Virtual Reality Simulation in the Endovascular Field

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Citation
US Cardiology - Volume 5 Issue 1;2008:5(1):41-45

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The last decade has witnessed exponential growth in the field of endovascular interventions, although only in the last few years has there been a widespread interest in the carotid artery stent (CAS). Endovascular physicians with different medical backgrounds such as interventional cardiologists, radiologists, and vascular surgeons all recognize the importance of this changing technology.1 This procedure is almost unique, as the risks to the patient (stroke and death) as a result of the physician’s learning curve are unacceptably high. This has been summarized by editorials written after the publication of the Carotid and Vertebral Artery Angioplasty Study (CAVATAS)2–4 and the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trial (EVA-3S).5–7 Recent publications of the rates of medical errors and adverse events within healthcare8 have drawn the spotlight toward methods of establishing credentials for physicians preparing to perform complex procedures. In order to improve patient safety, operators must have the appropriate cognitive and technical skills and experience of CAS. Furthermore, physicians should have previously achieved a high level of proficiency in other catheter-based interventions and completed dedicated training in CAS.9,10
Traditional methods have focused on meeting a minimum number of procedures and on the duration of training to ensure competence, inappropriately correlating experience with competence.11,12 What is needed, given the complexity and risk of CAS plus the conflicting skill sets of physicians across several subspecialties, is a standardized and objective method for assessing procedural performance. Within aviation and in other medical fields such as laparoscopy, virtual reality (VR) simulation is able to train and objectively assess technical performance, and subsequently to define the benchmark level of skill.13–15 Therefore, the three specialties involved in the treatment of CAS have joined forces and launched the European Virtual Reality Endovascular Research Team (EVEREST). The ultimate goal of this group is to improve the training of current and future endovascular therapists.
In this article, an overview of different endovascular VR simulators and validation studies will be given, highlighting the role of the EVEREST members. Additionally, the possible benefits of VR simulation in the endovascular field, integration of VR simulation within a proficiency-based endovascular curriculum, and future applications will be explained.

