Feasibility of a customizable training environment for neurointerventional skills assessment.

Marie Teresa Nawka,Andreas Maximilian Frölich,Jan-Hendrik Buhk,Uta Hanning,Helena Guerreiro,Fabian Flottmann,Noel Van Horn,Jens Fiehler,Karen M Doyle

doi:10.1371/journal.pone.0238952

Marie Teresa Nawka, Andreas Maximilian Frölich + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0238952

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Abstract

ObjectiveTo meet increasing demands to train neuroendovascular techniques, we developed a dedicated simulator applying individualized three-dimensional intracranial aneurysm models (‘HANNES’; Hamburg Anatomic Neurointerventional Endovascular Simulator). We hypothesized that HANNES provides a realistic and reproducible training environment to practice coil embolization and to exemplify disparities between neurointerventionalists, thus objectively benchmarking operators at different levels of experience.MethodsSix physicians with different degrees of neurointerventional procedural experience were recruited into a standardized training protocol comprising catheterization of two internal carotid artery (ICA) aneurysms and one basilar tip aneurysm, followed by introduction of one framing coil into each aneurysm and finally complete coil embolization of one determined ICA aneurysm. The level of difficulty increased with every aneurysm. Fluoroscopy was recorded and assessed for procedural characteristics and adverse events.ResultsPhysicians were divided into inexperienced and experienced operators, depending on their experience with microcatheter handling. Mean overall catheterization times increased with difficulty of the aneurysm model. Inexperienced operators showed longer catheterization times (median; IQR: 47; 30-84s) than experienced operators (21; 13-58s, p = 0.011) and became significantly faster during the course of the attempts (rho = -0.493, p = 0.009) than the experienced physicians (rho = -0.318, p = 0.106). Number of dangerous maneuvers throughout all attempts was significantly higher for inexperienced operators (median; IQR: 1.0; 0.0–1.5) as compared to experienced operators (0.0; 0.0–1.0, p = 0.014).ConclusionHANNES represents a modular neurointerventional training environment for practicing aneurysm coil embolization in vitro. Objective procedural metrics correlate with operator experience, suggesting that the system could be useful for assessing operator proficiency.

Highlights

Over the last decades, endovascular therapy of intracranial aneurysms (IA) using coil embolization has been established as a standard treatment approach [1]
Six physicians with different degrees of neurointerventional procedural experience were recruited into a standardized training protocol comprising catheterization of two internal carotid artery (ICA) aneurysms and one basilar tip aneurysm, followed by introduction of one framing coil into each aneurysm and complete coil embolization of one determined ICA aneurysm
Mean overall catheterization times increased with difficulty of the aneurysm model

Summary

Introduction

Endovascular therapy of intracranial aneurysms (IA) using coil embolization has been established as a standard treatment approach [1]. Owing to the wide range of materials and devices available, a well-founded education for beginning neurointerventionalists and constant practice for advanced physicians is indispensable, aiming to maintain high neurointerventional standards [2, 3]. Simulation technology for medical teaching and training can provide opportunities to learn and enhance medical skills [2]. There is a growing array of neurointerventional setups to teach and train distinct endovascular procedures, either operating with silicone models or by means of rapid prototyping technologies [4,5,6]. Among the available training models and simulators, anatomically precise three-dimensional (3D) printed IA models integrated into in vitro training environments [7, 8] represent a unique way of translating actual clinical challenges into a protected training environment. In vitro training can potentially help to increase patient safety [7]

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