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Scullen T, Milburn J, Mathkour M, Larrota A, Aduloju O, Dumont A, Nerva J, Amenta P, Wang A. Training Cerebrovascular and Neuroendovascular Surgery Residents: A Systematic Literature Review and Recommendations. Ochsner J 2024; 24:36-46. [PMID: 38510222 PMCID: PMC10949058 DOI: 10.31486/toj.23.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: The rapid evolution of neuroendovascular intervention has resulted in the inclusion of endovascular techniques as a core competency in neurosurgical residency training. Methods: We conducted a literature review of studies involving the training of neurosurgical residents in cerebrovascular and endovascular neurosurgery. We reviewed the evolution of cerebrovascular neurosurgery and the effects of these changes on residency, and we propose interventions to supplement contemporary training. Results: A total of 48 studies were included for full review. Studies evaluated trainee education and competency (29.2%, 14/48), neuroendovascular training models (20.8%, 10/48), and open cerebrovascular training models (52.1%, 25/48), with some overlap. We used a qualitative analysis of reviewed reports to generate a series of suggested training supplements to optimize cerebrovascular education. Conclusion: Cerebrovascular neurosurgery is at a crossroads where trainees must develop disparate skill sets with inverse trends in volume. Continued longitudinal exposure to both endovascular and open cerebrovascular surgical fields should be mandated in general resident education, and blended learning tactics using adjunct simulation systems and models should be incorporated with didactics to both optimize learning and alleviate restraints placed by decreased volume and autonomy.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA
| | - James Milburn
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA
| | - Angela Larrota
- International School of Louisiana, West Bank Campus, New Orleans, LA
| | | | - Aaron Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA
| | - John Nerva
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Amenta
- Department of Neurological Surgery, University of Massachusetts, Worchester, MA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA
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Kweki AG, Sarwar Khan Tharin M, Baptista V, Kenneth E, Rohin F, Scoote M, Howard AQ. The Impact of Simulation-Based Training in Cardiovascular Medicine: A Systematic Review. Cureus 2023; 15:e50414. [PMID: 38098737 PMCID: PMC10719544 DOI: 10.7759/cureus.50414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
Cardiovascular medicine and practice in recent times have evolved as complex procedures are performed to manage difficult cases. The majority of these interventions are done percutaneously in order to minimize patient risk. Additionally, training specialist in handling these interventions require a lot of exposure to them; as such, patients are at higher risk of errors and complications from trainees before attaining expertise. In order to avoid these possible risks to patients and ensure their safety, using simulation commonly in cardiovascular specialist education is a possible trend in the future. This article aims to review randomized controlled trials that were performed in cardiology and vascular medicine regarding the use of simulating models to transfer skills to trainees. This study is a systematic review that includes publications dated from 2010 from any country and only in English. The search involved several combinations of search terms from medical subject headings (MeSH). Keywords in the title, abstract, and text for the population, intervention, control, and outcomes were first done in a pilot search to establish the sensitivity of the search strategy. Studies were searched in PubMed, Medline, Cochrane Library, Embase, CINAHL, and Hirani. Data were presented in the PRISMA flowchart and tabular form. A total of 389 studies were obtained from five databases using the search strategies. Eighty-nine studies were excluded for duplication. The total number of studies that did not meet the inclusion criteria was 269, and they were excluded based on abstract and title screening. Another 18 studies were excluded based on full-text screening. In this study, 13 articles were selected ranging from 2011 to 2022. The majority of the outcomes of the study demonstrated that simulation tutoring complements traditional methods of training. Countries of publication were the United States of America, Canada, Italy, Korea, California, Ireland, Germany, Belgium, Switzerland, United Kingdom, Netherlands, and France. Procedures simulated include coronary angiography, transseptal catheterization, cardiopulmonary resuscitation, ultrasound-guided radial artery cannulation, diagnostic angiograms, coiled carotid terminus aneurysms in the setting of subarachnoid hemorrhage, middle cerebral artery embolectomies, renal artery angioplasty/stenting, endovascular aneurysm repair, transvenous pacing wire, intra-aortic balloon pump, and pericardiocentesis. Despite the accredited drawback of availability and cost noted with simulation-based education, there is evidence that it offers many advantages compared to traditional teaching methods. From this study, simulation-based teaching has been shown to effectively transfer skills to trainees especially when used as an adjunct to the apprenticeship method. As a result, we recommend that virtual reality education should be integrated with real-life teaching in modern cardiovascular modules as this will help ensure early skill transfer while maintaining patient safety.
