Torres I O, De Luccia N
Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, São Paulo, Brazil.
Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, São Paulo, Brazil.
Eur J Vasc Endovasc Surg. 2017 Aug;54(2):247-253. doi: 10.1016/j.ejvs.2017.05.011. Epub 2017 Jun 21.
To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil.
This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered.
Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40-58 vs. 33 min, 95% CI 26-42 [p < .01]), total procedure time by 29% (mean 292 min [95% CI 235-336] vs. 207 [95% CI 173-247]; p < .01), and volume of contrast used by 25% (mean 87 mL [95% CI 73-103] vs. 65 mL [95% CI 52-81]; p = .02). The residents considered the training useful and realistic, and reported that it increased their self confidence. The 3D printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost.
An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents' surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence.
利用三维（3D）打印动脉瘤开发一种血管内动脉瘤修复（EVAR）模拟系统，并评估在巴西一家大学医院进行EVAR手术前针对患者的特定训练对血管外科住院医师手术操作表现的影响。
这是一项前瞻性、对照、单中心研究。2015年期间，圣保罗大学医学院接受择期EVAR手术患者的动脉瘤被3D打印出来，并用于血管外科住院医师的培训课程。对Stratasys-Connex 350、Formlabs-Form1+和Makerbot这三款3D打印机进行了测试。10名住院医师被纳入对照组（2014年5名住院医师和30名患者）或训练组（2015年5名住院医师和25名患者）。对照组在资深血管外科医生的监督下进行手术（常规程序，无模拟器训练）。训练组在常规程序之前在针对患者的模拟器上练习手术。分析客观参数，并回答一份关于训练效用和真实感的主观问卷。
针对患者的特定训练使透视时间减少了30%（平均48分钟，95%置信区间[CI]40 - 58分钟 vs. 33分钟，95%CI 26 - 42分钟[p <.01]），总手术时间减少了29%（平均292分钟[95%CI 235 - 336] vs. 207分钟[95%CI 173 - 247]；p <.01），造影剂用量减少了25%（平均87毫升[95%CI 73 - 103] vs. 65毫升[95%CI 52 - 81]；p =.02）。住院医师认为该训练有用且逼真，并报告说增强了他们的自信心。基于模拟器质量和成本，Form1+（使用柔性树脂）和Makerbot（使用硅胶）这两款3D打印机表现最佳。
使用3D打印动脉瘤的EVAR模拟系统是可行的。使用Form1+（使用柔性树脂）和Makerbot（使用硅胶）这两款3D打印机获得了最佳结果。在巴西一家大学医院进行EVAR手术前针对患者的特定训练改善了住院医师的手术操作表现（基于透视时间、手术时间和造影剂用量）并增强了他们的自信心。
