Rationale, scope, and 20-year experience of vascular surgical training with lifelike pulsatile flow models

Abstract

Vascular surgical training currently has to cope with various challenges, including restrictions on work hours, significant reduction of open surgical training cases in many countries, an increasing diversity of open and endovascular procedures, and distinct expectations by trainees. Even more important, patients and the public no longer accept a "learning by doing" training philosophy that leaves the learning curve on the patient's side. The Vascular International (VI) Foundation and School aims to overcome these obstacles by training conventional vascular and endovascular techniques before they are applied on patients. To achieve largely realistic training conditions, lifelike pulsatile models with exchangeable synthetic arterial inlays were created to practice carotid endarterectomy and patch plasty, open abdominal aortic aneurysm surgery, and peripheral bypass surgery, as well as for endovascular procedures, including endovascular aneurysm repair, thoracic endovascular aortic repair, peripheral balloon dilatation, and stenting. All models are equipped with a small pressure pump inside to create pulsatile flow conditions with variable peak pressures of ~90 mm Hg. The VI course schedule consists of a series of 2-hour modules teaching different open or endovascular procedures step-by-step in a standardized fashion. Trainees practice in pairs with continuous supervision and intensive advice provided by highly experienced vascular surgical trainers (trainer-to-trainee ratio is 1:4). Several evaluations of these courses show that tutor-assisted training on lifelike models in an educational-centered and motivated environment is associated with a significant increase of general and specific vascular surgical technical competence within a short period of time. Future studies should evaluate whether these benefits positively influence the future learning curve of vascular surgical trainees and clarify to what extent sophisticated models are useful to assess the level of technical skills of vascular surgical residents at national or international board examinations. This article gives an overview of our experiences of >20 years of practical training of beginners and advanced vascular surgeons using lifelike pulsatile vascular surgical training models.

Treinamento de anastomoses vasculares de baixo custo: o cirurgião vai à feira

“…During the early stages of acquisition of this skill, use of alternative, non-living, models that can be used to simulate surgical steps should be encouraged, thereby minimizing mistakes in human beings. 1,3,4,8 This study evaluated three vegetable models of vascular anastomoses, hoping to identify a low cost alternative that could be easily reproduced at different training centers. Of the models studied, it was only possible to achieve successful anastomosis in the green beans and yardlong beans; the second of which appears more advantageous because it is less thick and better simulates the morphological characteristics of an arterial vessel.…”

“…In each case an end-to-end anastomosis was attempted, using the triangulation technique. 4,6 The method was standardized with 10 stitches: two at angles of 0° and 180°, four in the anterior wall and four in the posterior wall. Sutures were performed using 6-0 polypropylene thread.…”

“…[1][2][3] In the majority of cases, surgery novices' first training in this skill is given in human beings, which can result in harm to patients and increased hospital expenses because of increased length of stay and additional procedures. 2,4,5 With the objective of reducing this harm, there has been increasing use of simulators in medical education, because they enable training at any time, reduce the risk to patients, allow the level of difficulty to be controlled, and allow training to be conducted at successively higher skill levels. 3,6 Therefore, preliminary training with simulators should be a basic step in the education of future surgeons.…”

“…There is therefore a need to identify alternative models that are less expensive, that can reproduce the skill acquisition offered by current systems, that avoid unnecessary use of animals in experiments, and that respect current ethical principles. [1][2][3][4][5][6][7] Many products of vegetable origin have similar characteristics to blood vessels (long, cylindrical, and with an internal lumen). This study was conducted to assess the feasibility of three types of vegetables for use a as a low-cost and easily-obtained model of vascular anastomosis.…”

The European medical specialist examination in vascular surgery

“…All candidates admitted to the examination also have a 1-day oral and practical examination, which includes questioning of theoretical background knowledge and its practical application. This takes place mostly in the context of specific clinical case studies, as well as via practical examinations on lifelike models and the following procedures are examined: an infrarenal aortic anastomosis, a carotid endarterectomy (CEA) and a crural bypass anastomosis on pulsatile perfused lifelike models [3,4,[10][11][12]14]. In the endovascular part, the applicants ability to introduce a guidewire into the renal artery is assessed [13].…”