Endovascular Simulation Leads to Efficiency and Competence in Thoracic Endovascular Aortic Repair Procedures

Objective Endovascular interventions such as thoracic endovascular aortic repair (TEVAR) have largely replaced invasive open procedures, and have been demonstrated to be effective in treating patients. Our study used endovascular simulation to assess the effect of TEVAR rehearsal on surgical trainees at different levels in training. Design Participants were oriented on an endovascular simulator and subsequently a simulated TEVAR was performed during 4 separate sessions over a 1-month period. Metrics included total procedure/fluoroscopy time and volume of contrast used. Likert scale qualitative analysis evaluated participants skills involving major procedural steps. Analysis of data across cohorts included 1-way analysis of variance, Kruskal-Wallis, and paired t-tests. Setting All data were collected at University Hospitals - Case Medical Center, Cleveland, OH. Participants In all, 12 trainees in 3 cohorts (student, surgery resident postgraduate year [PGY] 1-3, surgery resident/fellow PGY 4-7, n = 4 each) were recruited. Results All trainees reduced total procedure time (mean = 537 ± 148 vs 269 ± 66 s, first session vs fourth, P < 0.05, CI: 195-341) and fluoroscopy time (mean = 201 ± 74 vs 110 ± 37 s, P < 0.05, CI: 51-132) with TEVAR case progression. The student cohort decreased procedure time from 551 ± 84 s to 313 ± 65 s (P < 0.05, CI: 189-287) whereas PGYs 1 to 3 decreased procedure time from 591 ± 149 s to 264 ± 29 s (P < 0.05, CI: 113-541). Use of contrast decreased over time, but the difference was not significant. Participants acquired proficiency after a few runs in most steps of the procedure. The average qualitative score for all groups combined improved significantly (P < 0.03). PGY 4 to 7 trainees had higher technical scores but this was not statistically significant. The initial gap in junior vs senior trainee performance narrowed after a few practice sessions in all aspects evaluated. Conclusions TEVAR rehearsal on an endovascular simulator can reduce overall procedure and fluoroscopy time, independent of trainee skill level or experience, as well as improve subjective measures of technical success. Further studies are needed to compare simulator performance to outcomes in live cases.