title: Virtual reality simulation training can improve inexperienced surgeons' endovascular skills.
abstract: OBJECTIVE
  The aim of this study was to evaluate virtual reality (VR) simulation for endovascular training of surgeons inexperienced in this technique.
  
  
  METHODS
  Twenty consultant vascular surgeons were divided into those who had performed >50 endovascular procedures (e.g. aortic and carotid stent) as primary operator (n=8), and those having performed <10 procedures (n=12). To test for endovascular skill rather than procedural knowledge, all subjects performed a renal artery balloon angioplasty and stent procedure. The simulator uses real tools with active force feedback, and provides a realistic image of the virtual patient. Surgeons with endovascular skills performed two repetitions and those without completed six repetitions of the same task. The simulator recorded time taken for the procedure, the amount of contrast fluid used and total fluoroscopy time.
  
  
  RESULTS
  Initially, surgeons with endovascular skills were significantly faster (median 571.5 vs. 900.0 s, p=0.039) and used less contrast fluid (19.1 vs. 42.9 ml, p=0.047) than inexperienced operators, though differences for fluoroscopy time were not significant (273 vs. 441 s, p=0.305). Over the six sessions, the inexperienced group made significant improvements in performance for time taken (p=0.007) and contrast fluid usage (p=0.021), achieving similar scores at the end of the training program to the experienced group.
  
  
  CONCLUSIONS
  Surgeons with minimal endovascular experience can improve their time taken and contrast usage during short-phase training on a VR endovascular task. VR simulation may be useful for the early part of the learning curve for surgeons who wish to expand their endovascular interests.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. rajesh.aggarwal@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: S A
authors.initials: SA
authors.lastname: Black
authors.forename: J R
authors.initials: JR
authors.lastname: Hance
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: N J W
authors.initials: NJ
authors.lastname: Cheshire
mesh_terms: D000800:Angioplasty, Balloon / Q000193:education; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D004502:Education, Medical, Continuing / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D012077:Renal Artery / Q000601:surgery; D015203:Reproducibility of Results; D015607:Stents; D013997:Time Factors; D014584:User-Computer Interface; D014656:Vascular Surgical Procedures / Q000193:education*