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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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Gholinejadzirmanlou M, Aghazadeh Attari AM, Sheikhalipour Z, Lotfi M, Ghaffarifar S, Qayumi K. An appropriate simulation-based training for surgical technology students. Nurse Educ Pract 2023; 70:103680. [PMID: 37354693 DOI: 10.1016/j.nepr.2023.103680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Using simulation in an appropriate education plan which has always been challenging; To be used alone or in combination with other methods and the order of it's use. This article was intended to compare student's knowledge, clinical skill and readiness-capability using simulation and combination of it with traditional training methods to collect necessary evidence for development of an appropriate simulation- based educational plan for surgical technology students. METHODS This is a controlled pre/post-test quasi-experimental study in 2019. All surgical technology students who had selected the scrub and circulate course (n = 28) were randomly divided into two groups. One of the groups was educated with traditional training method (TTM). On the same day, the other group was educated with simulation training method (STM). After two weeks, group α received simulation training and group β was subject to traditional training. Multiple-Choice Test for Knowledge Assessment and Clinical Skills as well as Readiness-Capability (KCSRC) of appendectomy Surgery checklist were used in this study. Data were analysed after each training method, after Two weeks and after blended education.For data analysis, Mixed-Design ANOVA and SPSS software 24/v were employed. RESULTS The mean scores of knowledge, clinical skills, and readiness-capability were 14.2 ± 2.91, 44.42 ± 17.74, 21.58 ± 4.18 in group α and 12.66 ± 3.21, 41.17 ± 16.19, and 18.58 ± 7.85 in group β, respectively. The comparison between mean scores of KCSRC before the first training and after combined training in each group showed that the mean of all scores significantly increased in group α (p < 0.0001), which indicates that the education plan starting with TTM and continued with STM has the most significant effect on results. CONCLUSION According to the results of the study, it seems that starting the education plan for surgical students with TTM and then continuing with STM would be more effective on education of students, especially on students' long term learning.
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Affiliation(s)
- Mahsa Gholinejadzirmanlou
- Student of Medical Surgical Nursing, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zahra Sheikhalipour
- Medical, Surgical Nursing Department, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Lotfi
- Medical Education Research Center, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Karim Qayumi
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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CT-Derived 3D Printing for Coronary Artery Cannulation Simulator Design Manufacturing. Bioengineering (Basel) 2022; 9:bioengineering9080338. [PMID: 35892751 PMCID: PMC9330152 DOI: 10.3390/bioengineering9080338] [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: 06/15/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Mastering coronary angiography requires practice. Cadavers and animals do not accurately represent the human anatomical body, and practicing with actual patients has medical safety issues. Simulation offers safe and realistic conditions for cardiology intervention training. In this study, we propose a novel 3D printed simulator that contains physically realistic anatomy and has four access points. It increases safety for patients and students, and production is low-cost. We aimed to make and validate this simulator design as a prototype for coronary cannulation training. It was designed using computed tomography (CT) scan data of aorta, coronary, and heart models, and was printed by 3D printing with resin materials consisting of 75% or 85% clear resin and 25% or 15% flexible resin additive. The simulator was constructed with a camera above the simulator with a degree of LAO of 30°/0°, a display table, and an acrylic box. Twelve validators were interviewed for their expert opinions and analyzed by a qualitative method. They scored the simulator’s suitability on a four-point Likert scale questionnaire. They described the simulator as having admirable values for all aspects (85.8%), curriculum suitability (92%), educational importance (94%), accuracy (83%), efficiency (78%), safety (87.5%), endurance (81.2%), aesthetics (80.7%), storage (85.4%), and affordability (85.8%).
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Bernardi FLDM, Ribeiro HB, Nombela-Franco L, Cerrato E, Maluenda G, Nazif T, Lemos PA, Sztejfman M, Lamelas P, Echeverri D, Lopes MACQ, Brito FSD, Abizaid AA, Mangione JA, Eltchaninoff H, Søndergaard L, Rodes-Cabau J. Evolução e Estado Atual das Práticas de Implante Transcateter de Válvula Aórtica na América Latina – Estudo WRITTEN LATAM. Arq Bras Cardiol 2022; 118:1085-1096. [PMID: 35703645 PMCID: PMC9345155 DOI: 10.36660/abc.20210327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Fundamento: Implante transcateter de valva aórtica (TAVI) é um procedimento adotado em todo o mundo e suas práticas evoluem rapidamente. Variações regionais e temporais são esperadas. Objetivo: Comparar a prática de TAVI na América Latina com aquela no resto do mundo e avaliar suas mudanças na América Latina de 2015 a 2020. Método: A pesquisa foi realizada em centros de TAVI em todo o mundo entre março e setembro de 2015, e novamente nos centros latino-americanos entre julho de 2019 e janeiro de 2020. As seguintes questões foram abordadas: i) informação geral sobre os centros; ii) avaliação pré-TAVI; iii) técnicas do procedimento; iv) conduta pós-TAVI; v) seguimento. As respostas da pesquisa dos centros latino-americanos em 2015 (LATAM15) foram comparadas àquelas dos centros no resto do mundo (WORLD15) e ainda àquelas da pesquisa dos centros latino-americanos de 2020 (LATAM20). Adotou-se o nível de significância de 5% na análise estatística. Resultados: 250 centros participaram da pesquisa em 2015 (LATAM15=29; WORLD15=221) e 46 na avaliação LATAM20. No total, foram 73.707 procedimentos, sendo que os centros WORLD15 realizaram, em média, 6 e 3 vezes mais procedimentos do que os centros LATAM15 e LATAM20, respectivamente. Os centros latino-americanos realizaram menor número de TAVI minimalista do que os do restante do mundo, mas aumentaram significativamente os procedimentos menos invasivos após 5 anos. Quanto à assistência pós-procedimento, observaram-se menor tempo de telemetria e de manutenção do marca-passo temporário, além de menor uso de terapia dupla antiplaquetária nos centros LATAM20. Conclusão: A despeito do volume de procedimentos ainda significativamente menor, muitos aspectos da prática de TAVI nos centros latino-americanos evoluíram recentemente, acompanhando a tendência dos centros dos países desenvolvidos.
