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Eng EM, Childers JT, Lack BT, Haff CW, Mouhawasse E, Jackson GR, Sabesan VJ. Arthroscopic Shoulder Simulation May Improve Short-Term Speed, Accuracy, and Efficiency of Surgical Movements in Orthopedic Residents and Fellows: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00743-6. [PMID: 39326577 DOI: 10.1016/j.arthro.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/08/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To systematically review the effectiveness and validity of orthopedic surgery training using simulation technologies including augmented-reality, virtual-reality, and/or mixed-reality within arthroscopic shoulder surgery. METHODS A literature search utilized EMBASE and PubMed databases from inception to January 2024 per the 2020 PRISMA guidelines. Included studies described arthroscopic shoulder surgery simulation training among orthopedic surgery trainees. Exclusion criteria included studies assessing non-arthroscopic and non-shoulder simulations, non-English language studies, case reports, animal studies, studies with overlapping cohorts, and review articles. Simulation characteristics, performance measurements, and validity assessed were extracted. The Cochrane risk-of-bias tool and Newcastle-Ottawa Scale assessed study quality. Simulation type, validation type, and simulation outcomes were assessed. RESULTS A total of 15 included articles, published from 2011 to 2021, evaluated 421 residents or fellows and 17 medical students. Virtual reality (VR) was used in 40% of studies and mixed reality in 60%. The most common outcomes assessed were time to completion (80%), visualizing and probing task performance (60%), and the Arthroscopic Surgery Skill Evaluation Tool (ASSET) (33.3%). Construct validity was assessed in 46.7% of studies, transfer validity in 26.7%, face validity in 20%, and content validity in 6.7%. Three studies demonstrated improved performance in those undergoing simulation training compared to non-simulation groups. Two studies (13.3%) demonstrated improved time-to-task completion and decreased camera distance travelled when using simulation training. One study demonstrated that PGY-1 and PGY-5 residents derived the greatest benefit from simulation training. CONCLUSION Arthroscopic shoulder simulation training may benefit the surgical skills of orthopedic residents of all levels of experience as measured by time-to-completion, accuracy, and efficiency of surgical movements. Simulation training exhibits differences in operative time between more and less experienced orthopedic surgeons and trainees. Virtual reality simulation training may result in more efficient orthopedic surgical techniques. LEVEL OF EVIDENCE III, Systematic review of level I-III studies.
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Affiliation(s)
- Emma M Eng
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Justin T Childers
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Benjamin T Lack
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Christopher W Haff
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Edwin Mouhawasse
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
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Koh CH, Khawari S, Booker J, Choi D, Khan DZ, Layard Horsfall H, Sayal P, Marcus HJ, Prezerakos G. Validation of a surgical simulator and establishment of quantitative performance thresholds-RealSpine simulation system for open lumbar decompressions. Spine J 2024:S1529-9430(24)00945-8. [PMID: 39173915 DOI: 10.1016/j.spinee.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND CONTEXT The majority of surgical training is conducted in real-world operations. High-fidelity surgical simulators may provide a safer environment for surgical training. However, the extent that it reflects real-world operations and surgical ability is often poorly characterized. PURPOSE (1) Assess the validity and fidelity of a surgical simulator; (2) Examine the quantitative relationship between simulation performance and markers of real-world ability; (3) Establish thresholds for surgical expertise, and estimate their external validity and accuracy. STUDY DESIGN/SETTING A cohort study of surgeons at a British neurosurgical center. STUDY SAMPLE Ten early-career "novice" surgeons and 8 board-certified "expert" neurosurgeons. OUTCOMES MEASURES (1) Face and content validity, and visual and haptic fidelity; (2) Construct validity; (3) Predictive and discriminative utility of quantitative performance thresholds. METHODS Participants performed unilateral lumbar decompressions on high-fidelity spinal simulators that replicate the bony and soft tissue anatomy along with physiological processes such as bleeding and CSF leaks. Operating times, measured from first surgical action to either self-perceived satisfactory decompression or the end of allocated time, were recorded. The performance was also assessed independently by 2 blinded spinal subspecialist neurosurgeons using OSATS, a validated surgical assessment tool that utilizes 5-point scales on a variety of