The Hidden Value of a High-Fidelity 3D-Printed Endarterectomy Training Model: Results of a Pilot Study

Introduction
Arterial endarterectomy and patch angioplasty are common vascular surgery procedures that need to be mastered by surgery residents. We set out to assess the value of a novel 3D-printed atherosclerosis simulated model to teach this crucial skill.

Methods
After IRB approval, general surgery residents were enrolled in a 2-hour vascular skills session. Pre-simulation, all participants received an educational video, written materials detailing the procedure, and a survey regarding prior exposure and confidence levels. During the simulation, participants were scored by attending vascular surgeon staff based on a 20-point scale assessing individual skills of arteriotomy (4 points), endarterectomy (4 points), patch angioplasty (7 points) and overall instrumentation/tissue handling (5 points). All participants were assessed with simple PTFE grafts and then with provided a 3D-printed models. A post-simulation survey was given to quantify satisfaction with the model and procedure confidence. Paired student’s t-test* and Fisher’s Exact test** were utilized.

Results
Twelve residents participated and all completed pre- and post-simulation surveys. 91.7% of participants had performed or seen an endarterectomy intraoperatively, with 33.3% participating in approximately 3-5 pre-simulation. 41.7% rated their confidence with vascular anastomosis as average, 8.3% as below average, and 8.3% as poor. 83.3% (n=10) of residents found the 3D-printed model extremely helpful, and 91.6% found the artery very to moderately realistic. Eleven of the twelve residents completed confidence assessments with a statistically significant increase in procedural confidence levels pre-session vs. post-simulation session (respectively 2.8 ± 0.9 vs. 3.8 ± 0.3,p=0.017*). Overall scores, patch angioplasty and instrument/tissue handling scores were statistically significantly increased.

Conclusion
We present the use of a novel high-fidelity 3D-printed vascular endarterectomy model that significantly shifted learner’s confidence and technical surgical skills. Future utilization of 3D-printed simulations in vascular surgery could be utilized to achieve a variety of educational goals in a larger randomized control fashion.