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Affiliation(s)
- Anthony G Kweki
- Internal Medicine/Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
| | - Mohammad Sarwar Khan Tharin
- Internal Medicine/Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
| | - Victor Baptista
- Surgery, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
| | - Echofa Kenneth
- Anaesthesiology, Delta State University Teaching Hospital, Oghara, NGA
| | - Francis Rohin
- Internal Medicine/Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
| | - Mark Scoote
- Internal Medicine/Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
| | - Adam Q Howard
- Vascular Surgery, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Colchester, GBR
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Bravo J, Wali AR, Hirshman BR, Gopesh T, Steinberg JA, Yan B, Pannell JS, Norbash A, Friend J, Khalessi AA, Santiago-Dieppa D. Robotics and Artificial Intelligence in Endovascular Neurosurgery. Cureus 2022; 14:e23662. [PMID: 35371874 PMCID: PMC8971092 DOI: 10.7759/cureus.23662] [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] [Accepted: 03/30/2022] [Indexed: 11/05/2022] Open
Abstract
The use of artificial intelligence (AI) and robotics in endovascular neurosurgery promises to transform neurovascular care. We present a review of the recently published neurosurgical literature on artificial intelligence and robotics in endovascular neurosurgery to provide insights into the current advances and applications of this technology. The PubMed database was searched for "neurosurgery" OR "endovascular" OR "interventional" AND "robotics" OR "artificial intelligence" between January 2016 and August 2021. A total of 1296 articles were identified, and after applying the inclusion and exclusion criteria, 38 manuscripts were selected for review and analysis. These manuscripts were divided into four categories: 1) robotics and AI for the diagnosis of cerebrovascular pathology, 2) robotics and AI for the treatment of cerebrovascular pathology, 3) robotics and AI for training in neuroendovascular procedures, and 4) robotics and AI for clinical outcome optimization. The 38 articles presented include 23 articles on AI-based diagnosis of cerebrovascular disease, 10 articles on AI-based treatment of cerebrovascular disease, two articles on AI-based training techniques for neuroendovascular procedures, and three articles reporting AI prediction models of clinical outcomes in vascular disorders of the brain. Innovation with robotics and AI focus on diagnostic efficiency, optimizing treatment and interventional procedures, improving physician procedural performance, and predicting clinical outcomes with the use of artificial intelligence and robotics. Experimental studies with robotic systems have demonstrated safety and efficacy in treating cerebrovascular disorders, and novel microcatheterization techniques may permit access to deeper brain regions. Other studies show that pre-procedural simulations increase overall physician performance. Artificial intelligence also shows superiority over existing statistical tools in predicting clinical outcomes. The recent advances and current usage of robotics and AI in the endovascular neurosurgery field suggest that the collaboration between physicians and machines has a bright future for the improvement of patient care. The aim of this work is to equip the medical readership, in particular the neurosurgical specialty, with tools to better understand and apply findings from research on artificial intelligence and robotics in endovascular neurosurgery.
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Routledge H, Sharp AS, Kovac J, Westwood M, Keeble TR, Bathula R, Eteiba H, Grunwald IQ, Curzen N. Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group. Interv Cardiol 2022; 17:e07. [PMID: 35774864 PMCID: PMC9214600 DOI: 10.15420/icr.2021.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022] Open
Abstract
There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.
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Affiliation(s)
| | - Andrew Sp Sharp
- University Hospital of Wales Cardiff, Wales, UK.,University of Exeter Exeter, UK
| | - Jan Kovac
- University Hospitals of Leicester NHS Trust Leicester, UK
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin University Chelmsford, Essex, UK
| | - Raj Bathula
- London North West University Healthcare NHS Trust London, UK
| | - Hany Eteiba
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital Glasgow, Scotland, UK
| | - Iris Q Grunwald
- University of Dundee Dundee, Scotland, UK.,Cardiovascular Center Frankfurt Frankfurt, Germany
| | - Nick Curzen
- Faculty of Medicine, University of Southampton Southampton, UK.,Cardiothoracic Unit, University Hospital Southampton Southampton, UK
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Patchana T, Wiginton J, Ghanchi H, Favre AW, Tayag EC, Schiraldi M, Miulli DE. Use of Endovascular Simulator in Training of Neurosurgery Residents - A Review and Single Institution Experience. Cureus 2020; 12:e11931. [PMID: 33425512 PMCID: PMC7785465 DOI: 10.7759/cureus.11931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022] Open
Abstract
Simulators for surgical procedures and interventions have undergone significant technological advancement in the past decade and are becoming more commonplace in medical training. Neurosurgery residents across multiple training levels underwent performance evaluation using a neuro-interventional simulator, employing a variety of metrics for assessment. We identified seven core metrics used in the evaluation of neurosurgery residents performing simulated mechanical thrombectomies. Additionally, a systematic PubMed search for studies related to Neurointerventional Radiology training via simulation was performed. The purpose of this study is to examine the validity and benefits of training with these simulation devices and compare our institution's experience. Additionally, an exploration of their applicability to neurosurgery resident training is discussed.
