar punctures were given a brief education and practiced fluoroscopically guided lumbar punctures on the phantom. A survey from the residents was then done. The phantom was qualitatively quite durable and deemed adequate for educational purposes. All the residents surveyed expressed the desire to have this phantom available and it increased comfort, knowledge, and perceived likelihood of success. Few articles have been published that focused on low-cost phantom creation for fluoroscopic-procedure training. This study supports the benefits of using phantoms for fluoroscopic training as well as step-by-step instructions for creation of this phantom. The residents responded positively and felt more confident in their fluoroscopically guided techniques. The ability to make a long-term training device for resident education would be inexpensive and relatively easy to implement in academic programs.
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Affiliation(s)
- D J Lerner
- From the Department of Radiology (D.J.L., A.M., E.S.), University of Washington School of Medicine, Seattle, Washington
| | - S E Gifford
- Department of Physical Medicine and Rehabilitation (S.E.G., N.O.), Washington University School of Medicine, St. Louis, Missouri
| | - N Olafsen
- Department of Physical Medicine and Rehabilitation (S.E.G., N.O.), Washington University School of Medicine, St. Louis, Missouri
| | - A Mileto
- From the Department of Radiology (D.J.L., A.M., E.S.), University of Washington School of Medicine, Seattle, Washington
| | - E Soloff
- From the Department of Radiology (D.J.L., A.M., E.S.), University of Washington School of Medicine, Seattle, Washington
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Wolk S, Kleemann M, Reeps C. [Artificial intelligence in vascular surgery and vascular medicine]. Chirurg 2020; 91:195-200. [PMID: 32060576 DOI: 10.1007/s00104-020-01143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
New digital technologies will also gain in importance in vascular surgery. There is a wide field of potential applications. Simulation-based training of endovascular procedures can lead to improvement in procedure-specific parameters and reduce fluoroscopy and procedural times. The use of intraoperative image-guided navigation and robotics also enables a reduction of the radiation dose. Artificial intelligence can be used for risk stratification and individualization of treatment approaches. Health apps can be used to improve the follow-up care of patients.
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Affiliation(s)
- S Wolk
- Gefäß- und Endovaskuläre Chirurgie, Klinik und Poliklinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Kleemann
- Gefäß- und Endovaskuläre Chirurgie, Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - C Reeps
- Gefäß- und Endovaskuläre Chirurgie, Klinik und Poliklinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Våpenstad C, Lamøy SM, Aasgaard F, Manstad-Hulaas F, Aadahl P, Søvik E, Stensæth KH. Influence of patient-specific rehearsal on operative metrics and technical success for endovascular aneurysm repair. MINIM INVASIV THER 2020; 30:195-201. [PMID: 32057277 DOI: 10.1080/13645706.2020.1727523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patient-specific rehearsal (PsR) is a recent technology within virtual reality (VR) simulation that lets the operators train on patient-specific data in a simulated environment prior to the procedure. Endovascular aneurysm repair (EVAR) is a complex procedure where operative metrics and technical success might improve after PsR. MATERIAL AND METHODS We compared technical success and operative metrics (endovascular procedure time, contralateral gate cannulation time, fluoroscopy time, total radiation dose, number of angiograms and contrast medium use) between 30 patients, where the operators performed PsR (the PsR group), and 30 patients without PsR (the control group). RESULTS The endovascular procedure time was significantly shorter in the PsR group than in the control group (median 44 versus 55 min, p = .017). The other operative metrics were similar. Technical success rates were higher in the PsR group, 96.7% primary and assisted primary outcome versus 90.0% in the control group. The differences were not significant (p = .076). CONCLUSIONS PsR before EVAR reduced endovascular procedure time, and our results indicate that it might improve technical success, but further studies are needed to confirm those results.
