A simulator for training in endovascular aneurysm repair: The use of three dimensional printers

Eur J Vasc Endovasc Surg. 2017 Aug;54(2):247-253. doi: 10.1016/j.ejvs.2017.05.011. Epub 2017 Jun 21.


Objectives: To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil.

Methods: This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered.

Results: Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40-58 vs. 33 min, 95% CI 26-42 [p < .01]), total procedure time by 29% (mean 292 min [95% CI 235-336] vs. 207 [95% CI 173-247]; p < .01), and volume of contrast used by 25% (mean 87 mL [95% CI 73-103] vs. 65 mL [95% CI 52-81]; p = .02). The residents considered the training useful and realistic, and reported that it increased their self confidence. The 3D printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost.

Conclusion: An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents' surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence.

Keywords: 3D printing; EVAR; Patient specific; Simulations; Training.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / education*
  • Brazil
  • Clinical Competence
  • Computed Tomography Angiography
  • Education, Medical, Graduate / methods*
  • Endovascular Procedures / education*
  • High Fidelity Simulation Training / methods*
  • Hospitals, University
  • Humans
  • Internship and Residency*
  • Multidetector Computed Tomography
  • Operative Time
  • Patient-Specific Modeling*
  • Printing, Three-Dimensional*
  • Prospective Studies
  • Radiation Dosage
  • Radiation Exposure
  • Surgery, Computer-Assisted / education*
  • Task Performance and Analysis
  • Time Factors
  • Treatment Outcome