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Tapiala J, Iso-Mustajärvi M, Timonen T, Vrzáková H, Dietz A. Impact of virtual reality training on mastoidectomy performance: a prospective randomised study. Eur Arch Otorhinolaryngol 2024; 281:701-710. [PMID: 37505263 PMCID: PMC10796652 DOI: 10.1007/s00405-023-08143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE The opportunities for surgical training and practice in the operating room are in decline due to limited resources, increased efficiency demands, growing complexity of the cases, and concerns for patient safety. Virtual reality (VR) offers a novel opportunity to enhance surgical training and provide complementary three-dimensional experience that has been usually available in the operating room. Since VR allows viewing and manipulation of realistic 3D models, the VR environment could enhance anatomical and topographical knowledge, in particular. In this study, we explored whether incorporating VR anatomy training improves novices' performance during mastoidectomy over traditional methods. METHODS Thirty medical students were randomized into two groups and taught mastoidectomy in a structured manner. One group utilized a VR temporal bone model during the training while the other group used more traditional materials such as anatomy books. After the training, all participants completed a mastoidectomy on a 3D-printed temporal bone model under expert supervision. Performance during the mastoidectomy was evaluated with multiple metrics and feedback regarding the two training methods was gathered from the participants. RESULTS The VR training method was rated better by the participants, and they also needed less guidance during the mastoidectomy. There were no significant differences in operational time, the occurrence of injuries, self-assessment scores, and the surgical outcome between the two groups. CONCLUSION Our results support the utilization of VR training in complete novices as it has higher trainee satisfaction and leads to at least as good results as the more traditional methods.
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Affiliation(s)
- Jesse Tapiala
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland.
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
| | - Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
| | - Hana Vrzáková
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Aarno Dietz
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
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Banko L, Patel RV, Nawabi N, Altshuler M, Medeiros L, Cosgrove GR, Bi WL. Strategies to improve surgical technical competency: a systematic review. Acta Neurochir (Wien) 2023; 165:3565-3572. [PMID: 37945995 DOI: 10.1007/s00701-023-05868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND A cornerstone of surgical residency training is an educational program that produces highly skilled and effective surgeons. Training structures are constantly being revised due to evolving program structures, shifting workforces, and variability in the clinical environment. This has resulted in significant heterogeneity in all surgical resident education, training tools utilized, and measures of training efficacy. METHODS We systematically reviewed educational interventions for technical skills in neurosurgery published across PubMed, Embase, and Web of Science over four decades. We extracted general characteristics of each surgical training tool while categorizing educational interventions by modality and neurosurgical application. RESULTS We identified 626 studies which developed surgical training tools across eight different training modalities: textbooks and literature (11), online resources (53), didactic teaching and one-on-one instruction (7), laboratory courses (50), cadaveric models (63), animal models (47), mixed reality (166), and physical models (229). While publication volume has grown exponentially, a majority of studies were cited with relatively low frequency. Most training programs were published in the development and validation phase with only 2.1% of tools implemented long-term. Each training modality expressed unique strengths and limitations, with limited data reported on the educational impact connected to each training tool. CONCLUSIONS Numerous surgical training tools have been developed and implemented across residency training programs. Though many creative and cutting-edge tools have been devised, evidence supporting educational efficacy and long-term application is lacking. Increased utilization of novel surgical training tools will require validation of metrics used to assess the training outcomes and optimized integration with clinical practice.
