Carotid Endarterectomy Surgical Simulation Model Using a Bovine Placenta Vessel BACKGROUND: Carotid endarterectomy (CEA) is a common, well-developed surgical procedure. Although surgical simulation is gaining in importance for residency training, CEA practice opportunities for surgical residents are limited. OBJECTIVE: To describe a new haptic CEA model. METHODS: Six bovine placentas were used to create the model. Each placenta pro- vided about 6 large arterial and venous bifurcations. In total, 36 large-vessel bifurcations were dissected and prepared for the CEA simulation. Bovine placenta vessels were arranged to simulate the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA). The diameters and wall thicknesses were measured and compared with human CCA, ICA, and ECA parameters. RESULTS: All bovine placentas provided vessels suitable for modeling carotid artery bifurcations and CEA training. Mean 6 SD diameters of simulated CCAs, ECAs, and ICAs were 11.2 6 1.8, 4.3 6 0.5, and 9.8 6 3.0 mm, respectively, from nondilated veins and 8.7 6 1.4, 4.4 6 1.3, and 7.2 6 1.7 mm, respectively, from nondilated arteries. Mean vessel wall thicknesses were 2.0 6 0.6 mm for arteries and 1.4 6 0.5 mm for veins. Placental vessel tissue had dimensions and handling characteristics similar to those of human carotid arteries. The CEA procedure and its subtasks, including vessel-tissue preparation and surgical skills performance, could be reproduced with high fidelity. CONCLUSION: A bovine placenta training model for CEA is inexpensive and readily available and closely resembles human carotid arteries. The model can provide a con- venient and valuable simulation and practice addition for vascular surgery training. KEY WORDS: Bovine, Carotid artery, Endarterectomy, Placenta, Simulation, Training Neurosurgery 77:825–830, 2015 DOI: 10.1227/NEU.0000000000000924 www.neurosurgery-online.com S troke is the fourth leading cause of death in the United States 1 and the second major cause of death around the world. 2 Carotid endarterectomy (CEA) is a surgical procedure that is commonly performed by multiple sub- specialists, with proven benefits for stroke pre- vention in appropriately selected patients. 3 The novice doctor in residency or fellowship training currently faces a learning paradox. Complications occurring during the learning curve are becoming less tolerated, and the demands of supervision have increased, which has resulted in fewer opportunities for surgical trainees to hone their skills on living patients. 4 For many years, surgical skill was acquired only by performing actual procedures. Increasingly, trainees’ early exposure is gained in the form of simulation models. With increased demand for the best possible outcomes in every patient, limitations on training experiences imposed by working-hour restrictions, and medicolegal con- cerns, simulation is a logical and practical method to bridge novices’ development as they attain competence. 5 The best known methods for surrogate surgical training are to use animals, human cadavers, silicone, and virtual models. 6 The validation and importance of vascular surgery practice on models are evidenced by the many residency program directors who have discussed a minimal training curriculum as part of the requirements for board certification. 7 The human placenta has been described by our group as an attractive Evgenii G. Belykh, MD*‡§ Ting Lei, MD*‡ Magaldi M. Oliveira, MD, PhD‡¶ Rami O. Almefty, MD‡ Kaan Yagmurlu, MD‡ Ali M. Elhadi, MD, PhD‡ Guozhu Sun, MD, PhD‡ William D. Bichard, BS‡ Robert F. Spetzler, MD‡ Mark C. Preul, MD‡ Peter Nakaji, MD‡ ‡Division of Neurological Surgery, Bar- row Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; §Scientific Center of Reconstruc- tive and Restorative Surgery, Laboratory of Neurosurgery, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; ¶De- partment of Surgery, Federal University of Minas Gerais, Minas Gerais, Brazil *These authors have contributed equally to this article. Correspondence: Peter Nakaji, MD, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013. E-mail: neuropub@dignityhealth.org Received, February 6, 2015. Accepted, June 22, 2015. Published Online, July 30, 2015. Copyright © 2015 by the Congress of Neurological Surgeons. ABBREVIATIONS: CCA, common carotid artery; CEA, carotid endarterectomy; ECA, external carotid artery; ICA, internal carotid artery CONCEPTS, INNOVATIONS AND TECHNIQUES CONCEPTS, INNOVATIONS AND TECHNIQUES NEUROSURGERY VOLUME 77 | NUMBER 5 | NOVEMBER 2015 | 825 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited. Downloaded from https://academic.oup.com/neurosurgery/article/77/5/825/2452187 by UNIVERSITY OF VIRGINIA user on 03 March 2021