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References
  1. Coward LJ, Featherstone RL, Brown MM, Stroke, 2005;36(4):905–11.
    Crossref | PubMed
  2. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), Lancet, 2001;357(9270):1729–37.
    Crossref | PubMed
  3. Brown M, Author’s reply, Lancet, 2001;358(9297):1999–2000.
    Crossref
  4. Kirkpatrick PJ, Martin P,Warburton E, Pickard JD, Lancet, 2001;358(9297):1998–9.
    Crossref | PubMed
  5. Bonvini RF, Righini M, N Engl J Med, 2007;356(3):305, author reply 6–7.
    Crossref | PubMed
  6. Furlan AJ, N Engl J Med, 2006;355(16):1726–9.
    Crossref | PubMed
  7. Mas JL, Chatellier G, Beyssen B, et al., N Engl J Med, 2006;355(16):1660–71.
    Crossref | PubMed
  8. Kohn JT CJ, Donaldson MS,Washington DC: National Academy Press, 1999.
  9. Bates ER, Babb JD, Casey DE Jr, et al.,J Am Coll Cardiol, 2007;49(1):126–70.
    Crossref | PubMed
  10. Gaines P, Nicholson TA, Eur J Radiol, 2006;60(1):37–9.
    Crossref | PubMed
  11. Beard JD, Br J Surg, 2007;94(11):1315–16.
    Crossref | PubMed
  12. Wholey MH, Wholey M, Mathias K, et al., Catheter Cardiovasc Interv, 2000;50(2):160–67.
    Crossref | PubMed
  13. Aggarwal R, Moorthy K, Darzi A, Br J Surg, 2004;91(12):1549–58.
    Crossref | PubMed
  14. Grantcharov TP, Kristiansen VB, Bendix J, et al., Br J Surg, 2004;91(2):146–50.
    Crossref | PubMed
  15. Seymour NE, Gallagher AG, Roman SA, et al., Ann Surg, 2002;236(4):458–63, discussion 63–4.
    Crossref | PubMed
  16. Dawson S, Radiology, 2006;241(1):17–25.
    Crossref | PubMed
  17. Dawson SL, Cotin S, Meglan D, et al., Catheter Cardiovasc Interv, 2000;51(4):522–7.
    Crossref | PubMed
  18. Sutherland LM, Middleton PF, Anthony A, et al., Eur J Vasc Endovasc Surg, 2006;31(6):588–93.
  19.  
  20. Van Herzeele I, Aggarwal R, Choong A, et al., J Vasc Surg, 2007;46(5):855–63.
    Crossref | PubMed
  21. Dayal R, Faries PL, Lin SC, et al., J Vasc Surg, 2004;40(6):1112–17.
    Crossref | PubMed
  22. Hislop SJ, Hsu JH, Narins CR, et al., J Vasc Surg, 2006;43(1):47–55.
    Crossref | PubMed
  23. Hsu JH, Younan D, Pandalai S, et al., J Vasc Surg, 2004;40(6):1118–25.
    Crossref | PubMed
  24. Wang T, Darzi A, Foale R, Schilling R, J Am Coll Cardiol, 2001;37:493–4A.
    Crossref
  25. Darzi A, Smith S, Taffinder N, Bmj, 1999;318(7188):887–8.
    Crossref | PubMed
  26. Patel AD, Gallagher AG, Nicholson WJ, Cates CU, J Am Coll Cardiol, 2006;47(9):1796–1802.
    Crossref | PubMed
  27. Dawson S, Gould DA, Lancet, 2007;369(9574):1671–3.
    Crossref | PubMed
  28. Berry M, Lystig T, Reznick R, Lonn L, J Endovasc Ther, 2006;13(2):237–43.
    Crossref | PubMed
  29. Berry MLT, Beard J, Klingestierna H, et al., Cardiovasc Inter Radiol, 2007;30:455–61.
    Crossref | PubMed
  30. Dawson DL, Meyer J, Lee ES, Pevec WC, J Vasc Surg, 2007;45(1):149–54.
    Crossref | PubMed
  31. Nicholson WJ, Cates CU, Patel AD, et al., J Soc Med Simul Healthcare, 2006;1:147–50.
    Crossref | PubMed
  32. Passman MA, Fleser PS, Dattilo JB, et al., Am J Surg, 2007;194(2):212–19.
    Crossref | PubMed
  33. Van Herzeele I, Aggarwal R, Neequaye S, et al., Eur J Vasc Endovasc Surg, 2008;35(5):541–50.
    Crossref | PubMed
  34. Lin PH, Bush RL, Peden EK, et al., Am J Surg, 2005;190(6):850–57.
    Crossref | PubMed
  35. Dankelman J, World J Surg, 2008;32(2):149–55.
    Crossref | PubMed
  36. Neequaye SK, Aggarwal R, Brightwell R, et al., Eur J Vasc Endovasc Surg, 2007;33(5):525–32.
    Crossref | PubMed
  37. Chaer RA, Derubertis BG, Lin SC, et al., Ann Surg, 2006;244(3):343–52.
    Crossref | PubMed
  38. Neequaye SK, Aggarwal R, Van Herzeele I, et al., J Vasc Surg, 2007;46(5):1055–64.
    Crossref | PubMed
  39. Berry M, Reznick R, Lönn L, J Vasc Interv Radiol, 2008;19(2):233–8.
    Crossref | PubMed
  40. MacRae HM, Satterthwaite L, Reznick RK, World J Surg, 2008;32(2):189–95.
    Crossref | PubMed
  41. Satava RM, Minim Invasive Ther Allied Technol, 2005;14(4):257–61.
    Crossref | PubMed
  42. Aggarwal R, Grantcharov TP, Darzi A, J Am Coll Surg, 2007;204(4):697–705.
    Crossref | PubMed
  43. Aggarwal R, Grantcharov T, Moorthy K, et al., Ann Surg, 2007;245(6):992–9.
    Crossref | PubMed