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Affiliation(s)
- Lauren Banko
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruchit V Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Noah Nawabi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Marcelle Altshuler
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Lila Medeiros
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Newall N, Khan DZ, Hanrahan JG, Booker J, Borg A, Davids J, Nicolosi F, Sinha S, Dorward N, Marcus H. High fidelity simulation of the endoscopic transsphenoidal approach: Validation of the UpSurgeOn TNS Box. Front Surg 2022; 9:1049685. [PMID: 36561572 PMCID: PMC9764859 DOI: 10.3389/fsurg.2022.1049685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Endoscopic endonasal transsphenoidal surgery is an established technique for the resection of sellar and suprasellar lesions. The approach is technically challenging and has a steep learning curve. Simulation is a growing training tool, allowing the acquisition of technical skills pre-clinically and potentially resulting in a shorter clinical learning curve. We sought validation of the UpSurgeOn Transsphenoidal (TNS) Box for the endoscopic endonasal transsphenoidal approach to the pituitary fossa. Methods Novice, intermediate and expert neurosurgeons were recruited from multiple centres. Participants were asked to perform a sphenoidotomy using the TNS model. Face and content validity were evaluated using a post-task questionnaire. Construct validity was assessed through post-hoc blinded scoring of operative videos using a Modified Objective Structured Assessment of Technical Skills (mOSAT) and a Task-Specific Technical Skill scoring system. Results Fifteen participants were recruited of which n = 10 (66.6%) were novices and n = 5 (33.3%) were intermediate and expert neurosurgeons. Three intermediate and experts (60%) agreed that the model was realistic. All intermediate and experts (n = 5) strongly agreed or agreed that the TNS model was useful for teaching the endonasal transsphenoidal approach to the pituitary fossa. The consensus-derived mOSAT score was 16/30 (IQR 14-16.75) for novices and 29/30 (IQR 27-29) for intermediate and experts (p < 0.001, Mann-Whitney U). The median Task-Specific Technical Skill score was 10/20 (IQR 8.25-13) for novices and 18/20 (IQR 17.75-19) for intermediate and experts (p < 0.001, Mann-Whitney U). Interrater reliability was 0.949 (CI 0.983-0.853) for OSATS and 0.945 (CI 0.981-0.842) for Task-Specific Technical Skills. Suggested improvements for the model included the addition of neuro-vascular anatomy and arachnoid mater to simulate bleeding vessels and CSF leak, respectively, as well as improvement in materials to reproduce the consistency closer to that of human tissue and bone. Conclusion The TNS Box simulation model has demonstrated face, content, and construct validity as a simulator for the endoscopic endonasal transsphenoidal approach. With the steep learning curve associated with endoscopic approaches, this simulation model has the potential as a valuable training tool in neurosurgery with further improvements including advancing simulation materials, dynamic models (e.g., with blood flow) and synergy with complementary technologies (e.g., artificial intelligence and augmented reality).
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Affiliation(s)
- Nicola Newall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom,Correspondence: Nicola Newall
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - James Booker
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joseph Davids
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Siddharth Sinha
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Neil Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
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Paro MR, Hersh DS, Bulsara KR. History of Virtual Reality and Augmented Reality in Neurosurgical Training. World Neurosurg 2022; 167:37-43. [PMID: 35977681 DOI: 10.1016/j.wneu.2022.08.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
Virtual reality (VR) and augmented reality (AR) are rapidly growing technologies. Both have been applied within neurosurgery for presurgical planning and intraoperative navigation, but VR and AR technology is particularly promising for the education of neurosurgical trainees. With the increasing demand for high impact yet efficient educational strategies, VR- and AR-based simulators allow neurosurgical residents to practice technical skills in a low-risk setting. Initial studies have confirmed that such simulators increase trainees' confidence, improve their understanding of operative anatomy, and enhance surgical techniques. Knowledge of the history and conceptual underpinnings of these technologies is useful to understand their current and future applications towards neurosurgical training. The technological precursors for VR and AR were introduced as early as the 1800s, and draw from the fields of entertainment, flight simulation, and education. However, computer software and processing speeds are needed to develop widespread VR- and AR-based surgical simulators, which have only been developed within the last 15 years. During that time, several devices had become rapidly adopted by neurosurgeons, and some programs had begun to incorporate them into the residency curriculum. With ever-improving technology, VR and AR are promising additions to a multi-modal training program, enabling neurosurgical residents to maximize their efforts in preparation for the operating room. In this review, we outline the historical development of the VR and AR systems that are used in neurosurgical training and discuss representative examples of the current technology.
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Affiliation(s)
- Mitch R Paro
- UConn School of Medicine, Farmington, Connecticut, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Ketan R Bulsara
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA.
