Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training.
Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training.
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DOI：
10.7759/cureus.756
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发表时间：
2016-08-29
期刊：
影响因子：
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通讯作者：
Khalessi AA
中科院分区：
文献类型：
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作者：
Pannell JS;Santiago-Dieppa DR;Wali AR;Hirshman BR;Steinberg JA;Cheung VJ;Oveisi D;Hallstrom J;Khalessi AA
本研究基于具有不同培训和经验水平的个体受训者的纵向改善，建立了血管造影术和神经血管内外科手术的性能指标。在30天的过程中，5名受训者进行了10次诊断性血管造影，在蛛网膜下腔出血的情况下对10个颈动脉终末动脉瘤进行了弹簧圈栓塞，并在Simbionix Angio Mentor™模拟器上进行了10次左侧大脑中动脉栓塞切除术。所有手术均为非连续性手术。记录总手术时间、透视时间、造影剂剂量、心率、血压、所用药物、填塞密度、所用弹簧圈数量和支架取栓器通过次数，对图像质量进行评级，并记录技术上不安全事件的绝对值。根据传统的Likert量表评分（1=失败，2=差，3=满意，4=良好，5=优秀），对受训者的器械选择、大血管通路、微血管通路、临床管理和受训者的总体表现进行评价。在进行了5次诊断性血管造影和5次栓子切除术后，所有参与者均表现出手术时间、荧光透视剂量、造影剂剂量和不良技术事件的显著减少;另外还观察到图像质量、器械选择、入路评分和总体技术性能的显著改善（p < 0.05）。同样，受训者在5次弹簧圈栓塞术后的技术性能和临床管理方面表现出显著改善（p < 0.05）。然而，之前展开弹簧圈经验较少的受训者在第8次栓塞手术中继续发生术中破裂;这一观察结果可能与施加大于弹簧圈放置适当力的触觉手术经验较少相对应。所有级别的培训和既往经验的受训者在完成我们的模拟器课程（包括5例诊断性血管造影、5例栓子切除术病例和10例动脉瘤弹簧圈栓塞术）后表现出显著的性能改善。
This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience. Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded. Image quality was rated, and the absolute value of technically unsafe events was recorded. The trainees’ device selection, macrovascular access, microvascular access, clinical management, and the overall performance of the trainee was rated during each procedure based on a traditional Likert scale score of 1=fail, 2=poor, 3=satisfactory, 4=good, and 5=excellent. These ordinal values correspond with published assessment scales on surgical technique. After performing five diagnostic angiograms and five embolectomies, all participants demonstrated marked decreases in procedure time, fluoroscopy doses, contrast doses, and adverse technical events; marked improvements in image quality, device selection, access scores, and overall technical performance were additionally observed (p < 0.05). Similarly, trainees demonstrated marked improvement in technical performance and clinical management after five coiling procedures (p < 0.05). However, trainees with less prior experience deploying coils continued to experience intra-procedural ruptures up to the eighth embolization procedure; this observation likely corresponded with less tactile procedural experience to an exertion of greater force than appropriate for coil placement. Trainees across all levels of training and prior experience demonstrated a significant performance improvement after completion of our simulator curriculum consisting of five diagnostic angiograms, five embolectomy cases, and 10 aneurysm coil embolizations.