Vascular Surgeons Agree: Case Rehearsal Improves Outcomes

Main Category: Cardiovascular / Cardiology
Article Date: 13 Nov 2008 - 0:00 PST

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Surgeons at the University of Rochester Medical Center, NY indicated that patient-specific CTA data can be converted to an endovascular simulator (ANGIO Mentor(TM), Simbionix US) with high face validity. The surgeons "strongly agreed" that the simulation improved the operative flow, increased patient safety and efficiency of instrument use, decreased overall operative and fluoroscopy time and the amount of contrast used, and that the operative and simulator outcomes were similar.

An abstract of the study is provided below:

Patient Specific Case Rehearsals Using an Endovascular Simulator Prior to Carotid Artery Stenting

Sean J Hislop, MD, Joseph H Hedrick, MD, Michael J Singh, MD, Jeffrey M Rhodes, MD, Joseph P Hart, MD, Marcia Johansson, ACNP, and Karl A Illig, MD

Division of Vascular Surgery, at the Strong Heart and Vascular Center, University of Rochester Medical Center, NY

Objectives: To determine whether a patient's specific carotid anatomy can be modeled using CTA on an endovascular simulator and whether preoperative patient-specific case rehearsal accurately predicts operative experience.

Methods: Patients underwent CTA of the arch and carotid circulation. Simbionix (Cleveland, OH and Lod, Israel) used deidentified CTAs to create simulation files (using PROcedure(TM) Rehersal Studio). The surgeon performed the simulated case within 24 hours of the actual procedure. Likert surveys (strongly agree - strongly disagree) were completed assessing face validity, or the degree to which the simulation mimicked real life.

Results: Five patient-specific simulations were performed. The surgeons "strongly agreed" (median score 5/5) that the simulation improved the operative flow, increased patient safety and efficiency of instrument use, assisted in selection of EPD, stent, diagnostic catheter and balloon, decreased overall operative and fluoroscopy time and the amount of contrast used, and that the operative and simulator outcomes were similar. They "agreed" (median score 4/5) that the simulation assisted with vessel access and with wire selection. Face validity was excellent: surgeons "strongly agreed" that the simulator was easy to use, realistically replicated reality, produced realistic imaging and tactile feedback (haptics), realistically replicated patient arch, carotid and lesion anatomy and that it accurately predicted stent dimensions. All simulated EPD, stent, and balloon dimensions matched those used in the operating room. Subjective observations suggested that the simulation predicted difficulty with vessel cannulation but did not accurately model post-stent deployment changes in bifurcation angulation.

Conclusions: These data indicate that patient-specific CTA-derived data can be converted to an endovascular simulator with high face validity. We suggest that case rehearsal prior to an operation may be useful in the planning and execution of carotid artery intervention.

Simbionix Ltd.
http://www.simbionix.com