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5
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Iop A, El-Hajj VG, Gharios M, de Giorgio A, Monetti FM, Edström E, Elmi-Terander A, Romero M. Extended Reality in Neurosurgical Education: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:6067. [PMID: 36015828 PMCID: PMC9414210 DOI: 10.3390/s22166067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Surgical simulation practices have witnessed a rapid expansion as an invaluable approach to resident training in recent years. One emerging way of implementing simulation is the adoption of extended reality (XR) technologies, which enable trainees to hone their skills by allowing interaction with virtual 3D objects placed in either real-world imagery or virtual environments. The goal of the present systematic review is to survey and broach the topic of XR in neurosurgery, with a focus on education. Five databases were investigated, leading to the inclusion of 31 studies after a thorough reviewing process. Focusing on user performance (UP) and user experience (UX), the body of evidence provided by these 31 studies showed that this technology has, in fact, the potential of enhancing neurosurgical education through the use of a wide array of both objective and subjective metrics. Recent research on the topic has so far produced solid results, particularly showing improvements in young residents, compared to other groups and over time. In conclusion, this review not only aids to a better understanding of the use of XR in neurosurgical education, but also highlights the areas where further research is entailed while also providing valuable insight into future applications.
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Affiliation(s)
- Alessandro Iop
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- KTH Royal Institute of Technology, 114 28 Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Maria Gharios
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Andrea de Giorgio
- SnT—Interdisciplinary Center for Security, Reliability and Trust, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | | | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mario Romero
- KTH Royal Institute of Technology, 114 28 Stockholm, Sweden
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6
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James J, Irace AL, Gudis DA, Overdevest JB. Simulation training in endoscopic skull base surgery: A scoping review. World J Otorhinolaryngol Head Neck Surg 2022; 8:73-81. [PMID: 35619934 PMCID: PMC9126166 DOI: 10.1002/wjo2.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/22/2021] [Indexed: 01/16/2023] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Joel James
- City University of New York School of Medicine New York New York USA
| | - Alexandria L. Irace
- Department of Otolaryngology‐Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons Columbia University Irving Medical Center, New York‐Presbyterian Hospital New York New York USA
| | - David A. Gudis
- Department of Otolaryngology‐Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons Columbia University Irving Medical Center, New York‐Presbyterian Hospital New York New York USA
| | - Jonathan B. Overdevest
- Department of Otolaryngology‐Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons Columbia University Irving Medical Center, New York‐Presbyterian Hospital New York New York USA
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7
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Davids J, Manivannan S, Darzi A, Giannarou S, Ashrafian H, Marcus HJ. Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance. Neurosurg Rev 2021; 44:1853-1867. [PMID: 32944808 PMCID: PMC8338820 DOI: 10.1007/s10143-020-01378-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.
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Affiliation(s)
- Joseph Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK.
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK.
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton University NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Stamatia Giannarou
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hutan Ashrafian
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
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8
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Takami H, Velásquez C, Asha MJ, Oswari S, Almeida JP, Gentili F. Creative and Innovative Methods and Techniques for the Challenges in the Management of Adult Craniopharyngioma. World Neurosurg 2021; 142:601-610. [PMID: 32987616 DOI: 10.1016/j.wneu.2020.05.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/05/2020] [Indexed: 10/23/2022]
Abstract
Craniopharyngioma remains a major challenge in daily clinical practice. The pathobiology of the tumor is still elusive, and there are no consensus or treatment guidelines on the optimal management strategy for this relatively rare tumor. However, recent technical and scientific advances, including genomic and radiomic profiling, innovation in surgical approaches, more precise radiotherapy protocols, targeted therapy, and restoration of lost functions all have the potential to significantly improve the outcome of patients with craniopharyngioma in the near future. Although many of these innovative tools in the new armamentarium of the clinician are still in their infancy, they could reduce craniopharyngioma-related morbidity and mortality and improve the patients' quality of life. In this article, we discuss these creative and innovative approaches that may offer solutions to the obstacles faced in treating craniopharyngioma and future possibilities in improving the care of these patients.
