Abstract
This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience.Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded. Image quality was rated, and the absolute value of technically unsafe events was recorded. The trainees’ device selection, macrovascular access, microvascular access, clinical management, and the overall performance of the trainee was rated during each procedure based on a traditional Likert scale score of 1=fail, 2=poor, 3=satisfactory, 4=good, and 5=excellent. These ordinal values correspond with published assessment scales on surgical technique.After performing five diagnostic angiograms and five embolectomies, all participants demonstrated marked decreases in procedure time, fluoroscopy doses, contrast doses, and adverse technical events; marked improvements in image quality, device selection, access scores, and overall technical performance were additionally observed (p < 0.05). Similarly, trainees demonstrated marked improvement in technical performance and clinical management after five coiling procedures (p < 0.05). However, trainees with less prior experience deploying coils continued to experience intra-procedural ruptures up to the eighth embolization procedure; this observation likely corresponded with less tactile procedural experience to an exertion of greater force than appropriate for coil placement.Trainees across all levels of training and prior experience demonstrated a significant performance improvement after completion of our simulator curriculum consisting of five diagnostic angiograms, five embolectomy cases, and 10 aneurysm coil embolizations.
Highlights
Simulation has been integrated into medical training for many years, whether in the form of cadaveric dissection, the use of animal models, or synthetic models
This study evaluated seven resident-level learners with no prior angiography experience before simulator experience [25]
The purpose of this study is to establish performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience
Summary
Simulation has been integrated into medical training for many years, whether in the form of cadaveric dissection, the use of animal models, or synthetic models. The idea of simulation in modern medicine dramatically evolved with the emergence of the computer during the latter portion of the 20th century. The term "simulation" is synonymous with computerized virtual reality devices and been effectively introduced in aviation. Though neurosurgery remains a field unforgiving of technical errors, simulation devices remain underutilized due to challenges in three-dimensional (3D) simulation. Endovascular interventions rely on a two-dimensional (2D) angiographic interface and reasonably reproduced haptics of catheter and wire manipulation. Neurovascular surgery, is a natural target for the development of a robust simulation curriculum
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