Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Technical and Team Training in an Immersive Virtual Reality Environment

PurposeThis study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario.Materials and MethodsVirtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR). Timed performance metrics were recorded as surrogate measures of performance. Participants (N = 22) completed postprocedure questionnaires evaluating face validity, as well as technical and human factor aspects, of the simulation on a Likert scale from 1 (not at all) to 5 (very much).ResultsExperienced team leaders were significantly faster than trainees in obtaining proximal control with an intra-aortic occlusion balloon (352 vs. 501 s, p = 0.047) and all completed the procedure within the allotted time, whilst no trainee was able to do so. Total fluoroscopy times were significantly lower in the experienced group (782 vs. 1,086 s, p = 0.016). Realism of the simulated angiosuite was scored highly by experienced team leaders (median 4/5, IQR 4–5). Participants found the simulation useful for acquiring technical (4/5, IQR 4–5) and communication skills (4/5, IQR 4–5) and particularly valuable for enhancing teamwork (5/5, IQR 4–5) and patient safety (5/5, IQR 4–5).ConclusionThis study shows feasibility of creation of a crisis scenario in a fully immersive angiosuite simulation and team performance of a simulated rEVAR. Performance metrics differentiated between experienced specialists and trainees, and the realism of the simulation exercise and environment were rated highly by experienced endovascular specialists. This simulation has potential as a powerful training and assessment tool with opportunities to improve team performance in rEVAR through both technical and human factor skills training.

[1]  N. Cheshire,et al.  Identification of patient safety improvement targets in successful vascular and endovascular procedures: analysis of 251 hours of complex arterial surgery. , 2011, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[2]  Z. Rancic,et al.  10 Years of Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortoiliac Aneurysms: Lessons Learned , 2009, Annals of surgery.

[3]  A. Tielbeek,et al.  Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol. , 2003, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[4]  P. McCulloch,et al.  The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre , 2009, Quality & Safety in Health Care.

[5]  Charles Vincent,et al.  Systems Approaches to Surgical Quality and Safety: From Concept to Measurement , 2004, Annals of surgery.

[6]  A. Vats,et al.  Reducing error and improving efficiency during vascular interventional radiology: implementation of a preprocedural team rehearsal. , 2012, Radiology.

[7]  R. Geelkerken,et al.  Ruptured abdominal aortic aneurysm: endovascular repair is feasible in 40% of patients. , 2003, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[8]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[9]  A. Gallagher,et al.  Virtual reality simulation training in a high-fidelity procedure suite: operator appraisal. , 2012, Journal of Vascular and Interventional Radiology.

[10]  J. Birkmeyer,et al.  Simulation Improves Resident Performance in Catheter-Based Intervention: Results of a Randomized, Controlled Study , 2006, Annals of surgery.

[11]  P. McCulloch,et al.  The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre , 2009, Quality & Safety in Health Care.

[12]  Douglas A Wiegmann,et al.  The Mayo High Performance Teamwork Scale: Reliability and Validity for Evaluating Key Crew Resource Management Skills , 2007, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[13]  Nick Sevdalis,et al.  Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams , 2007, World Journal of Surgery.

[14]  A. Darzi,et al.  Experienced endovascular interventionalists objectively improve their skills by attending carotid artery stent training courses. , 2008, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[15]  Eugene S. Lee,et al.  Training with simulation improves residents' endovascular procedure skills. , 2007, Journal of vascular surgery.

[16]  C. Walsh,et al.  Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy. , 2012, The Cochrane database of systematic reviews.

[17]  P. Neary,et al.  Skills Transfer After Proficiency-Based Simulation Training in Superficial Femoral Artery Angioplasty , 2012, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[18]  T. Pfammatter,et al.  Complete Replacement of Open Repair for Ruptured Abdominal Aortic Aneurysms by Endovascular Aneurysm Repair. A Two-Center 14-Year Experience , 2013 .

[19]  John C. Morey,et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. , 2002, Health services research.

[20]  Matthew J Bown,et al.  Changing Epidemiology of Abdominal Aortic Aneurysms in England and Wales: Older and More Benign? , 2012, Circulation.

[21]  M. Bown,et al.  Endovascular treatment of ruptured and symptomatic abdominal aortic aneurysms. , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.