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Affiliation(s)
- Hirokazu Takami
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Carlos Velásquez
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mohammed J Asha
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Selfy Oswari
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Joao Paulo Almeida
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
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9
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Gallet P, Rebois J, Nguyen DT, Jankowski R, Perez M, Rumeau C. Simulation-based training in endoscopic endonasal surgery: Assessment of the cyrano simulator. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:29-34. [DOI: 10.1016/j.anorl.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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In Reply to the Letter to the Editor Regarding "Development and Evaluation of a Pediatric Mixed Reality Model for Neuroendoscopic Surgical Training". World Neurosurg 2020; 140:446-447. [PMID: 32797969 DOI: 10.1016/j.wneu.2020.06.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/21/2022]
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11
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Letter to the Editor Regarding "Development and Evaluation of a Pediatric Mixed-Reality Model for Neuroendoscopic Surgical Training". World Neurosurg 2020; 140:445. [PMID: 32797968 DOI: 10.1016/j.wneu.2020.05.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 11/22/2022]
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12
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Feasibility Study of the Low-Cost Motion Tracking System for Assessing Endoscope Holding Skills. World Neurosurg 2020; 140:312-319. [DOI: 10.1016/j.wneu.2020.04.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022]
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13
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Chytas D, Chronopoulos E, Salmas M, Babis GC, Kaseta MK, Nikolaou VS. Letter: Design and Validation of a Cervical Laminectomy Simulator using 3-Dimensional Printing and Hydrogel Phantoms. Oper Neurosurg (Hagerstown) 2020; 19:E220-E221. [PMID: 32392299 DOI: 10.1093/ons/opaa118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dimitrios Chytas
- 2nd Orthopaedic Department School of Medicine National and Kapodistrian University of Athens "Konstantopoulio-Patission" Hospital Nea Ionia, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department School of Medicine National and Kapodistrian University of Athens "Konstantopoulio-Patission" Hospital Nea Ionia, Greece
| | - Marios Salmas
- Department of Anatomy School of Medicine National and Kapodistrian University of Athens Athens, Greece
| | - George C Babis
- 2nd Orthopaedic Department School of Medicine National and Kapodistrian University of Athens "Konstantopoulio-Patission" Hospital Nea Ionia, Greece
| | - Maria-Kyriaki Kaseta
- 2nd Orthopaedic Department School of Medicine National and Kapodistrian University of Athens "Konstantopoulio-Patission" Hospital Nea Ionia, Greece
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department School of Medicine National and Kapodistrian University of Athens "Konstantopoulio-Patission" Hospital Nea Ionia, Greece
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Gallet P. WITHDRAWN: Simulation-based training in endoscopic endonasal surgery: Assessment of the cyrano simulator. Eur Ann Otorhinolaryngol Head Neck Dis 2020:S1879-7296(20)30148-4. [PMID: 32616393 DOI: 10.1016/j.anorl.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article a du être retiré conformément à la ligne de conduite d'Elsevier concernant le retrait d'articles. Vous pouvez consulter le site (https://www.elsevier.com/about/our-business/policies/article-withdrawal) pour de plus amples renseignements. L'éditeur vous prie d'accepter ses excuses pour ce désagrément.
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Affiliation(s)
- P Gallet
- Département d'ORL et chirurgie cervico-faciale, université de Lorraine, CHRU de Nancy, 54511 Vandoeuvre-les-Nancy, France.
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15
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Training and Surgical Simulation in Skull Base Surgery: a Systematic Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00280-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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16
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A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery. World Neurosurg 2020; 133:e850-e873. [DOI: 10.1016/j.wneu.2019.08.262] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023]
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17
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Zeiger J, Costa A, Bederson J, Shrivastava RK, Iloreta AMC. Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery. Oper Neurosurg (Hagerstown) 2019; 19:43-52. [DOI: 10.1093/ons/opz355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 09/13/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies.
OBJECTIVE
To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery.
METHODS
A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures.
The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy.
RESULTS
A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures.
CONCLUSION
We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.