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Affiliation(s)
- Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Hammad Ghanchi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Andrew W Favre
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Emilio C Tayag
- Neurology and Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Michael Schiraldi
- Neurosurgery, Redlands Community Hospital, Redlands, USA
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Sandmann J, Müschenich FS, Riabikin A, Kramer M, Wiesmann M, Nikoubashman O. Can silicone models replace animal models in hands-on training for endovascular stroke therapy? Interv Neuroradiol 2019; 25:397-402. [PMID: 30895839 DOI: 10.1177/1591019919833843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Since thrombectomy has become a standard treatment technique for stroke, there is great demand for well-trained interventionalists. We offer practical courses on both silicone models and porcine models, and conducted a survey to evaluate whether ex vivo training models could replace in vivo models in the future. METHODS In total, 110 neurointerventionalists participating in 30 training courses were included in our survey using a semi-structured questionnaire. RESULTS The level of experience in thrombectomy maneuvers was almost balanced in our sample (52% experienced and 48% less-experienced participants). Silicone models were regarded as useful training tools regardless of the participants' experience (p = 1.000): 94% of less-experienced and 92% of experienced participants considered a silicone model to be a useful introduction for training with animal models. Of the participants, 95% indicated that training on animal models was helpful and necessary, even if they already had experience in performing interventions in humans (p = 1.000). After joining this course, 97% of all participants felt well prepared to perform thrombectomies in humans. CONCLUSION Even experienced participants benefit from silicone models. Silicone models are a good preparation for animal models but cannot replace them. Categorizing participants depending on their experience and their individual needs before practical training may allow for more efficient endovascular training.
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Affiliation(s)
- Johanna Sandmann
- 1 Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | | | - Alexander Riabikin
- 1 Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Martin Kramer
- 2 Department of Veterinary Clinical Sciences, Justus-Liebig-University, Gießen, Germany
| | - Martin Wiesmann
- 1 Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Omid Nikoubashman
- 1 Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
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A radiopaque 3D printed, anthropomorphic phantom for simulation of CT-guided procedures. Eur Radiol 2018; 28:4818-4823. [PMID: 29789910 DOI: 10.1007/s00330-018-5481-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop an anthropomorphic phantom closely mimicking patient anatomy and to evaluate the phantom for the simulation of computed tomography (CT)-guided procedures. METHODS Patient CT images were printed with aqueous potassium iodide solution (1 g/mL) on paper. The printed paper sheets were stacked in alternation with 1-mm thick polyethylene foam layers, cut to the patient shape and glued together to create an anthropomorphic abdomen phantom. Ten interventional radiologists performed periradicular infiltration on the phantom and rated the phantom procedure regarding different aspects of suitability for simulating CT-guided procedures. RESULTS Radiopaque printing in combination with polyethylene foam layers achieved a phantom with detailed patient anatomy that allowed needle placement. CT-guided periradicular infiltration on the phantom was rated highly realistic for simulation of anatomy, needle navigation and overall course of the procedure. Haptics were rated as intermediately realistic. Participants strongly agreed that the phantom was suitable for training and learning purposes. CONCLUSIONS A radiopaque 3D printed, anthropomorphic phantom provides a realistic platform for the simulation of CT-guided procedures. Future work will focus on application for training and procedure optimisation. KEY POINTS • Radiopaque 3D printing combined with polyethylene foam achieves patient phantoms for CT-guided procedures. • Radiopaque 3D printed, anthropomorphic phantoms allow realistic simulation of CT-guided procedures. • Realistic visual guidance is a key aspect in simulation of CT-guided procedures. • Three-dimensional printed phantoms provide a platform for training and optimisation of CT-guided procedures.
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