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Simulated Procedure Rehearsal Is More Effective Than a Preoperative Generic Warm-Up for Endovascular Procedures

Willaert, Willem I. M. MD, PhD*,‡; Aggarwal, Rajesh MD, PhD*; Daruwalla, Farhad BSc*; Van Herzeele, Isabelle MD, PhD*,‡; Darzi, Ara W. MD*; Vermassen, Frank E. MD, PhD; Cheshire, Nicholas J. MD*,†on behalf of the European Virtual Reality Endovascular Research Team EVEResT

doi: 10.1097/SLA.0b013e31824f9dbf
Original Articles

Introduction: Patient-specific simulated rehearsal (PsR) of a carotid artery stenting procedure (CAS) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software. This study aimed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality (VR) generic CAS warm-up procedure or no preparation at all.

Methods: During a 10-session cognitive/technical VR course, medical residents were trained in CAS. Thereafter, in a randomized crossover study, each participant performed a patient-specific CAS case 3 times on the simulator, preceded by 3 different tasks: a PsR, a generic case, or no preparation. Technical performances were assessed using simulator-based metrics and expert-based ratings.

Results: Twenty medical residents (surgery, cardiology, radiology) were recruited. Training plateaus were observed after 10 sessions for all participants. Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time (16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes, P = 0.001) and fluoroscopy time (9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes, P = 0.022) but did not influence contrast volume or number of roadmaps used during the “real” case. PsR significantly improved the quality of performance as measured by the expert-based ratings (scores 28 vs 25 vs 25, P = 0.020).

Conclusions: Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance, compared to a generic VR warm-up or no warm-up. This technology requires further investigation with respect to improved outcomes on patients in the clinical setting.

Patient-specific simulated rehearsal of a carotid stenting procedure significantly improves operative performance, compared to a generic virtual reality warm-up or no warm-up at all. This technology has the potential to enhance outcomes and safety for patients undergoing endovascular interventions in the clinical setting.

*Department of Biosurgery and Surgical Technology

Regional Vascular Unit, St Mary's Hospital, Imperial College, London, United Kingdom

Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.

Reprints: Willem I. M. Willaert, MD, PhD, Department of Thoracic and Vascular Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail:

Disclosure: This study was supported by funding from the Imperial College Healthcare Biomedical Research Centre, UK; a Clinical Doctoral Grant from the Fund for Scientific Research Flanders (FWO), Belgium; grants from Simbionix, Cleveland, Ohio, and from Boston Scientific International, France. However, they did not interfere in the study design, data collection, analysis, or interpretation of the data or in the decision to submit the article for publication. Rajesh Aggarwal is funded by a Clinician Scientist Award from the National Institute for Health Research, Department of Health, London, UK.

© 2012 Lippincott Williams & Wilkins, Inc.