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Original article
peer-reviewed

Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training



Abstract

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.



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Original article
peer-reviewed

Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training


Author Information

J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa Corresponding Author

Department of Neurosurgery, University of California, San Diego

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

Brian R. Hirshman

Department of Neurosurgery, University of California, San Diego

Jeffrey A. Steinberg

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

David Oveisi

Department of Internal Medicine, University of California, Los Angeles

Jon Hallstrom

Neuroradiology, University of New Mexico

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training


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Original article
peer-reviewed

Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training

  • Author Information
    J. Scott Pannell

    Department of Neurosurgery, University of California, San Diego

    David R. Santiago-Dieppa Corresponding Author

    Department of Neurosurgery, University of California, San Diego

    Arvin R. Wali

    Department of Neurosurgery, University of California, San Diego

    Brian R. Hirshman

    Department of Neurosurgery, University of California, San Diego

    Jeffrey A. Steinberg

    Department of Neurosurgery, University of California, San Diego

    Vincent J. Cheung

    Department of Neurosurgery, University of California, San Diego

    David Oveisi

    Department of Internal Medicine, University of California, Los Angeles

    Jon Hallstrom

    Neuroradiology, University of New Mexico

    Alexander A. Khalessi

    Department of Neurosurgery, University of California, San Diego


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: August 29, 2016

    DOI

    10.7759/cureus.756

    Cite this article as:

    Pannell J, Santiago-dieppa D R, Wali A R, et al. (August 29, 2016) Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training. Cureus 8(8): e756. doi:10.7759/cureus.756

    Publication history

    Received by Cureus: August 05, 2016
    Peer review began: August 15, 2016
    Peer review concluded: August 16, 2016
    Published: August 29, 2016

    Copyright

    © Copyright 2016
    Pannell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

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.



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J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa

Department of Neurosurgery, University of California, San Diego

For correspondence:
drsantiagodieppa@ucsd.edu

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

Brian R. Hirshman

Department of Neurosurgery, University of California, San Diego

Jeffrey A. Steinberg

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

David Oveisi

Department of Internal Medicine, University of California, Los Angeles

Jon Hallstrom

Neuroradiology, University of New Mexico

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego

J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa

Department of Neurosurgery, University of California, San Diego

For correspondence:
drsantiagodieppa@ucsd.edu

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

Brian R. Hirshman

Department of Neurosurgery, University of California, San Diego

Jeffrey A. Steinberg

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

David Oveisi

Department of Internal Medicine, University of California, Los Angeles

Jon Hallstrom

Neuroradiology, University of New Mexico

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego