Vascular surgery training trends from 2001-2007: A substantial increase in total procedure volume is driven by escalating endovascular procedure volume and stable open procedure volume

Schanzer, Andres; Steppacher, Robert; Eslami, Mohammad H.; Arous, Elias J.; Messina, Louis M.; Belkin, Michael

doi:10.1016/j.jvs.2008.12.019

Cited by 103 publications

(62 citation statements)

References 17 publications

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“…7,17 These findings are attributable to the increased prevalence of vascular disease in the general, aging population and to the current endovascular treatment options for patients who were previously not candidates for OS.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil

Puech-Leão

Wolosker

Zerati

et al. 2011

Journal of Surgical Education

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Section: Discussionmentioning

confidence: 99%

“…The impact of ES on decreasing OS volume was most evident in this group. Interestingly, Schanzer et al 17 found that the overall volume of carotid endarterectomies was not affected by endovascular procedures.…”

Section: Discussionmentioning

confidence: 99%

Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil

Puech-Leão

Wolosker

Zerati

et al. 2011

Journal of Surgical Education

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“…The number of open aneurysms seen by vascular surgical residents and fellows during their training is markedly decreased from what it once was. While vascular volumes for trainees are rising overall, this increase is predominantly comprised of endovascular cases [27]. It is projected that by 2020, the average vascular surgical trainee will have performed only five open surgical aortic aneurysm repairs [5].…”

Section: Effect Of Trends On Training Of Vascular Surgeonsmentioning

confidence: 99%

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

2015

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Since its advent in 1991, endovascular aortic aneurysm repair (EVAR) has become a mainstay of treatment for abdominal aortic aneurysms (AAA). Studies such as the comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR 1) trial, have demonstrated the effectiveness of EVAR in reducing perioperative mortality. Technological improvements in graft design and delivery account for an increasing utilization of endovascular repair. Newer branch and fenestrated graft designs have allowed for treatment of patients with complex aortic anatomy that previously could not be treated with EVAR. Endovascular repair, while dominant, is unlikely to eliminate the need for open repair or to relegate open surgery for AAA to historical interest only. The unprecedented adoption of EVAR has led to complications and modes of failure that were not seen with open repair. The rate of failure is markedly increased when endografts are used outside of the instructions for use (IFU). The long-term durability of fenestrated and investigational branch devices remains to be established. The demand for an endovascular approach by patients and the willingness of physicians to place endografts outside the anatomic IFU criteria may have resulted in the pendulum swinging too far away from open surgical management. The consequence of reduced open aortic surgeries is a concern for both patient care as well as training for vascular surgery fellows. Vascular surgery training programs will require innovative changes in training to assure that vascular surgery trainees will have the requisite skill and experience required to competently perform open surgical repair on what will undoubtedly be some of the most complex aortic pathology.

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“…Such need is driven by evidence that skill level can affect clinical outcomes after surgery (Reznick & MacRae, 2006). Assessment is often done informally through subjective feedback from other surgeons (Chaer et al, 2006;Bech et al, 2011;Riga et al, 2011) or based on a simple count of the number of times a procedure has been performed (Cronenwett, 2006;Schanzer et al, 2009). …”

mentioning

confidence: 99%

Toward training surgeons with motion-based feedback: Initial validation of smoothness as a measure of motor learning

Pandey¹,

Byrne²,

Jantscher

et al. 2017

Proceedings of the Human Factors and Ergonomics Society Annual

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Surgery is a challenging domain for motor skill acquisition. A critical contributing factor in this difficulty is that feedback is often delayed from performance and qualitative in nature. Collection of highdensity motion information may offer a solution. Metrics derived from this motion capture, in particular indices of movement smoothness, have been shown to correlate with task outcomes in multiple domains, including endovascular surgery. The open question is whether providing feedback based on these metrics can be used to accelerate learning. In pursuit of that goal, we examined the relationship between a motion metric that is computationally simple to compute-spectral arc length-and performance on a simple but challenging motor task, mirror tracing. We were able to replicate previous results showing that movement smoothness measures are linked to overall performance, and now have performance thresholds to use in subsequent work on using these metrics for training. INTRODUCTION BackgroundTraining in many motor domains can be a challenge. Consider learning to do some motor task with a well-defined "success" vs. "failure" outcome metric, such as shooting a free throw in basketball. A trainee can shoot repeatedly and easily determine for each shot whether the shot was successful, but it may be very difficult for the trainee, and even a coach, to determine why different shots resulted in success or failure. In a domain like surgery, this is even more of a challenge, as "success" vs. "failure" may not be known for weeks or even months after a procedure is performed. Furthermore, the "coach" in surgery is typically one or more other surgeons, whose expertise is valuable and time spent training is time taken away from other activities.Surgical skill is notoriously difficult to assess and evaluate (Moorthy, Munz, Sarker, & Darzi, 2003). The development of effective metrics to evaluate surgical skill is an active area of research (Reiley, Lin, Yuh, & Hager, 2011). The need for objective and quantitative assessment tools has been a topic of considerable interest and importance (Lin, Shafran, Yuh, & Hager, 2006;van Hove, Tuijthof, Verdaasdonk, Stassen, & Dankelman, 2010;Tsue, Dugan, & Burkey, 2007). Such need is driven by evidence that skill level can affect clinical outcomes after surgery (Reznick & MacRae, 2006). Assessment is often done informally through subjective feedback from other surgeons (Chaer et al., 2006;Bech et al., 2011;Riga et al., 2011) or based on a simple count of the number of times a procedure has been performed (Cronenwett, 2006;Schanzer et al., 2009).Collection of high-density motion information, if the relevant metrics can be linked successfully with task outcomes, offers the opportunity to provide more detailed feedback that may speed the learning process. A quantitative and motion-based approach to performance assessment in manual control tasks is starting to gain traction in the research community, especially in the domain of robotic surgery and the corresponding simulation environments that a...

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Vascular surgery training trends from 2001-2007: A substantial increase in total procedure volume is driven by escalating endovascular procedure volume and stable open procedure volume

Cited by 103 publications

References 17 publications

Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil

Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

Toward training surgeons with motion-based feedback: Initial validation of smoothness as a measure of motor learning

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