Influence of patient-specific rehearsal on operative metrics and technical success for endovascular aneurysm repair

Cadaveric aortic aneurysm creation: A life-like model for training endovascular repair

The recent decline in RAAA incidence and the fast paced scenario with associated challenges regarding training calls for initiative for a better training environment to maximize learning. This led us to the creation of a pulsatile human cadaveric RAAA model. Fresh frozen cadaver was used to create RAAA with BioTissue in hybrid suite with ability to perform CBCTA for sizing. As a proof of concept, the model was used to perform REVAR with proximal CODA balloon control. The model proved to be feasible and we believe it is a better environment to train and gain adequate proficiency in RAAA management.

The Role of Simulators in Interdisciplinary Medical Work

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.

Simulation-Based Virtual-Reality Patient-Specific Rehearsal Prior to Endovascular Procedures: A Systematic Review

Patient-specific rehearsal (PsR) is a new concept whereby a procedure can be rehearsed virtually using the exact patient’s anatomical data prior to performing the real procedure. The aim of this study was to ascertain if endovascular virtual-reality PsR simulation enhanced performance in real life. This was done by performing a systematic review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted in PubMed, Embase, The Cochrane Library and Web of Science concerning PsR in endovascular procedures. All publications were handled using Covidence. Reference lists were also screened. Data extracted from the studies were realism rating, procedure time, fluoroscopy time, contrast volume, number of angiograms and reduction of errors. Kirkpatrick’s four-level model for measuring the efficiency of training was used for guidance of the relevance of studies. The search yielded 1155 results after the exclusion of duplicates, and 11 studies were included. Four studies had a control group, including one randomized trial; the remaining seven were feasibility studies. The realism was rated high, and overall, the studies showed improvements in procedure time, fluoroscopy time and contrast volume after PsR. One study assessed and confirmed the reduction in errors after PsR. Only two studies included more than 15 patients in their cohort. Kirkpatrick’s model was applied to all studies, with one study reaching level 4. All studies found the concept of PsR to be feasible and realistic. The studies with a control group showed a reduction of overall procedure time, radiation exposure and potential errors in endovascular procedures following PsR.