The Role of Simulation in Boosting the Learning Curve in EVAR Procedures

Abstract

Objective: Simulation may be a useful tool for training in endovascular procedures. The aim of this study was to evaluate the effect of endovascular repair of abdominal aortic aneurysms (EVAR) simulation in boosting trainees' learning curve.

Design: Ten vascular surgery residents were recruited and divided in 2 groups (Trainee Group and Control group). At a first session (t₀), each resident performed 2 simulated EVAR procedures using an endovascular simulator. After 2 weeks, each participant simulated other 2 EVAR procedures in a final session (t₁). In the period between t₀ and t₁, each resident in the Trainee Group performed 6 simulated EVAR procedures, whereas the Control Group did not perform any other simulation. Both quantitative and qualitative performance evaluations were performed at t₀ and t₁. Quantitative evaluation from simulator metrics included total procedural time (T_P), total fluoroscopy time (T_F), time for contralateral gate cannulation (T_G), and contrast medium volume (CM) injected. Qualitative evaluation was based on a Likert scale used to calculate a total performance score referred to skills involving major EVAR procedural steps.

Results: All residents in the Trainee Group significantly reduced T_P (48 ± 12 vs 32 ± 8 minutes, t₀ vs t₁, p < 0.05), T_F (18 ± 7 vs 11 ± 6 minutes, p < 0.05), and CM used over time (121 ± 37 vs 85 ± 26ml, p < 0.05), but not T_G (5 ± 5 vs 3 ± 4 minutes, p = 0.284). In the Control Group metrics did not change significantly in any field (T_P = 55 ± 11 vs 46 ± 10 minutes; T_F = 25 ± 9 vs 21 ± 4 minutes; CM = 132 ± 51 vs 102 ± 42ml; T_G = 6 ± 4 vs 8 ± 5 minutes, all p > 0.05). The average Trainee Group qualitative total performance score improved significantly (p < 0.05) after rehearsal sessions when compared with the Control Group.

Conclusion: Simulation is an effective method to improve competence of vascular surgery residents with EVAR procedures.

Keywords: EVAR; Simulation; Training; Vascular Surgery; Virtual Reality.