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Affiliation(s)
- Cecilie Våpenstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health Research, SINTEF AS, Trondheim, Norway.,The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, Trondheim University Hospital, Trondheim, Norway
| | - Siv Marit Lamøy
- Department of Radiology and Nuclear Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Frode Aasgaard
- Department of Vascular Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Frode Manstad-Hulaas
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, Trondheim University Hospital, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Petter Aadahl
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Medical Simulation Centre, Trondheim, Norway
| | - Edmund Søvik
- Department of Radiology and Nuclear Medicine, Trondheim University Hospital, Trondheim, Norway.,Medical Simulation Centre, Trondheim, Norway
| | - Knut Haakon Stensæth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Radiology and Nuclear Medicine, Trondheim University Hospital, Trondheim, Norway
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Provision of simulation-based training (SBT) within UK vascular surgery training programmes. Surgeon 2019; 17:321-325. [DOI: 10.1016/j.surge.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/25/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022]
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Dorweiler B, Vahl CF, Ghazy A. Zukunftsperspektiven digitaler Visualisierungstechnologien in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2019. [DOI: 10.1007/s00772-019-00570-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Shahul SS, Tung A. The Hidden Value of Ultrasound? Anesth Analg 2019; 127:1285-1286. [PMID: 30433917 DOI: 10.1213/ane.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sajid S Shahul
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Nayahangan LJ, Van Herzeele I, Konge L, Koncar I, Cieri E, Mansilha A, Debus S, Eiberg JP. Achieving Consensus to Define Curricular Content for Simulation Based Education in Vascular Surgery: A Europe Wide Needs Assessment Initiative. Eur J Vasc Endovasc Surg 2019; 58:284-291. [DOI: 10.1016/j.ejvs.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 10/26/2022]
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Yiasemidou M, Glassman D, Jayne D, Miskovic D. Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis. Comput Assist Surg (Abingdon) 2019; 23:57-68. [PMID: 30497290 DOI: 10.1080/24699322.2018.1495266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD = -1.56 [-2.19, -0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD = -0.1 [-0.63, 0.42] p = 0.7, fluoroscopy volume: SMD = -0.43[-0.97, 0.11], p = 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD = -0.47 [-0.79, -0.16], P = 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD =0.03[-0.23, 0.29], p = 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.
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Affiliation(s)
- Marina Yiasemidou
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | | | - David Jayne
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | - Danilo Miskovic
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
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Tulipan J, Miller A, Park AG, Labrum JT, Ilyas AM. Touch Surgery: Analysis and Assessment of Validity of a Hand Surgery Simulation "App". Hand (N Y) 2019; 14:311-316. [PMID: 29363359 PMCID: PMC6535950 DOI: 10.1177/1558944717751192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. METHODS Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants' score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. RESULTS All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. CONCLUSIONS The study confirms app validity and usefulness by demonstrating that every cohort's simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app's veracity and utility increased with lower levels of training experience.
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Affiliation(s)
- Jacob Tulipan
- Thomas Jefferson University,
Philadelphia, PA, USA,Jacob Tulipan, Orthopaedic Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Room
516 College, Philadelphia, PA 19107-5005, USA.
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Bakhsh A, Martin GFJ, Bicknell CD, Pettengell C, Riga C. An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance. JOURNAL OF SURGICAL EDUCATION 2019; 76:864-871. [PMID: 30527702 DOI: 10.1016/j.jsurg.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/29/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To measure the physiological stress response associated with high-fidelity endovascular team simulation. DESIGN This is a prospective cohort study. SETTING This study was performed at St Mary's Hospital (Imperial College London, London, UK), in a tertiary setting. PARTICIPANTS Thirty-five participants (10 vascular surgical residents, 4 surgical interns, 12 theatre nurses, 2 attending vascular surgeons, 6 medical students and 1 technician) were recruited from the Imperial Vascular Unit at St Mary's Hospital, Imperial College London by direct approach. All participants finished the study. RESULTS Junior surgeons experienced significantly increased sympathetic tone (Low frequency/high frequency (LF/HF) ratio) during team simulation compared to individual simulation (6.01 ± 1.68 vs. 8.32 ± 2.84, p < 0.001). Within team simulation junior surgeons experienced significantly higher heart rate (beats per minute) than their senior counterparts (82 ± 5.83 vs. 76 ± 6.02, p = 0.033). Subjective workload scores (NASA Task Load Index [NASA-TLX]) correlated moderately and significantly with sympathetic tone in surgeons across all stages of simulation. (r = 0.39, p = 0.01). CONCLUSIONS A discrete, measurable increase in stress is experienced by surgeons during high-fidelity endovascular simulation and differentially effects junior surgeons. High-fidelity team simulation may have a role to play in improving nontechnical skill, reducing intra-operative stress, and reducing error.
