Patient-specific rehearsal prior to EVAR: a pilot study

Area of Science:

• Medical simulation
• Endovascular surgery
• Surgical planning

Background:

• Endovascular aortic aneurysm repair (EVAR) is a complex procedure requiring precise technical execution.
• Pre-operative planning is crucial for optimizing outcomes in EVAR.
• Patient-specific rehearsal (PsR) using 3D models offers a novel approach to pre-operative planning.

Purpose of the Study:

• To evaluate the feasibility, face validity, technical impact, and subjective utility of patient-specific rehearsal (PsR) before EVAR.
• To assess the realism and effectiveness of PsR in preparing surgical teams.

Main Methods:

• A prospective, multicentre pilot study involving patients undergoing EVAR.
• Generation of patient-specific 3D anatomical models for rehearsal.
• Conducting rehearsals within 24 hours prior to the actual EVAR procedure.
• Recording technical metrics and using subjective questionnaires to assess realism and utility.

Main Results:

• Ten patients were enrolled; one treatment plan was altered based on PsR.
• PsR significantly influenced the optimal C-arm position in 7/9 patients, with identical angles used in the real procedure.
• All team members found PsR highly useful for selecting fluoroscopy angles and overall team preparation, rating realism highly (median 4).

Conclusions:

• Patient-specific rehearsal (PsR) for EVAR enables realistic case simulations.
• Subjective feedback suggests PsR can optimize C-arm angles and enhance team preparedness.
• A randomized controlled trial is warranted to confirm the impact of PsR on technical performance and patient safety.