technical domains to grade the overall technical proficiency. Validity and fidelity were assessed by expert neurosurgeons using quantitative questionnaires. Construct validity was assessed by ordinal regression of simulation performance against real-world surgical grade and portfolio. Thresholds of expert status by simulation performance was established, and their predictive and discriminative utility assessed by crossvalidation accuracy and AUC-ROC. RESULTS Operating time and expert assessments of simulation performance (OSATS) were strong and significant prdictors of surrogate markers of real-world surgical ability. The thresholds for expert status were operating time of 15 minutes and modified OSATS score of 15/20. These thresholds predicted expert status with 84.2% and 71.4% accuracy respectively. Strong discriminative ability was demonstrated by AUC-ROC of 0.95 and 0.83 respectively. All expert surgeons agreed that RealSpine simulators demonstrate high face validity, and high visual and haptic fidelity, with overall scores showing statistically significant agreement on these items (all scores at least 4/5, p<.0001). There was less consensus on content validity, but with still significant overall agreement (average score: 3.75/5, p=.023). CONCLUSIONS Real-world surgical ability and experience can be accurately predicted by defining objective quantitative thresholds on high-fidelity simulations. The thresholds established here, along with other data presented in this paper, may inform objectives and standards to be established in a spinal surgical training curriculum.
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Affiliation(s)
- Chan Hee Koh
- Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Neurosciences Department, Cleveland Clinic London, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom.
| | - Sogha Khawari
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 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, University College London, London, United Kingdom
| | - David Choi
- Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Danyal Z Khan
- Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Parag Sayal
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J Marcus
- Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - George Prezerakos
- Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Neurosciences Department, Cleveland Clinic London, London, United Kingdom
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Silvestre J, Kang JD, Ravinsky RA, Lawrence JP, Reitman CA. Establishing case volume benchmarks for ACGME-accredited orthopedic surgery of the spine fellowship training. Spine J 2024; 24:1495-1501. [PMID: 38554735 DOI: 10.1016/j.spinee.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND CONTEXT There has been increasing scrutiny on the standardization of surgical training in the US. PURPOSE This study provides case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic spine surgery fellowship training. STUDY DESIGN/SETTING This was a retrospective cross-sectional study of fellows at ACGME-accredited orthopedic spine surgery fellowships (2017-2022). PATIENT SAMPLE N/A. OUTCOME MEASURES Reported case volume during fellowship training. METHODS Case volume percentiles were calculated across ACGME-defined case categories and temporal changes assessed via linear regression. Variability between the highest and lowest deciles by case volume was calculated as fold-differences (90th percentile/10th percentile). Sensitivity analyses were performed to identify potential targets for case minimum requirements. RESULTS A total of 163 spine surgery fellows were included in this study. Total mean reported spine surgery case volume increased from 313.2±122 in 2017 to 382.0±164 in 2022 (p=.19). Most cases were classified as adult (range, 97.2%-98.0%) over pediatric cases (range, 2.0%-2.8%). An average of 322.0 cases were reported and most were classified as laminectomy (32%), posterior arthrodesis (29%), and anterior arthrodesis (20%). Overall variability in total case volume was 2.4 and the greatest variability existed for posterior instrumentation (38.1), application of cage (34.6), anterior instrumentation (20.8), and fractures and dislocations (17.3). If case minimum requirements for total reported cases was assumed at 200 cases, then all spine fellows included in this study would achieve this requirement. However, if case minimum requirements were assumed at 250 total cases, then approximately thirty percent of fellows (n=49) would not achieve this requirement for graduation. CONCLUSIONS Increasingly, national societies and accrediting bodies for surgical education recognize the need for standardized training. This study provides benchmarks to inform potential case minimum requirements and help reduce variability during spine fellowship training. Future studies are needed to establish case minimum requirements for spine surgery fellowship training across comprehensive and granular case categories that cover the full gamut of orthopedic spine surgery.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA.