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Affiliation(s)
- Ali Bakhsh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Guy F J Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Colin D Bicknell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Chris Pettengell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
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Aeckersberg G, Gkremoutis A, Schmitz-Rixen T, Kaiser E. The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training. J Vasc Surg 2019; 69:227-235. [PMID: 30579447 DOI: 10.1016/j.jvs.2018.10.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of simulators has shown a profound impact on the development of both training and assessment of endovascular skills. Furthermore, there is evidence that simulator training is of great benefit for novice trainees. However, there are only a few simulators available geared specifically toward novice learners. Whereas research suggests that low-fidelity simulators could fill this gap, there are insufficient data available to determine the role of low-fidelity simulators in the training of endovascular skills. METHODS Medical students in their fifth year (N = 50) with no previous endovascular experience were randomized into three groups: conventional learning through a video podcast (group V; n = 12), low-fidelity simulation training with tablet-paired touch-gesture navigation (group A; n = 12), and low-fidelity simulation training with tablet-paired physical endovascular tool navigation (group S; n = 26). Within their respective groups, all students attended a 1-day class on basic endovascular skills. Questionnaire items for self-assessment before and after the class and assessment after the class of the participant's practical skills on a high-fidelity simulator were analyzed across all three groups as well as for each group separately using nonparametric tests. RESULTS All 50 participants completed the training. Participants in group S showed a significantly increased interest in working in interventional cardiology (P = .02) and vascular surgery (P = .03) after the class. Evaluation of the questionnaire items after the class showed that participants in group S rated their practical skills significantly higher after the class compared with those in group V and group A (P < .001 for pairwise comparison of all three groups, respectively), creating a significant trend across the three groups. However, analysis of the practical skills assessment for all three groups showed a significant difference between the groups only for choosing a guidewire (P = .045) and a significant trend in performance across the groups for choosing a guidewire and for positioning the guidewire in the vessel (P = .02 and P = .05, respectively). All other steps of the skills assessment showed no significant differences or a trend across the groups. CONCLUSIONS Low-fidelity simulation training, particularly with physical endovascular tool navigation, led to increased motivation in novice trainees. Whereas simulator training was associated with increased confidence of trainees in their skills, assessment of their practical skills showed no actual improvement in this study. Overall, low-fidelity simulation has the potential to benefit novice trainees, but possible risks of simulation training should be further evaluated.
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Affiliation(s)
- Gina Aeckersberg
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Asimakis Gkremoutis
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Erhard Kaiser
- Private Practice for Internal Medicine and Cardiology, Frankfurt am Main, Germany.
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Johnson CE, Manzur MF, Wilson TA, Brown Wadé N, Weaver FA. The financial value of vascular surgeons as operative consultants to other surgical specialties. J Vasc Surg 2019; 69:1314-1321. [PMID: 30528406 PMCID: PMC8386947 DOI: 10.1016/j.jvs.2018.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Vascular surgeons provide assistance to other surgical specialties through planned and unplanned joint operative cases. The financial impact to the hospital of vascular surgeons as consultants in this context has yet to be quantified. We sought to quantify the financial value of services provided by consulting vascular surgeons in the performance of joint operative procedures, both planned and unplanned. METHODS Hospital financial data were reviewed for all inpatient operative cases during a 3-year period (2013-2015). Cases in which a vascular surgeon provided operative assistance as a consultant to a nonvascular surgeon were identified and designated planned or unplanned. Contribution margin, defined as hospital revenue minus variable cost, was determined for each case. In addition, the contribution margin ratio (contribution margin divided by revenue) was determined for each cohort. Financial data for consulting cases was compared with all nonconsult cases. Data analysis was performed with nonparametric statistics. RESULTS There were 208 cases with a primary nonvascular surgeon that required a vascular co-surgeon during the study period, 169 planned and 39 unplanned. For comparison, 19,594 nonconsult cases of other surgical specialties were identified. The median contribution margin was higher for vascular surgery consult cases compared with nonconsult cases ($14,406 [interquartile range, $63,192] vs $5491 [interquartile range $28,590]; P = .002). The overall contribution margin ratio was higher for vascular surgery consult cases (0.41) compared with control nonconsult cases (0.35). There was no difference in contribution margin and contribution margin ratio between planned and unplanned vascular surgery consult cases. CONCLUSIONS Vascular surgeons provide essential operative assistance to other surgical specialties. This operative assistance is frequent and provides significant financial value, with high contribution margin and contribution margin ratio. Vascular surgeons, as consulting surgeons, enable the completion of highly complex cases and in this capacity provide significant financial value to the hospital.
