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Patient-specific Rehearsal Before EVAR: Influence on Technical and Nontechnical Operative Performance. A Randomized
Liesbeth M Desender1, Isabelle Van Herzeele, Mario L Lachat
1*Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium†Department of Vascular Surgery, Zurich University Hospital, Zurich, Switzerland‡Department of Vascular and Thoracic Surgery, St. Maarten Hospital, Duffel, Belgium§Department of Surgery and Cancer, Imperial College London, UK¶Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands||Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Patient-specific virtual reality rehearsal (PsR) significantly reduced errors and procedural delays during endovascular infrarenal aneurysm repair (EVAR). This innovative technique enhances patient safety and optimizes surgical efficiency in complex vascular procedures.
Area of Science:
- Vascular Surgery
- Medical Simulation
- Health Services Research
Background:
- Endovascular procedures like EVAR are complex and performed on high-risk patients, increasing potential for harm and inefficiency.
- Patient-specific virtual reality rehearsal (PsR) offers a method for endovascular teams to pre-operatively practice and refine surgical plans in a virtual environment.
- This approach aims to mitigate risks associated with complex endovascular interventions.
Purpose of the Study:
- To evaluate the impact of preoperative patient-specific virtual reality rehearsal (PsR) on technical performance and procedural errors during endovascular infrarenal aneurysm repair (EVAR).
- To quantify the reduction in operative errors, fluoroscopy time, contrast volume, and radiation dose associated with PsR.
- To assess the feasibility and effectiveness of PsR across different hospital settings and varying levels of surgical team experience.
Main Methods:
- A multicenter, prospective, randomized controlled trial involving 100 patients undergoing EVAR for infrarenal or iliac aneurysms.
- Patients were randomized to either preoperative PsR or standard care without PsR.
- Primary outcomes included procedural errors, total endovascular time, fluoroscopy time, contrast volume, number of angiograms, and radiation dose.
Main Results:
- The PsR group demonstrated a significant reduction in errors: 26% for minor errors and 76% for major errors.
- Errors causing procedural delay were reduced by 27% in the PsR group.
- The number of angiograms required for landing zone visualization decreased by 23% (proximal) and 21% (distal) in the PsR group, indicating improved procedural precision.
Conclusions:
- Patient-specific virtual reality rehearsal (PsR) is a viable tool for improving outcomes in endovascular infrarenal aneurysm repair (EVAR).
- PsR effectively reduces perioperative errors and the need for repeat imaging, leading to decreased procedural delays.
- Implementation of PsR can enhance patient safety and procedural efficiency in diverse clinical settings, regardless of team experience.