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Tatar İ, Huri E, Selçuk İ, Moon YL, Paoluzzi A, Skolarikos A. Review of the effect of 3D medical printing and virtual reality on urology training with ‘MedTRain3DModsim’ Erasmus + European Union Project. Turk J Med Sci 2019; 49:1257-1270. [PMID: 31648427 PMCID: PMC7018298 DOI: 10.3906/sag-1905-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background/aim It is necessary to incorporate novel training modalities in medical education, especially in surgical fields, because of the limitations of cadaveric training. Traditional medical education has many drawbacks, such as residency working hour restrictions, patient safety conflicts with the learning needs, and the lack of hands-on workshops. The MedTRain3DModsim Project aimed to produce 3-dimensional (3D) medical printed models, simulations, and innovative applications for every level of medical training using novel worldwide technologies. It was aimed herein to improve the interdisciplinary and transnational approaches, and accumulate existing experience for medical education, postgraduate studies, and specialty training. Materials and methods This project focused on models of solid organs and the urinary system, including the kidney, prostate, ureter, and liver. With 3D medical printing, it is possible to produce a body part from inert materials in just a few hours with the standardization of medical 3D modeling. Results The target groups of this project included medical students and residents, graduate students from engineering departments who needed medical education and surgical training, and medical researchers interested in health technology or clinical and surgical an atomy. Conclusion It was also intended to develop a novel imaging platform for education and training by reevaluating the existing data using new software and 3D modalities. Therefore, it was believed that our methodology could be implemented in all related medical fields.
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Affiliation(s)
- İlkan Tatar
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Huri
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlker Selçuk
- Department of Gynecologic-Oncology, Zekai Tahir Burak Research and Educational Hospital, Ankara, Turkey
| | - Young Lee Moon
- Department of Orthopedics, Chosun University, Chosun, South Korea
| | - Alberto Paoluzzi
- Department of Mathematics and Physics, Rome Tre University, Rome, Italy
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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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Hemingway MW, Osgood P, Mannion M. Implementing a Cardiac Skills Orientation and Simulation Program. AORN J 2018; 107:215-223. [PMID: 29385256 DOI: 10.1002/aorn.12023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with cardiac morbidities admitted for cardiac surgical procedures require perioperative nurses with a high level of complex nursing skills. Orienting new cardiac team members takes commitment and perseverance in light of variable staffing levels, high-acuity patient populations, an active cardiac surgical schedule, and the unpredictability of scheduling patients undergoing cardiac transplantation. At an academic medical center in Boston, these issues presented opportunities to orient new staff members to the scrub person role, but hampered efforts to provide active learning opportunities in a safe environment. As a result, facility personnel created a program to increase new staff members' skills, confidence, and proficiency, while also increasing the number of staff members who were proficient at scrubbing complex cardiac procedures. To address the safe learning requirement, personnel designed a simulation program to provide scrubbing experience, decrease orientees' supervision time, and increase staff members' confidence in performing the scrub person role.
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Korzeniowski P, White RJ, Bello F. VCSim3: a VR simulator for cardiovascular interventions. Int J Comput Assist Radiol Surg 2018; 13:135-149. [PMID: 29079992 PMCID: PMC5754385 DOI: 10.1007/s11548-017-1679-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/13/2017] [Indexed: 12/02/2022]
Abstract
PURPOSE Effective and safe performance of cardiovascular interventions requires excellent catheter/guidewire manipulation skills. These skills are currently mainly gained through an apprenticeship on real patients, which may not be safe or cost-effective. Computer simulation offers an alternative for core skills training. However, replicating the physical behaviour of real instruments navigated through blood vessels is a challenging task. METHODS We have developed VCSim3-a virtual reality simulator for cardiovascular interventions. The simulator leverages an inextensible Cosserat rod to model virtual catheters and guidewires. Their mechanical properties were optimized with respect to their real counterparts scanned in a silicone phantom using X-ray CT imaging. The instruments are manipulated via a VSP haptic device. Supporting solutions such as fluoroscopic visualization, contrast flow propagation, cardiac motion, balloon inflation, and stent deployment, enable performing a complete angioplasty procedure. RESULTS We present detailed results of simulation accuracy of the virtual instruments, along with their computational performance. In addition, the results of a preliminary face and content validation study conveyed on a group of 17 interventional radiologists are given. CONCLUSIONS VR simulation of cardiovascular procedure can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. VCSim3 is still a prototype, yet the initial results indicate that it provides promising foundations for further development.
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Affiliation(s)
- Przemyslaw Korzeniowski
- Simulation and Modelling in Medicine and Surgery, Centre for Engagement and Simulation Science, Imperial College London, London, UK.
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - Ruth J White
- Simulation and Modelling in Medicine and Surgery, Centre for Engagement and Simulation Science, Imperial College London, London, UK
| | - Fernando Bello
- Simulation and Modelling in Medicine and Surgery, Centre for Engagement and Simulation Science, Imperial College London, London, UK
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Kapoor PM, Irpachi K. Simulation in cardiac critical care: New times and new solutions. Ann Card Anaesth 2016; 19:385-8. [PMID: 27397438 PMCID: PMC4971962 DOI: 10.4103/0971-9784.185514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Kalpana Irpachi
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
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