Virtual reality simulation training can improve inexperienced surgeons' endovascular skills

Purpose. 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 = 0.02 1), 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.