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Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures

Willem Willaert (UGent) , Rajesh Aggarwal, Farhad Daruwalla, Isabelle Van Herzeele (UGent) , Ara W Darzi, Frank Vermassen (UGent) and Nicholas J Cheshire
(2012) ANNALS OF SURGERY. 255(6). p.1184-1189
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Abstract
Introduction: Patient-specific simulated rehearsal (PsR) of a carotid artery stenting procedure (CAS) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software. This study aimed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality (VR) generic CAS warm-up procedure or no preparation at all. Methods: During a 10-session cognitive/technical VR course, medical residents were trained in CAS. Thereafter, in a randomized crossover study, each participant performed a patient-specific CAS case 3 times on the simulator, preceded by 3 different tasks: a PsR, a generic case, or no preparation. Technical performances were assessed using simulator-based metrics and expert-based ratings. Results: Twenty medical residents (surgery, cardiology, radiology) were recruited. Training plateaus were observed after 10 sessions for all participants. Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time (16.3 +/- 0.6 vs 19.7 +/- 1.0 vs 20.9 +/- 1.1 minutes, P = 0.001) and fluoroscopy time (9.3 +/- 0.1 vs 11.2 +/- 0.6 vs 11.2 +/- 0.5 minutes, P = 0.022) but did not influence contrast volume or number of roadmaps used during the "real" case. PsR significantly improved the quality of performance as measured by the expert-based ratings (scores 28 vs 25 vs 25, P = 0.020). Conclusions: Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance, compared to a generic VR warm-up or no warm-up. This technology requires further investigation with respect to improved outcomes on patients in the clinical setting.
Keywords
VIRTUAL-REALITY SIMULATION, PATIENT-SPECIFIC SIMULATION, MISSION REHEARSAL, PERFORMANCE, SKILLS, TRIAL, INTERVENTIONALISTS, ANGIOPLASTY, EXPERIENCE

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MLA
Willaert, Willem, Rajesh Aggarwal, Farhad Daruwalla, et al. “Simulated Procedure Rehearsal Is More Effective Than a Preoperative Generic Warm-up for Endovascular Procedures.” ANNALS OF SURGERY 255.6 (2012): 1184–1189. Print.
APA
Willaert, Willem, Aggarwal, R., Daruwalla, F., Van Herzeele, I., Darzi, A. W., Vermassen, F., & Cheshire, N. J. (2012). Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures. ANNALS OF SURGERY, 255(6), 1184–1189.
Chicago author-date
Willaert, Willem, Rajesh Aggarwal, Farhad Daruwalla, Isabelle Van Herzeele, Ara W Darzi, Frank Vermassen, and Nicholas J Cheshire. 2012. “Simulated Procedure Rehearsal Is More Effective Than a Preoperative Generic Warm-up for Endovascular Procedures.” Annals of Surgery 255 (6): 1184–1189.
Chicago author-date (all authors)
Willaert, Willem, Rajesh Aggarwal, Farhad Daruwalla, Isabelle Van Herzeele, Ara W Darzi, Frank Vermassen, and Nicholas J Cheshire. 2012. “Simulated Procedure Rehearsal Is More Effective Than a Preoperative Generic Warm-up for Endovascular Procedures.” Annals of Surgery 255 (6): 1184–1189.
Vancouver
1.
Willaert W, Aggarwal R, Daruwalla F, Van Herzeele I, Darzi AW, Vermassen F, et al. Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures. ANNALS OF SURGERY. 2012;255(6):1184–9.
IEEE
[1]
W. Willaert et al., “Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures,” ANNALS OF SURGERY, vol. 255, no. 6, pp. 1184–1189, 2012.
@article{3072436,
  abstract     = {Introduction: Patient-specific simulated rehearsal (PsR) of a carotid artery stenting procedure (CAS) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software. This study aimed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality (VR) generic CAS warm-up procedure or no preparation at all. 
Methods: During a 10-session cognitive/technical VR course, medical residents were trained in CAS. Thereafter, in a randomized crossover study, each participant performed a patient-specific CAS case 3 times on the simulator, preceded by 3 different tasks: a PsR, a generic case, or no preparation. Technical performances were assessed using simulator-based metrics and expert-based ratings. 
Results: Twenty medical residents (surgery, cardiology, radiology) were recruited. Training plateaus were observed after 10 sessions for all participants. Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time (16.3 +/- 0.6 vs 19.7 +/- 1.0 vs 20.9 +/- 1.1 minutes, P = 0.001) and fluoroscopy time (9.3 +/- 0.1 vs 11.2 +/- 0.6 vs 11.2 +/- 0.5 minutes, P = 0.022) but did not influence contrast volume or number of roadmaps used during the "real" case. PsR significantly improved the quality of performance as measured by the expert-based ratings (scores 28 vs 25 vs 25, P = 0.020). 
Conclusions: Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance, compared to a generic VR warm-up or no warm-up. This technology requires further investigation with respect to improved outcomes on patients in the clinical setting.},
  author       = {Willaert, Willem and Aggarwal, Rajesh and Daruwalla, Farhad and Van Herzeele, Isabelle and Darzi, Ara W and Vermassen, Frank and Cheshire, Nicholas J},
  issn         = {0003-4932},
  journal      = {ANNALS OF SURGERY},
  keywords     = {VIRTUAL-REALITY SIMULATION,PATIENT-SPECIFIC SIMULATION,MISSION REHEARSAL,PERFORMANCE,SKILLS,TRIAL,INTERVENTIONALISTS,ANGIOPLASTY,EXPERIENCE},
  language     = {eng},
  number       = {6},
  pages        = {1184--1189},
  title        = {Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures},
  url          = {http://dx.doi.org/10.1097/SLA.0b013e31824f9dbf},
  volume       = {255},
  year         = {2012},
}
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