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Affiliation(s)
- Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Miguel F Manzur
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Todd A Wilson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Niquelle Brown Wadé
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Abstract
With the ongoing changes in graduate medical education, emphasis has been placed on simulation models to increase clinical exposure and optimize learning. In specific, high-fidelity simulation presents as a potential option for procedural-skill development in interventional radiology. With improved haptic, visual, and tactile dynamics, high-fidelity endovascular simulators have gained increasing support from trainees and certified interventionalists alike. The 2 most common high-fidelity endovascular simulators utilized today are the Procedicus VIST and ANGIO Mentor, which contain notable differences in technical features, case availability, and cost. From the perspective of a trainee, high-fidelity simulation allows for the ability to perform a greater volume of cases. Additionally, without the risk of potential harm to the patient, trainees can focus on repetition and improved performance in a stress-free environment. When errors are made, high-fidelity simulator metrics will generate instantaneous feedback and error notification, erasing ambiguity and thus facilitating learning. Furthermore, in an environment devoid of time and cost stressors, the supervising physician is afforded the opportunity to properly mentor and instruct the trainee throughout the case. For the experienced interventionalists, high-fidelity simulation allows for a decreased learning curve for new procedures or techniques, as well as the opportunity for procedure rehearsal for unusual or high-risk cases. Despite the limitations created by cost, high-fidelity endovascular simulation should continue to be increasingly utilized in the development of the interventional radiology curriculum.
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Affiliation(s)
- Ayush Amin
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
| | - Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Thomas Sullivan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
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Endovascular Training Using a Simulation Based Curriculum is Less Expensive than Training in the Hybrid Angiosuite. Eur J Vasc Endovasc Surg 2018; 56:583-590. [DOI: 10.1016/j.ejvs.2018.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/10/2018] [Indexed: 01/12/2023]
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Torres I, De Luccia N. Artificial vascular models for endovascular training (3D printing). Innov Surg Sci 2018; 3:225-234. [PMID: 31579786 PMCID: PMC6604582 DOI: 10.1515/iss-2018-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/17/2018] [Indexed: 12/27/2022] Open
Abstract
The endovascular technique has led to a revolution in the care of patients with vascular disease; however, acquiring and maintaining proficiency over a broad spectrum of procedures is challenging. Three-dimensional (3D) printing technology allows the production of models that can be used for endovascular training. This article aims to explain the process and technologies available to produce vascular models for endovascular training, using 3D printing technology. The data are based on the group experience and a review of the literature. Different 3D printing methods are compared, describing their advantages, disadvantages and potential roles in surgical training. The process of 3D printing a vascular model based on an imaging examination consists of the following steps: image acquisition, image post-processing, 3D printing and printed model post-processing. The entire process can take a week. Prospective studies have shown that 3D printing can improve surgical planning, especially in complex endovascular procedures, and allows the production of efficient simulators for endovascular training, improving residents’ surgical performance and self-confidence.
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Affiliation(s)
- Inez Torres
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, Rua Oscar Freire, 1546, ap 33, Pinheiros, São Paulo - SP 05409-010, Brazil
| | - Nelson De Luccia
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, São Paulo, Brazil
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Strøm M, Lönn L, Konge L, Schroeder TV, Lindgren H, Nyheim T, Venermo M, Bech B. Assessment of EVAR Competence: Validity of a Novel Rating Scale (EVARATE) in a Simulated Setting. Eur J Vasc Endovasc Surg 2018; 56:137-144. [DOI: 10.1016/j.ejvs.2018.02.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
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