Validating a 3D-printed endovascular simulator for use in training surgical residents

Abstract

Objective

Three-dimensional (3D)-printed endovascular models can be an accessible alternative to expensive, state-of-the-art endovascular simulators but currently lack the rigorous validation needed to be dependable educational tools. This study describes the manufacture of a 3D-printed endovascular model of an aorta and determines the construct validity and preliminary content and face validity of the model.

Methods

A 3D-printed aorta was created using segmented data from a patient computerized tomography scan and a FormLabs 3B 3D printer with FormLabs Clear resin. Participants were asked to perform two tasks from a femoral access point: catheterize the contralateral common iliac artery and the superior mesenteric artery. Participants were assessed for task completion, technique, and time. Performance was compared between levels of education (medical student vs lower-year resident vs upper-year resident vs attending) and levels of endovascular experience (<5 procedures vs 6-20 procedures vs 21-100 procedures vs >100 procedures). Users completed questionnaires assessing the face and content validity of the simulator after their participation.

Results

48 participants were recruited (12 medical students, 19 lower-year residents, 13 upper-year residents, and 4 attendings). Of these, 26 participants had performed <5 procedures, 10 had performed 6 to 20 procedures, 7 had performed 21 to 100 procedures, and 5 had performed >100 real-world procedures. Neither education level nor experience level correlated with task completion. Increasing levels of training progressively increased rates of correct technique for both tasks combined (8% vs 21% vs 46% vs 75%, P = .032) and decreased cumulative time (307.3 vs 252.2 vs 185.8 vs 139 seconds, P = .005). Similarly, increased levels of experience progressively increased rates of correct technique for both tasks combined (7% vs 50% vs 71% vs 80%, for increasingly experienced groups, P < .001) and decreased cumulative completion times (276 vs 237 vs 187 vs 113 seconds, P = .003) for both tasks. Multivariate analysis showed that training level was not a predictor for time taken to complete any task, while experience level was a predictor for superior mesenteric artery cannulation time (P < .02). Participants rated the model as having somewhat realistic haptics, dissimilar “look and feel” to the operating room, and strongly believed that the model was valuable for practicing endovascular surgery.

Conclusions

These findings verify the construct validity of this endovascular simulator, as those with the most real-world experience used a correct technique more often and completed the tasks the fastest. Survey results supported the content validity of the model. Basic 3D-printed endovascular models should be considered as an affordable, readily accessible adjunct to surgical education.