| | - James D Kang
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Robert A Ravinsky
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA
| | - James P Lawrence
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA
| | - Charles A Reitman
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA
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Alkadri S, Del Maestro RF, Driscoll M. Face, content, and construct validity of a novel VR/AR surgical simulator of a minimally invasive spine operation. Med Biol Eng Comput 2024; 62:1887-1897. [PMID: 38403863 DOI: 10.1007/s11517-024-03053-8] [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: 06/14/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
Mixed-reality surgical simulators are seen more objective than conventional training. The simulators' utility in training must be established through validation studies. Establish face-, content-, and construct-validity of a novel mixed-reality surgical simulator developed by McGill University, CAE-Healthcare, and DePuy Synthes. This study, approved by a Research Ethics Board, examined a simulated L4-L5 oblique lateral lumbar interbody fusion (OLLIF) scenario. A 5-point Likert scale questionnaire was used. Chi-square test verified validity consensus. Construct validity investigated 276 surgical performance metrics across three groups, using ANOVA, Welch-ANOVA, or Kruskal-Wallis tests. A post-hoc Dunn's test with a Bonferroni correction was used for further analysis on significant metrics. Musculoskeletal Biomechanics Research Lab, McGill University, Montreal, Canada. DePuy Synthes, Johnson & Johnson Family of Companies, research lab. Thirty-four participants were recruited: spine surgeons, fellows, neurosurgical, and orthopedic residents. Only seven surgeons out of the 34 were recruited in a side-by-side cadaver trial, where participants completed an OLLIF surgery first on a cadaver and then immediately on the simulator. Participants were separated a priori into three groups: post-, senior-, and junior-residents. Post-residents rated validity, median > 3, for 13/20 face-validity and 9/25 content-validity statements. Seven face-validity and 12 content-validity statements were rated neutral. Chi-square test indicated agreeability between group responses. Construct validity found eight metrics with significant differences (p < 0.05) between the three groups. Validity was established. Most face-validity statements were positively rated, with few neutrally rated pertaining to the simulation's graphics. Although fewer content-validity statements were validated, most were rated neutral (only four were negatively rated). The findings underscored the importance of using realistic physics-based forces in surgical simulations. Construct validity demonstrated the simulator's capacity to differentiate surgical expertise.
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Affiliation(s)
- Sami Alkadri
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, QC, H3A 2K7, Canada
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 2200 Leo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 2200 Leo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, QC, H3A 2K7, Canada.
- Orthopaedic Research Lab, Montreal General Hospital, 1650 Cedar Ave (LS1.409), Montreal, QC, H3G 1A4, Canada.
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Bcharah G, Gupta N, Panico N, Winspear S, Bagley A, Turnow M, D'Amico R, Ukachukwu AEK. Innovations in Spine Surgery: A Narrative Review of Current Integrative Technologies. World Neurosurg 2024; 184:127-136. [PMID: 38159609 DOI: 10.1016/j.wneu.2023.12.124] [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: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Neurosurgical technologies have become increasingly more adaptive, featuring real-time and patient-specific guidance in preoperative, intraoperative, and postoperative settings. This review offers insight into how these integrative innovations compare with conventional approaches in spine surgery, focusing on machine learning (ML), artificial intelligence, augmented reality and virtual reality, and spinal navigation systems. Data on technology applications, diagnostic and procedural accuracy, intraoperative times, radiation exposures, postoperative outcomes, and costs were extracted and compared with conventional methods to assess their advantages and limitations. Preoperatively, augmented reality and virtual reality have applications in surgical training and planning that are more immersive, case specific, and risk-free and have been shown to enhance accuracy and reduce complications. ML algorithms have demonstrated high accuracy in predicting surgical candidacy (up to 92.1%) and tailoring personalized treatments based on patient-specific variables. Intraoperatively, advantages include more accurate pedicle screw insertion (96%-99% with ML), enhanced visualization, reduced radiation exposure (49 μSv with O-arm navigation vs. 556 μSv with fluoroscopy), increased efficiency, and potential for fewer intraoperative complications compared with conventional approaches. Postoperatively, certain ML and artificial intelligence models have outperformed conventional methods in predicting all postoperative complications of >6000 patients as well as predicting variables contributing to in-hospital and 90-day mortality. However, applying these technologies comes with limitations, such as longer operative times (up to 35.6% longer) with navigation, dependency on datasets, costs, accessibility, steep learning curve, and inherent software malfunctions. As these technologies advance, continuing to assess their efficacy and limitations will be crucial to their successful integration within spine surgery.
