The Value of Carotid Endarterectomy as a Learning Tool for Trainees

Cacioppa, Laura Maria; Pini, Rodolfo; Longhi, Matteo; Vacirca, Andrea; Gallitto, Enrico; Gargiulo, Mauro; Stella, Andréa

doi:10.1016/j.avsg.2017.08.024

Cited by 8 publications

(11 citation statements)

References 20 publications

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“…Both mortality and incidence of post-operative stroke were similar to those within some of the existing literature [19,20] though slightly higher than those found by Lutz et al and Cacioppa et al [22,23]. Across all of the existing literature, outcomes have remained similar between consultants and supervised trainees [[19], [20], [21], [22], [23]].…”

Section: Discussionsupporting

confidence: 82%

“…Work from Germany and Italy has looked at trainee led, consultant supervised carotid endarterectomies. Both confirmed the there was no significant difference in major outcomes, such mortality and post-operative stroke, but found significantly longer operating times for trainees One study also revealed a greater rate of peripheral nerve damage as a complication in the trainee group [22,23]. …”

Section: Discussionmentioning

confidence: 84%

“…Across all of the existing literature, outcomes have remained similar between consultants and supervised trainees [[19], [20], [21], [22], [23]]. …”

Section: Discussionmentioning

confidence: 99%

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Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees’ operative involvement: A retrospective cohort study

Brown

Anderson

Bhattacharya

2019

Annals of Medicine and Surgery

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BackgroundSurgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants.Materials and methodsConsecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate.ResultsOne-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups.ConclusionTrainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 84%

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Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees’ operative involvement: A retrospective cohort study

Brown

Anderson

Bhattacharya

2019

Annals of Medicine and Surgery

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“…Several reports have demonstrated similar complication rates compared with experienced and younger surgeons. 83,84) Cacioppa et al reported a teaching program for trainees learning CEA. With this program (5 years of training), trainees can obtain results similar to those of experienced surgeons in terms of outcomes of CEA.…”

Section: Effect Of Surgeon Experience On Perioperative Outcomesmentioning

confidence: 99%

“…With this program (5 years of training), trainees can obtain results similar to those of experienced surgeons in terms of outcomes of CEA. 83) In Japan, most surgeons encounter only a small volume of CEAs, and gaining experience with a sufficient number of cases is difficult. We have already reported on training models as an "in vivo" CEA procedure, 85) but the extent to which such models have gained acceptance is hard to say.…”

Section: Effect Of Surgeon Experience On Perioperative Outcomesmentioning

confidence: 99%

Surgical Technique for Carotid Endarterectomy: Current Methods and Problems

Uno

Takai

Yagi

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Over the last 60 years, many reports have investigated carotid endarterectomy (CEA) and techniques have thus changed and improved. In this paper, we review the recent literature regarding operational maneuvers for CEA and discuss future problems for CEA. Longitudinal skin incision is common, but the transverse incision has been reported to offer minimal invasiveness and better cosmetic effects for CEA. Most surgeons currently use microscopy for dissection of the artery and plaque. Although no monitoring technique during CEA has been proven superior, multiple monitors offer better sensitivity for predicting postoperative neurological deficit. To date, data are lacking regarding whether routine shunt or selective shunt is better. Individual surgeons thus need to select the method with which they are more comfortable. Many surgical techniques have been reported to obtain distal control of the internal carotid artery in patients with high cervical carotid bifurcation or high plaque, and minimally invasive techniques should be considered. Multiple studies have shown that patch angioplasty reduces the risks of stroke and restenosis compared with primary closure, but few surgeons in Japan have been performing patch angioplasty. Most surgeons thus experience only a small volume of CEAs in Japan, so training programs and development of in vivo training models are important.

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