title: Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment.
abstract: OBJECTIVE
  This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario.
  
  
  METHODS
  Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR). Timed performance metrics were recorded as surrogate measures of performance. Participants (N = 22) completed postprocedure questionnaires evaluating face validity, as well as technical and human factor aspects, of the simulation on a Likert scale from 1 (not at all) to 5 (very much).
  
  
  RESULTS
  Experienced team leaders were significantly faster than trainees in obtaining proximal control with an intra-aortic occlusion balloon (352 vs. 501 s, p = 0.047) and all completed the procedure within the allotted time, whilst no trainee was able to do so. Total fluoroscopy times were significantly lower in the experienced group (782 vs. 1,086 s, p = 0.016). Realism of the simulated angiosuite was scored highly by experienced team leaders (median 4/5, IQR 4-5). Participants found the simulation useful for acquiring technical (4/5, IQR 4-5) and communication skills (4/5, IQR 4-5) and particularly valuable for enhancing teamwork (5/5, IQR 4-5) and patient safety (5/5, IQR 4-5).
  
  
  CONCLUSIONS
  This study shows feasibility of creation of a crisis scenario in a fully immersive angiosuite simulation and team performance of a simulated rEVAR. Performance metrics differentiated between experienced specialists and trainees, and the realism of the simulation exercise and environment were rated highly by experienced endovascular specialists. This simulation has potential as a powerful training and assessment tool with opportunities to improve team performance in rEVAR through both technical and human factor skills training.
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM, South Wharf Road, 1003, London, W2 1NY, UK, N.Rudarakanchana@imperial.ac.uk.
authors.forename: Nung
authors.initials: N
authors.lastname: Rudarakanchana
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
authors.forename: Celia V
authors.initials: CV
authors.lastname: Riga
authors.forename: Alexander
authors.initials: A
authors.lastname: Rolls
authors.forename: Nicholas J W
authors.initials: NJ
authors.lastname: Cheshire
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Hamady
mesh_terms: D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D002983:Clinical Competence; D057510:Endovascular Procedures; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D014656:Vascular Surgical Procedures / Q000379:methods*