IMPLEMENTATION OF A SIMULATION TRAINING RESULTS IN THE PRACTICE OF RENDERING NEUROSURGICAL CARE TO PATIENTS WITH ANEURYSMATIC INTRACRANIAL HEMORRHAGES

Objective is to analyze the results of introduction of simulation training in skills of surgical revascularization of the brain in the practice of rendering neurosurgical care to patients with carotid stenosis.

Materials and methods. Simulation training in skills of surgical revascularization of the brain was performed by the original method in the framework of the 5-day course. Regions have been identified, of which the largest number of doctors were trained, and calculated target surgical activity indicators with carotid stenosis, depending on the population of these regions. Comparison of target and achieved by 2016 indi cators of surgical activity allowed to judge the effectiveness of the implementation of a simulation training results in health care practice.

Results. In the period from 01.01.2014 to 31.12.2016 were trained 52 doctors from 20 subjects of the Russian Federation. Across the country, there was an increase the number of operated patients from 302 in 2002 to 4305 in 2015, and 5377 in 2016 which however does not exceed 4 % of the required number of surgical interventions. By 2016 78 % of carotid stenosis surgeries were made outside of Moscow and St. Petersburg. The ratio of interventions performed by neurosurgeons and vascular surgeons in the Russian Federation in 2002 was 1:8, and by 2016 – already 1:4.

Conclusion. Organization of simulation training in skills of surgical revascularization of the brain in a master class format is an effective tool for increase surgical activity in carotid stenosis.

1. Крылов В.В., Коновалов А.Н., Дашьян В.Г. и др. Состояние нейрохирургической службы Российской Федерации. Нейрохирургия 2016;(3):3–44. [Krylov V.V., Konovalov A.N., Dash’yan V.G. et al. The current state of neurosurgery in Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2016;(3):3–44. (In Russ.)].

2. Юрченко Д.Л., Китачев К.В., Ерофеев А.А., Хубулава Г.Г. Хирургическое лечение стенозов сонных артерий. СПб.: Наука, 2010. 212 с. [Yurchenko D.L., Kitachev K.V., Erofeev A.A., Khubulava G.G. Surgical treatment of carotid artery stenosis. Saint Petersburg: Nauka, 2010. 212 p. (In Russ.)].

3. Caldwell K., Koch S., Khan I. et al. Impact of surgical specialty and operator experience on outcomes following carotid endarterectomy. J Vasc Surg 2015;61(2):577–8.

4. Earnshaw J.J. Carotid endarterectomy – the evidence. J R Soc Med 2002;95(4):168–70. PMID: 11934904.

5. Покровский А.В., Ивандаев А.С. Состояние сосудистой хирургии в России в 2016 году. Доступно по: http://www.angiolsurgery.org/society/situation/2016/ [Pokrovskiy A.V., Ivandaev A.S. State of vascular surgery in Russia in 2016. Available at: http://www.angiolsurgery.org/society/ situation/2016/ (In Russ.)].

6. Крылов В.В., Ярцев В.В., Кондаков Е.Н., Пирская Т.Н. Проблемы организации хирургического лечения больных с цереброваскулярной патологией в Российской Федерации. «Вопросы нейрохирургии им. Н.Н. Бурденко» 2005;(2):38–40. [Krylov V.V., Yartcev V.V., Kondakov E.N., Pirskaya T.N. Problems of organization of surgical treatment of patients with cerebrovascular pathology in the Russian Federation. Zhurnal “Voprosy neyrokhirurgii im. N.N. Burdenko” = Problems of Neurosurgery n. a. N.N. Burdenko 2005;(2):38–40. (In Russ.)].

7. Операции реваскуляризации головного мозга. Под ред. В.В. Крылова, В.Л. Леменева. М.: Бином, 2014. 272 с. [Brain revascularization operations. Ed. by V.V. Krylov, V.L. Lemenev. Moscow: Binom, 2014. 272 p. (In Russ.)].

8. Pichierri A., Frati A., Santoro A. et al. How to set up a microsurgical laboratory on small animal models: organization, techniques, and impact on residency training. Neurosurg Rev 2009;32(1):101– 10. DOI: 10.1007/s10143-008-0154-4. PMID: 18787849.

9. Belykh E., Byvaltsev V. Off-the-job microsurgical training on dry models: Siberian experience. World Neurosurg 2014;82(1–2):20–4. DOI: 10.1016/j.wneu.2014.01.018. PMID: 24495474.

10. Selber J.C., Chang E.I., Liu J. et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012;130(4):550–7. DOI: 10.1097/PRS.0b013e318262f14a. PMID: 23018716.