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Doyen B, Soenens G, Maurel B, Hertault A, Gordon L, Vlerick P, Vermassen F, Grantcharov T, van Herzeele I. Assessing endovascular team performances in a hybrid room using the Black Box system: a prospective cohort study. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:82-92. [PMID: 36168949 DOI: 10.23736/s0021-9509.22.12226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technologists) to master various skills, including the 'As Low As Reasonably Achievable' principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis. METHODS Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assessment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions. RESULTS Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure-specific scale, below the 'acceptable' score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses' task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below 'acceptable' in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure. CONCLUSIONS The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objective assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members' (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278).
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Affiliation(s)
- Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Blandine Maurel
- Department of Vascular Surgery, University Hospital Centre of Nantes, Nantes, France
| | - Adrien Hertault
- Department of Vascular Surgery, Valenciennes General Hospital, Valenciennes, France
| | - Lauren Gordon
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Vlerick
- Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Teodor Grantcharov
- Department of Surgery, Stanford University, Stanford, CA, USA.,Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Isabelle van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium -
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Strøm M, Rasmussen JL, Nayahangan LJ, de la Motte L, Vogt K, Konge L, Eiberg J. Learn EVAR sizing from scratch: The results of a one-day intensive course in EVAR sizing and stent graft selection for vascular trainees. Vascular 2020; 28:342-347. [DOI: 10.1177/1708538120913719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aim Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. Methods Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. Results All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30–48:20) min (median and range). The participants’ overall test scores (lower is better) were in median 17.9 (11.9–28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7–25.2) (<200 EVAR’s) ( p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 –18.7) (≥200 EVAR’s) ( p = .01). The sub-score for anatomical measurements was 10.6 (3.9–18.8) and comparable with the experienced group 9.7 (8.1–12.8) ( p = .83) but inferior to the expert operators 6.5 (5.2–10.2) ( p = .04). The sub-score for stent graft selection was 7.5 (4.9–14.1) and comparable with experienced operators scoring 4.5 (3.6–12.3) ( p = .09) but inferior to the expert operators score of 5.0 (3.6–8.4) ( p = .01). Conclusion This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.
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Affiliation(s)
- Michael Strøm
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Vascular Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Jonathan Lawaetz Rasmussen
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
| | - Louise de la Motte
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katja Vogt
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Eiberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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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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