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OBJECTIVES
Endovascular robotics systems, having now been approved for clinical use in the US and Europe, are seeing rapid growth in interest. As yet, determining who has sufficient expertise for safe and effective clinical use remains elusive. Our aim was to analyze performance of novice, intermediate and expert endovascular interventionalists on a robotic platform to determine if expertise in traditional manual techniques translates into improved robotic performance.
METHODS
Over 3 separate sessions, 20 subjects with varying levels of endovascular expertise (novice=9, intermediate=5, expert=6), and with minimal to no experience using an endovascular robot, performed a series of 4 tasks on an endovascular skills model. Prior to initiation of the study, participants were trained to use the robot according to approved guidelines and by a certified instructor. Subjects were given 5 minutes to complete each task. In addition of total time, electromagnetic tracking of the catheter tip was performed to capture metrics of smoothness and efficiency. Data from 2 expert users with >100 hours experience on the robotic system also completed 3 sessions each, in order to provide a gold standard for robotic expertise.
RESULTS
The tasks were successfully completed 93.75% of the time (92% for novices, 94% by intermediates and 96% by experts). There was no significant difference in completion times for the 3 groups of novice robot users, and for all groups there was a wide standard deviation in completion times. There was also wide variability in performance of users between sessions for all inexperienced users of the robot. The expert robotic user had shorter completion times, more efficient catheter motion, and times were more consistent between sessions. (Table 1)
CONCLUSIONS
Expertise in performance of traditional manual endovascular interventions does not translate to performance on the endovascular robot. Simulation task completion times, efficiency of catheter movement and consistency of performance on the robot may help identify those users who are sufficiently trained for safe clinical use of the system.

Experience Level	Task 1 Median time(s) (Std Dev)	Task 2 Median time(s) (Std Dev)	Task 3 Median time(s) (Std Dev)	Task 4 Median time(s) (Std Dev)
Novice	70(83)	82(60)	194(86)	75(62)
Intermediate	51(61)	85.5(79)	186(57)	74(45)
Expert	84(40)	91(71)	185(66)	79(31)
Expert robot	43(10)	49(7)	114(19)	47(3)