Development of a 3D transparent aortic model as a radiation-free training simulator for basic skills of endovascular aortic interventions.

BACKGROUND

Endovascular aortic repair (EVAR) are gradually replacing open surgical repair for aortic diseases, due to their minimally invasive nature. These procedures require a high level of expertise that is gained through extensive clinical experience, posing risks such as prolonged radiation exposure. Training on 3D-printed simulation models can offer safer environment for learning & improve procedural precision & outcome. METHOD: A single-center study to evaluate whether training on radiation-free three-dimensional (3D) printed aortic training models can reduce the time required from vascular surgeons to complete the basic endovascular navigation tasks, such as navigating the guide wire & probing the different branches. We involved 15 vascular doctors, 8 in-experienced (group1) & 7-experienced (group2). Participants received a 15-min lecture on aortic interventions and guide wire handling. Two self-made 3D printed training models were used. Models either are of the entire aorta (ascending to iliacs, see model1) or thoracoabdominal aorta (model2) were used. A covering box and a camera positioned above the aortic model that mirror the intervention on a monitor, simulating the indirect vision of the intraoperative fluoroscopy. Participants were required to probe and intubate four aortic branches (two renal arteries, coeliac trunk, & superior mesenteric artery) in three steps: initial assessment, 15-min training, & post-training assessment (next day). Task completion times were recorded & analyzed.

RESULTS

Group1 initially required 914 ± 420 s to intubate four ostia, which significantly decreased to 149 ± 48 s post-training (p = 0.001). Experts showed no significant time reductions following the training (p = 0.443). Initial times were significantly lower for Group2 (p = 0.002), but post-training times showed no significant difference between both groups (p = 0.134).

CONCLUSION

Using 3D-printed models in a simulation-training may help to familiarize & train participants with endovascular aortic procedures within limited material costs, leading to significant reductions in task completion time among trainees. Additionally, a significant reduction in simulated visualization time was observed, suggesting potential for reduced fluoroscopy exposure in real procedures. TRIAL REGISTRATION: The institutional ethics committee of the University Hospital of Mainz approved this study.