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Affiliation(s)
- Joshua Zeiger
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony Costa
- Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Lubelski D, Mukherjee D, Theodore N. Commentary: Simulation of Dural Repair in Minimally Invasive Spine Surgery With the Use of a Perfusion-Based Cadaveric Model. Oper Neurosurg (Hagerstown) 2019; 17:E231-E233. [PMID: 31120106 DOI: 10.1093/ons/opz111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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19
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Baby B, Singh R, Suri A, Dhanakshirur RR, Chakraborty A, Kumar S, Kalra PK, Banerjee S. A review of virtual reality simulators for neuroendoscopy. Neurosurg Rev 2019; 43:1255-1272. [PMID: 31444716 DOI: 10.1007/s10143-019-01164-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022]
Abstract
Neurosurgery is a challenging surgical specialty that demands many technical and cognitive skills. The traditional surgical training approach of having a trainee coached in the operating room by the faculty is time-consuming, costly, and involves patient risk factors. Simulation-based training methods are suitable to impart the surgical skills outside the operating room. Virtual simulators allow high-fidelity repeatable environment for surgical training. Neuroendoscopy, a minimally invasive neurosurgical technique, demands additional skills for limited maneuverability and eye-hand coordination. This study provides a review of the existing virtual reality simulators for training neuroendoscopic skills. Based on the screening, the virtual training methods developed for neuroendoscopy surgical skills were classified into endoscopic third ventriculostomy and endonasal transsphenoidal surgery trainers. The study revealed that a variety of virtual reality simulators have been developed by various institutions. Although virtual reality simulators are effective for procedure-based skills training, the simulators need to include anatomical variations and variety of cases for improved fidelity. The review reveals that there should be multi-centric prospective and retrospective cohort studies to establish concurrent and predictive validation for their incorporation in the surgical educational curriculum.
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Affiliation(s)
- Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.,Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Ramandeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. .,Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India.
| | - Rohan Raju Dhanakshirur
- Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Argha Chakraborty
- Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Subodh Kumar
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Prem Kumar Kalra
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Subhashis Banerjee
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
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20
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Francone A, Huang JM, Ma J, Tsao TC, Rosen J, Hubschman JP. The Effect of Haptic Feedback on Efficiency and Safety During Preretinal Membrane Peeling Simulation. Transl Vis Sci Technol 2019; 8:2. [PMID: 31293821 PMCID: PMC6613593 DOI: 10.1167/tvst.8.4.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose We determine whether haptic feedback improves surgical performance and outcome during simulated a preretinal membrane peeling procedure. Methods A haptic-enabled virtual reality preretinal membrane peeling simulator was developed using a surgical cockpit with two multifinger haptic devices. Six subjects (three trained retina surgeons and three nonsurgeons) performed the preretinal membrane peeling surgical procedure using two modes of operation: visual and haptic feedback, and visual feedback only. Results Task completion time, tool tip path trajectory, tool–retina collision force, and retinal damage were all reduced with haptic feedback used and compared to modes where haptic feedback was disabled. Conclusions Haptic feedback improves efficiency and safety during preretinal membrane peeling simulation. Translational Relevance These findings highlight the potential benefit of haptic feedback for improving performance and safety of vitreoretinal surgery.
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Affiliation(s)
- Anibal Francone
- University of California Los Angeles Stein Eye Institute, Los Angeles, CA, USA
| | - Jason Mingyi Huang
- University of California Los Angeles Stein Eye Institute, Los Angeles, CA, USA
| | - Ji Ma
- University of California Los Angeles Department of Mechanical and Aerospace Engineering, Los Angeles, CA, USA
| | - Tsu-Chin Tsao
- University of California Los Angeles Department of Mechanical and Aerospace Engineering, Los Angeles, CA, USA
| | - Jacob Rosen
- University of California Los Angeles Department of Mechanical and Aerospace Engineering, Los Angeles, CA, USA
| | - Jean-Pierre Hubschman
- University of California Los Angeles Stein Eye Institute, Los Angeles, CA, USA.,Center for Advanced Surgical and Interventional Technology (CASIT) at UCLA, Los Angeles, CA, USA.,Advanced Robotic Eye Surgery Laboratories, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
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21
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Xing J, Li H, Liu D. Anisotropic Vibration Tactile Model and Human Factor Analysis for a Piezoelectric Tactile Feedback Device. MICROMACHINES 2019; 10:mi10070448. [PMID: 31277292 PMCID: PMC6680780 DOI: 10.3390/mi10070448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 06/09/2023]
Abstract
Tactile feedback technology has important development prospects in interactive technology. In order to enrich the tactile sense of haptic devices under simple control, a piezoelectric haptic feedback device is proposed. The piezoelectric tactile feedback device can realize tactile changes in different excitation voltage amplitudes, different excitation frequencies, and different directions through the ciliary body structure. The principle of the anisotropic vibration of the ciliary body structure was analyzed here, and a tactile model was established. The equivalent friction coefficient under full-coverage and local-coverage of the skin of the touch beam was deduced and solved. The effect of system parameters on the friction coefficient was analyzed. The results showed that in the full-coverage, the tactile effect is mainly affected by the proportion of the same directional ciliary bodies and the excitation frequency. The larger the proportion of the same direction ciliary body is, the smaller the coefficient of friction is. The larger the excitation frequency is, the greater the coefficient of friction is. In the local-coverage, the tactile effect is mainly affected by the touch position and voltage amplitude. When changing the touch pressure, it has a certain effect on the change of touch, but it is relatively weak. The experiment on the sliding friction of a cantilever touch beam and the experiment of human factor were conducted. The experimental results of the sliding friction experiment are basically consistent with the theoretical calculations. In the human factor experiment, the effects of haptic regulation are mainly affected by voltage or structure of the ciliary bodies.
