1180. Placenta as a Micro Vascular Simulator in Neurosurgery Education

Authors: Nicolas Eric Alcala; Martin Piazza, MD; William Goodnight, MD; Gene Hobbs; Carolyn Quinsey, MD (Chapel Hill, NC)

Introduction: 
Prior work has shown that human placenta is an available and realistic model for aneurysm clip ligation simulation. Given the time constraints on neurosurgical trainees, we sought to find a measurable improvement in performance with only a few sessions of deliberate practice of microdissection and/or aneurysm clip ligation.

Methods:
11 neurosurgery residents were randomly assigned within their PGY level to 2 prospective cohorts: A: premade aneurysm clipping vs. B: microdissection, aneurysm creation, and clipping. In both groups, the aneurysm was punctured prior to clip ligation. Video recordings were made at baseline and then after 2 practice sessions over the course of 10 weeks. A 1-minute video was also recorded at the conclusion of the study to assess dissection skill. These videos were then rated by a board-certified vascular neurosurgeon using a modified version of the Objective Structured Assessment of Aneurysm Clipping Skills (OSAACS). Resident performance in both clipping skill and dissection skill was compared via t-testing. Time from start of aneurysm rupture to successful clipping was tracked and a t-test was performed to investigate differences.

Results:
Micro-dissection instrument handling in cohort B was scored higher using the OSAACS (p < 0.05). After the practice sessions, the same cohort took longer to clip a ruptured aneurysm (p < 0.05). No significant difference was found between the two groups related to OSAACS-rated technical performance in aneurysm clipping after 2 practice sessions (p > 0.05). Both groups of residents expressed enjoyment while preforming the exercises.

Conclusion:
These findings suggest that placenta as a simulation model provides microsurgical skill development in just a few deliberate practice sessions.  Likely, more sessions are needed to observe measurable improvements in aneurysm clip ligation technique. Both exercises were favorably regarded by the neurosurgical residents and their interest in continuing them was strong.