Fundamental Technical Skills of Endovascular Surgery: A Preliminary Study on Its Impact on Skills and Stress during Procedures
Authors
Anne-Florence Rouby 1 2 3, Nicole Neumann 1, Vincenzo Vento 1 2 3, Anne Lejay 1 2 3, Salomé Kuntz 1 2 3, Tristan Bourcier 1 4, Walid Oulehri 1 3 5, Jean Bismuth 6, Nabil Chakfé 1 2 3
Collaborators
Hélène Paris 1 3, Paul-Michel Mertes 1 3 5, David Rigberg 7, Murray L. Shames 8, Malachi Sheahan 9, Jason T. Lee 10, Erica L. Mitchell 11, John F. Eidt 12
1 GEPROMED, Strasbourg, France
2 Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
3 Faculty of Medicine of Strasbourg, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France
4 Department of Ophthalmology, University Hospital of Strasbourg, Strasbourg, France
5 Department of Anaesthesiology and Intensive Care, University of Strasbourg, Strasbourg, France
6 Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
7 Division of Vascular Surgery, Department for Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
8 Division of Vascular Surgery, Department of Surgery, University of South Florida Health Morsani School of Medecine, Tampa, FL
9 Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
10 Division of Vascular Surgery, Stanford, CA
11 Division of Vascular Surgery, Oregon Health and Science University, Portland, OR
12 University of South Carolina School of Medecine Greenville, Dallas, TX
Background
Our objective is twofold: determining if simulation allows residents to reach proficient surgeons' performance concerning fundamental technical skills of endovascular surgery (FEVS) while investigating effects of the program on surgeons’ stress.
Methods
Using a FEVS training simulator, 8 endovascular FEVS were performed by vascular surgery residents (simulator-naive or simulator-experienced residents [SER]) and seniors. Total time needed to complete the 8 tasks, called total completion time (TCT), was the main evaluation criterion. Analgesia Nociception Index (ANI) was monitored during simulation. Likert scale questionnaire was filled out after each simulation.
Results
For each task, TCT was significantly lower for SER and seniors than simulator-naive residents (P = 0.0163). After only 5 simulations, SER were able to reach and even exceed the seniors' level in terms of TCT, with a median time of 10.8 min for SER and 11.9 min for seniors, and wire's movements with a median distance during cannulation of 4.44 m for SER and 4.17 m for seniors. Seniors remained better than SER in terms of precise wire manipulation (wire movement after cannulation), 4.17 m against 4.44 m (3.72–5.96), respectively. Based on the Likert scale stress analysis, seniors felt less stressed than both residents' groups (P = 0.0618). Seniors’ initial ANI and mean ANI over the session were significantly lower than those of the residents, P = 0.0358 and P = 0.0250, respectively.
Conclusions
We showed that 5 simulation sessions allowed residents to reach experienced surgeons’ capacities on FEVS concerning TCT. Subjectively, seniors felt less stressed than residents, contrary to the results of our objective measures of stress.
