Mazzaccaro Daniela, Nano Giovanni
Ist Unit of Vascular Surgery, University of Milan, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
Ann Ital Chir. 2012 Mar-Apr;83(2):81-5.
Simulation has been proposed to improve learning curves in carotid artery stenting (CAS), but previous studies have only evaluated CAS simulation in a single type of arch usually either type I or type II. The aim of our study is to define the use of virtual reality for CAS training in type I and type III aortic arches for novice operators.
Fifty experienced interventionalists and fifty novice trainees with no prior experience with endovascular procedures performed a virtual CAS in a type I aortic arch case and one in a type III arch case. They trained on simulator for two hours and then repeated the procedures. Data of the procedures were collected and analysed.
Among novice operators, 38 out of 50 ended the first procedure on type I arch (76%) and 32% (16 out of 50) concluded the first procedure on type III arch (p < .05). After training, 100% of novice ended the easy case and 56% (28 out of 50) concluded the difficult case (p < .05). All experienced operators successfully carried out the simulations. The simulator induced greater improvement among novice in type I arch rather than in type III arch. Performances of experienced didn't improve significantly. Among novice, virtual performances of "difficult" cases were significantly worse than those of "easy" cases, both before and after training.
Simulator is an effective tool for training of novice operators in type I aortic arch; on the contrary its role has yet to be established in type III aortic arch.
有人提出利用模拟技术来改善颈动脉支架置入术（CAS）的学习曲线，但以往的研究仅在单一类型的主动脉弓（通常为I型或II型）中评估CAS模拟。我们研究的目的是确定虚拟现实技术在I型和III型主动脉弓中对新手操作者进行CAS培训的作用。
50名经验丰富的介入医师和50名此前没有血管内手术经验的新手学员，分别在一个I型主动脉弓病例和一个III型主动脉弓病例中进行虚拟CAS操作。他们在模拟器上训练两小时，然后重复操作。收集并分析操作数据。
在新手操作者中，50人中有38人（76%）完成了I型主动脉弓的首次操作，50人中有16人（32%）完成了III型主动脉弓的首次操作（p < 0.05）。训练后，100%的新手完成了简单病例，50人中有28人（56%）完成了困难病例（p < 0.05）。所有经验丰富的操作者均成功完成了模拟操作。模拟器在I型主动脉弓新手身上带来的改善比在III型主动脉弓新手身上更大。经验丰富者的操作表现没有显著改善。在新手当中，无论是训练前还是训练后，“困难”病例的虚拟操作表现均显著差于“简单”病例。
模拟器是培训I型主动脉弓新手操作者的有效工具；相反，其在III型主动脉弓中的作用尚未确立。
