Validating a 3D-Printed En7dovascular Simulator for Use in Training Surgical Residents

Abstract

Endovascular simulators have become a standard in education for surgical residents. However, these products are expensive to purchase and maintain, limiting their accessibility. Endovascular models created using in-house 3D printing can be an affordable alternative but currently lack the rigorous validation needed to be a dependable educational tool. The purpose of this study is to determine the construct validity of a 3D-printed endovascular model of an aorta. A 3D rendering of an aorta was created using a patient computed tomography scan and subsequently printed on a Form B printer with transparent clear V4 resin (Fig 1). The pieces were combined to create a final product with a material cost of $50. Participants were asked to perform 2 tasks from a femoral access point: catheterizing the contralateral common iliac artery and cannulating the superior mesenteric artery (SMA). For each task, a 5-point rubric was created to assess whether all components of the tasks were done correctly. Participants were also assessed on the time taken to perform the tasks. Participants’ level of education (medical student vs surgical resident vs attending) and level of endovascular experience (<5 procedures = no experience, 6-100 = some experience, and >100 extensive experience) were noted. Of a total of 37 participants, 12 were medical students, 21 were residents, and 4 were attendings. A total of 26 participants had no experience, 6 had some experience, and 5 had extensive experience. Neither education level nor experience level had a significant bearing on whether either task was completed. Those with higher education completed the SMA task more accurately (P = .007), but this pattern was not observed for higher levels of experience. Univariate analysis shows that both higher education and greater experience resulted in faster times for both tasks, but multivariate analysis shows that only the level of experience was a predictor for faster completion (Fig 2, P = .02). This is reinforced by the finding that among participants with no experience, higher levels of education do not result in faster times (P = .16). These findings verify the construct validity of this endovascular simulator, as those with the most real-world experience completed the tasks the fastest. The observation that residents did more of the steps correctly than medical students may be because they have greater knowledge of endovascular procedures, but this did not translate to faster performance, which requires muscle memory. Basic 3D-printed endovascular models should therefore be strongly considered as an affordable, readily accessible adjunct to surgical resident education.Fig 2Combined time, in seconds, for participants with no experience, some experience, and extensive experience to complete the catheterization of the contralateral common iliac artery and superior mesenteric artery (SMA). Error bars show 95% confidence interval (CI). Increasing real-world endovascular experience trends with decreased completion times, with statistical significance (P < .05) achieved between the “no experience” and “extensive experience” groups, denoted by *.View Large Image Figure ViewerDownload Hi-res image Download (PPT)