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Affiliation(s)
- Jichun Xing
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China.
| | - Huajun Li
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Dechun Liu
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
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22
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Perry A, Graffeo CS, Carlstrom LP, Anding WJ, Link MJ, Rangel-Castilla L. Novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under subarachnoid hemorrhage conditions: technical note and timing study. Neurosurg Focus 2019; 46:E17. [DOI: 10.3171/2018.11.focus18533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESylvian fissure dissection following subarachnoid hemorrhage (SAH) is a challenging but fundamental skill in microneurosurgery, and one that has become increasingly difficult to develop during residency, given the overarching management trends. The authors describe a novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions.METHODSA standardized microvascular anastomosis model comprising rat femoral arteries and veins was used for the experimental framework. In the experimental protocol, following exposure and skeletonization of the vessels, extensive, superficial (1- to 2-mm) soft-tissue debridement was conducted and followed by wound closure and delayed reexploration at intervals of 7, 14, and 28 days. Two residents dissected 1 rat each per time point (n = 6 rats), completing vessel skeletonization followed by end-to-end artery/vein anastomoses. Videos were reviewed postprocedure to assess scar score and relative difficulty of dissection by blinded raters using 4-point Likert scales.RESULTSAt all time points, vessels were markedly invested in friable scar, and exposure was subjectively assessed as a reasonable surrogate for sylvian fissure dissection under SAH conditions. Scar score and relative difficulty of dissection both indicated 14 days as the most challenging time point.CONCLUSIONSThe authors’ experimental model of femoral vessel skeletonization, circumferential superficial soft-tissue injury, and delayed reexploration provides a novel approximation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions. The optimal reexploration interval appears to be 7–14 days. To the authors’ knowledge, this is the first model of SAH simulation for microsurgical training, particularly in a live animal system.
