Abstract
Objectives: We assessed the effects of thoracic endovascular aortic repair (TEVAR) rehearsal with an endovascular surgical simulator in surgical trainees at different levels in training. Methods: Twelve trainees in three cohorts (student, postgraduate year [PGY]1-3, and PGY 4-7) were oriented to using the Simbionix AngioMentor simulator over four sessions. Likert scale qualitative analysis evaluated participant proficiency. Analysis of data included one-way analysis of variance and paired t-tests. Results: All groups had reduction of total procedure time (mean 537 6 148 seconds vs 269 6 66 seconds, first session vs fourth; confidence interval [CI], 195-341 seconds; P < .05) and fluoroscopy time (201 6 74 vs 110 6 37 seconds; CI, 51-132 seconds; P < .05) with case progression. Procedure time significantly decreased in students (551 6 84 vs 313 6 65 seconds; CI 189-287 seconds; P < .05) and PGY 1-3 (591 6 149 vs 264 6 29 seconds; CI, 113541 seconds;P< .02) had a significant decrease in procedure time. Fluoroscopy times were brief overall between individuals and groups and did not change significantly with case progression. Participants acquired proficiency after a few runs in almost every step of the procedure. Endograft sizing appeared to be the most challenging task by qualitative analysis. PGY 4-7 trainees had higher technical scores, but this was not statistically significant. Conclusions: Practice on endovascular surgical simulators can reduce overall procedure and fluoroscopy time, independent of trainee skill level or experience. Endovascular simulators can be effective tools in residency training and maintenance of proficiency. Further studies are needed to compare simulator performance with outcomes in real cases.
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