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Simulators Help Vascular Surgeons Learn

New York (Aug 21, 2009)

Young female surgeon stands in corridor

Vascular surgeons – surgeons who operate on the veins and arteries outside of the heart, often on smokers and diabetic patients – now perform most interventions using minimally invasive techniques as opposed to open surgery. How does a medical student or resident learn? How does a practicing surgeon get trained or obtain more experience with less common vascular procedures, such as those targeting the carotid or renal arteries?

Enter the surgical simulator, a computerized system that enables surgeons to learn and perform vascular procedures in a virtual environment. "The traditional teaching method in surgery is not necessarily curriculum-based – you learn only what you see in your own hospital during your residency," explained vascular surgeon Rajeev Dayal, MD. "So you may end up with limited knowledge of how to manage conditions that you don't see as frequently."

Endorsement of Vascular Simulators

Training using surgical simulation tools is supported by the American College of Surgeons and the Accreditation Council for Graduate Medical Education as a means of filling gaps in knowledge in a safe and efficient manner. "The simulator enables us to make sure surgeons are adequately trained to perform the procedures they are credentialed to do," noted John Karwowski, MD – also a vascular surgeon.

Vascular surgery simulators are used by medical students, residents, fellows, and visiting physicians at both NewYork-Presbyterian Hospital's Weill Cornell Medical Center and Columbia University Medical Center campuses to learn entirely new procedures or to brush up on procedures that they may not get to perform with regular frequency in their practices. The level of training is tailored to the user: a student may use the system to perform a basic physiological assessment of a model patient, while practicing physicians can receive in-depth training on more complex endovascular procedures, such as carotid stenting. Dr. Dayal noted that the simulator obviates the need for practicing vascular procedures on animals, thereby reducing costs.

How Simulated Surgery Works

Just like in a real operating room, the surgeon is surrounded by monitors and catheters. Surgeons pierce the simulator's "skin," then snake the catheter through the artery to the target area. Simulators mimic the use of fluoroscopy, and the surgeon watches what is happening inside the simulated patient on a monitor. In addition to technical complications created by the simulator during the procedure, users are presented with realistic medical management challenges when planning for the case such as administration of drugs and device selection. For example, the placement of a carotid stent increases the patient's risk of stroke. Simulator users must therefore remember to give the patient blood thinners before the procedure to reduce this risk; if they don't, the patient in the simulator may experience a stroke and the surgeon must take the appropriate steps to manage it.

Surgeons can also load imaging data from a real patient into the system and "rehearse" a procedure digitally before doing the real operation. "For a simulator to be really useful, we have to learn what complications may occur and how to manage them if they do," said Dr. Karwowski. "The simulator allows us to predict potential pitfalls so we don't have to figure it out on the fly in the OR."

Benefits of Vascular Simulators

The benefits of endovascular simulation for training were demonstrated in two studies published by NewYork-Presbyterian Hospital surgeons. One found that simulation training improved the performance of catheter-based interventions by residents. The other showed that simulation resulted in a significant improvement in the ability of trainees to perform carotid stent placement.

Future of Vascular Simulators

The future role of simulation in the training of surgeons is expected to continue to grow, as previous studies showed that students trained on simulators achieve better outcomes; perform faster, more accurate procedures; and use less fluoroscopy, which is better for patients. "We have to be able to provide surgeons with a well-rounded training program in as safe a manner as possible. The only way to do this is with more simulation, not less," said Dr. Dayal.

Faculty Contributing to this Article:

Rajeev Dayal, MD is an Assistant Attending Surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center, the Bi-Campus Director of Carotid Stenting at NewYork-Presbyterian Hospital, an Assistant Professor of Surgery at Columbia University College of Physicians and Surgeons, and an Adjunct Assistant Professor of Surgery at Weill Cornell Medical College.

John Karwowski, MD is an Assistant Attending Surgeon and the Interim Site Chief in the Division of Vascular Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, an Assistant Professor of Surgery at Weill Cornell Medical College, and an Adjunct Assistant Professor of Surgery at Columbia University College of Physicians and Surgeons

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