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Affiliation(s)
| | | | | | | | - Michael J. Link
- Departments of 1Neurologic Surgery,
- 3Otolaryngology–Head and Neck Surgery, and
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23
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Competency Assessment in Virtual Reality-Based Simulation in Neurosurgical Training. COMPREHENSIVE HEALTHCARE SIMULATION: NEUROSURGERY 2018. [DOI: 10.1007/978-3-319-75583-0_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Bugdadi A, Sawaya R, Olwi D, Al-Zhrani G, Azarnoush H, Sabbagh AJ, Alsideiri G, Bajunaid K, Alotaibi FE, Winkler-Schwartz A, Del Maestro R. Automaticity of Force Application During Simulated Brain Tumor Resection: Testing the Fitts and Posner Model. JOURNAL OF SURGICAL EDUCATION 2018; 75:104-115. [PMID: 28684100 DOI: 10.1016/j.jsurg.2017.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/12/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Fitts and Posner model of motor learning hypothesized that with deliberate practice, learners progress through stages to an autonomous phase of motor ability. To test this model, we assessed the automaticity of neurosurgeons, senior residents, and junior residents when operating on 2 identical tumors using the NeuroVR virtual reality simulation platform. DESIGN Participants resected 9 identical simulated tumors on 2 occasions (total = 18 resections). These resections were separated by the removal of a variable number of tumors with different visual and haptic complexities to mirror neurosurgical practice. Consistency of force application was used as a metric to assess automaticity and was defined as applying forces 1 standard deviation above or below a specific mean force application. Amount and specific location of force application during second identical tumor resection was compared to that used for the initial tumor. SETTING This study was conducted at the McGill Neurosurgical Simulation Research and Training Center, Montreal Neurologic Institute and Hospital, Montreal, Canada. PARTICIPANTS Nine neurosurgeons, 10 senior residents, and 8 junior residents. RESULTS Neurosurgeons display statistically significant increased consistency of force application when compared to resident groups when results from all tumor resections were assessed. Assessing individual tumor types demonstrates significant differences between the neurosurgeon and resident groups when resecting hard stiffness similar-to-background (white) tumors and medium-stiffness tumors. No statistical difference in consistency of force application was found when junior and senior residents were compared. CONCLUSION "Experts" display significantly more automaticity when operating on identical simulated tumors separated by a series of different tumors using the NeuroVR platform. These results support the Fitts and Posner model of motor learning and are consistent with the concept that automaticity improves after completing residency training. The potential educational application of our findings is outlined related to neurosurgical resident training.
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Affiliation(s)
- Abdulgadir Bugdadi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine,Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia.
| | - Robin Sawaya
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Duaa Olwi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Gmaan Al-Zhrani
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamed Azarnoush
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Biomedical Engineering, Amirkabir University of Technology, Tehran Polytechnic, Tehran, Iran
| | - Abdulrahman Jafar Sabbagh
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghusn Alsideiri
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Khalid Bajunaid
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Rolando Del Maestro
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
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25
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Sawaya R, Bugdadi A, Azarnoush H, Winkler-Schwartz A, Alotaibi FE, Bajunaid K, AlZhrani GA, Alsideiri G, Sabbagh AJ, Del Maestro RF. Virtual Reality Tumor Resection: The Force Pyramid Approach. Oper Neurosurg (Hagerstown) 2017; 14:686-696. [DOI: 10.1093/ons/opx189] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The force pyramid is a novel visual representation allowing spatial delineation of instrument force application during surgical procedures. In this study, the force pyramid concept is employed to create and quantify dominant hand, nondominant hand, and bimanual force pyramids during resection of virtual reality brain tumors.
OBJECTIVE
To address 4 questions: Do ergonomics and handedness influence force pyramid structure? What are the differences between dominant and nondominant force pyramids? What is the spatial distribution of forces applied in specific tumor quadrants? What differentiates “expert” and “novice” groups regarding their force pyramids?
METHODS
Using a simulated aspirator in the dominant hand and a simulated sucker in the nondominant hand, 6 neurosurgeons and 14 residents resected 8 different tumors using the CAE NeuroVR virtual reality neurosurgical simulation platform (CAE Healthcare, Montréal, Québec and the National Research Council Canada, Boucherville, Québec). Position and force data were used to create force pyramids and quantify tumor quadrant force distribution.
RESULTS
Force distribution quantification demonstrates the critical role that handedness and ergonomics play on psychomotor performance during simulated brain tumor resections. Neurosurgeons concentrate their dominant hand forces in a defined crescent in the lower right tumor quadrant. Nondominant force pyramids showed a central peak force application in all groups. Bimanual force pyramids outlined the combined impact of each hand. Distinct force pyramid patterns were seen when tumor stiffness, border complexity, and color were altered.
CONCLUSION
Force pyramids allow delineation of specific tumor regions requiring greater psychomotor ability to resect. This information can focus and improve resident technical skills training.
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Affiliation(s)
- Robin Sawaya
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
| | - Abdulgadir Bugdadi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia
| | - Hamed Azarnoush
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
| | - Fahad E Alotaibi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Bajunaid
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Saudi Arabia
| | - Gmaan A AlZhrani
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ghusn Alsideiri
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulrahman J Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rolando F Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
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