Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures

The in situ laser fenestration is an interesting option for the endovascular treatment of short‐necked aneurysms with an intraoperative modification of a standard endograft. According to literature evidence, diode laser emitting in the near‐infrared wavelength (810 nm) can be successfully used to fenestrate the endograft fabric. This paper describes a three‐dimensional navigation system for the accurate targeting of the fenestration site, then reports results of an ex vivo study to assess whether the laser operative conditions, which ensure the fabric fenestration, are harmless for the biological tissue surrounding the endoprosthesis. Two hundred twenty‐five samples of human aorta, including healthy specimens and abdominal aortic aneurysm samples, were irradiated ex vivo using a 810 nm diode laser. Energy and pulse duration were varied. Irradiated tissues were fixed in formaldehyde, sectioned and subjected to histological examination. Only 7.5% of the irradiated samples exhibited a thermal damage, which was always confined to the contact point between the laser fiber tip and the aortic wall. These experiments suggest that the diode laser can be safely used for the proposed surgical application.

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“…The navigation system proposed in this paper, has been already tested by using silicone deformable phantoms fabricated as in , and rigid models .…”

Section: Resultsmentioning

confidence: 99%

In situ diode laser fenestration: An ex‐vivo evaluation of irradiation effects on human aortic tissue

Piazza

Micheletti

Condino

et al. 2019

Journal of Biophotonics

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“…Concerning cost analysis, low-fidelity simulators are generally more affordable than most currently used high-fidelity simulators because of the lack of advanced features. 16 Norman et al 17 proposed that the use of highfidelity simulators often has no or only very little benefit compared with low-fidelity simulators. Especially if the skill that a simulator is intended to teach (eg, basic motor skills that require frequent repetition) and the often high cost of high-fidelity simulators are taken into consideration, the use of low-fidelity simulators may even be of advantage for novice learners.…”

Section: Discussionmentioning

confidence: 99%

The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training

Aeckersberg

Gkremoutis

Schmitz‐Rixen

et al. 2019

Journal of Vascular Surgery

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Objective: The use of simulators has shown a profound impact on the development of both training and assessment of endovascular skills. Furthermore, there is evidence that simulator training is of great benefit for novice trainees. However, there are only a few simulators available geared specifically toward novice learners. Whereas research suggests that low-fidelity simulators could fill this gap, there are insufficient data available to determine the role of low-fidelity simulators in the training of endovascular skills.Methods: Medical students in their fifth year (N ¼ 50) with no previous endovascular experience were randomized into three groups: conventional learning through a video podcast (group V; n ¼ 12), low-fidelity simulation training with tabletpaired touch-gesture navigation (group A; n ¼ 12), and low-fidelity simulation training with tablet-paired physical endovascular tool navigation (group S; n ¼ 26). Within their respective groups, all students attended a 1-day class on basic endovascular skills. Questionnaire items for self-assessment before and after the class and assessment after the class of the participant's practical skills on a high-fidelity simulator were analyzed across all three groups as well as for each group separately using nonparametric tests.Results: All 50 participants completed the training. Participants in group S showed a significantly increased interest in working in interventional cardiology (P ¼ .02) and vascular surgery (P ¼ .03) after the class. Evaluation of the questionnaire items after the class showed that participants in group S rated their practical skills significantly higher after the class compared with those in group V and group A (P < .001 for pairwise comparison of all three groups, respectively), creating a significant trend across the three groups. However, analysis of the practical skills assessment for all three groups showed a significant difference between the groups only for choosing a guidewire (P ¼ .045) and a significant trend in performance across the groups for choosing a guidewire and for positioning the guidewire in the vessel (P ¼ .02 and P ¼ .05, respectively). All other steps of the skills assessment showed no significant differences or a trend across the groups.Conclusions: Low-fidelity simulation training, particularly with physical endovascular tool navigation, led to increased motivation in novice trainees. Whereas simulator training was associated with increased confidence of trainees in their skills, assessment of their practical skills showed no actual improvement in this study. Overall, low-fidelity simulation has the potential to benefit novice trainees, but possible risks of simulation training should be further evaluated.

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“…Future studies will include accurate mechanical testing of the obtained catheter according to the methods proposed in the literature [24,25]. In vitro testing, involving a larger number of surgeons and using a simulator with a more realistic anatomical shape, will be performed for a further validation of the catheter prior to animal testing [44]. Moreover, simulated blood flow will be considered for quantitative evaluation of the catheter stability in a realistic scenario.…”

Section: Resultsmentioning

confidence: 99%

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

Piazza

Condino

Alberti

et al. 2017

Computer Assisted Surgery

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Purpose: The in situ fenestration of a standard endograft is currently limited by difficulties in targeting the fenestration site under fluoroscopic control and by the lack of a safe method to perforate the graft. Evidence in the literature suggests the use of a 3 D electromagnetic navigator to accurately guide the endovascular instruments to the target and a laser to selectively perforate the graft. The aim of this work is to provide design guidelines to develop a sensorized catheter to guide the laser tool to the fenestration site and conduct preliminary testing of the feasibility of the proposed solution. Matherials and methods: Different catheter designs were delineated starting from engineering considerations, then prototypes were preliminarily tested to collect surgeon opinions and to steer the design process toward the preferred solution reported by the user. Finally, mechanical simulations were performed with CathCAD, a design software system for the development of composite tubing for endovascular catheters. Results: Based on surgeon feedback, a 9-French steerable catheter with a stabilization system was designed. CathCAD simulations allowed us to define the construction parameters (e.g., materials and geometric constrains) for the fabrication of composite tubes with mechanical properties (flexural, axial, and torsional rigidities) compatible with target values in the literature for guiding catheters. Conclusion:The presented results preliminarily demonstrate the clinical reasonability and feasibility of the designed tool in terms of mechanical properties. Further mechanical tests and extensive in vitro clinical trials are required prior to animal testing.

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Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures

Cited by 10 publications

References 16 publications

In situ diode laser fenestration: An ex‐vivo evaluation of irradiation effects on human aortic tissue

In situ diode laser fenestration: An ex‐vivo evaluation of irradiation effects on human aortic tissue

The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

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