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Affiliation(s)
- George Bcharah
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Nithin Gupta
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Nicholas Panico
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Spencer Winspear
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Austin Bagley
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Morgan Turnow
- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Randy D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA
| | - Alvan-Emeka K Ukachukwu
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA; Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA.
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Bui T, Ruiz-Cardozo MA, Dave HS, Barot K, Kann MR, Joseph K, Lopez-Alviar S, Trevino G, Brehm S, Yahanda AT, Molina CA. Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:332. [PMID: 38399619 PMCID: PMC10890632 DOI: 10.3390/medicina60020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR's main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case-control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct.
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Affiliation(s)
- Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Harsh S. Dave
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sofia Lopez-Alviar
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Lai C, Lui JT, de Lotbiniere-Bassett M, Chen JM, Lin VY, Agrawal SK, Blevins NH, Ladak HM, Pirouzmand F. Virtual Reality Simulation for the Middle Cranial Fossa Approach: A Validation Study. Oper Neurosurg (Hagerstown) 2024; 26:78-85. [PMID: 37747333 DOI: 10.1227/ons.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) surgical rehearsal is an educational tool that exists in a safe environment. Validation is necessary to establish the educational value of this platform. The middle cranial fossa (MCF) is ideal for simulation because trainees have limited exposure to this approach and it has considerable complication risk. Our objectives were to assess the face, content, and construct validities of an MCF VR simulation, as well as the change in performance across serial simulations. METHODS Using high-resolution volumetric data sets of human cadavers, the authors generated a high-fidelity visual and haptic rendering of the MCF approach using CardinalSim software. Trainees from Neurosurgery and Otolaryngology-Head and Neck Surgery at two Canadian academic centers performed MCF dissections on this VR platform. Randomization was used to assess the effect of enhanced VR interaction. Likert scales were used to assess the face and content validities. Performance metrics and pre- and postsimulation test scores were evaluated. Construct validity was evaluated by examining the effect of the training level on simulation performance. RESULTS Twenty trainees were enrolled. Face and content validities were achieved in all domains. Construct validity, however, was not demonstrated. Postsimulation test scores were significantly higher than presimulation test scores ( P < .001 ). Trainees demonstrated statistically significant improvement in the time to complete dissections ( P < .001 ), internal auditory canal skeletonization ( P < .001 ), completeness of the anterior petrosectomy ( P < .001 ), and reduced number of injuries to critical structures ( P = .001 ). CONCLUSION This MCF VR simulation created using CardinalSim demonstrated face and content validities. Construct validity was not established because no trainee included in the study had previous MCF approach experience, which further emphasizes the importance of simulation. When used as a formative educational adjunct in both Neurosurgery and Otolaryngology-Head and Neck Surgery, this simulation has the potential to enhance understanding of the complex anatomic relationships of critical neurovascular structures.
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Affiliation(s)
- Carolyn Lai
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | - Madeleine de Lotbiniere-Bassett
- Section of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Vincent Y Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head & Neck Surgery, London Health Sciences Centre-University Hospital, Western University, London , Ontario , Canada
| | - Nikolas H Blevins
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto , California , USA
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London , Ontario , Canada
- Department of Electrical & Computer Engineering, Western University, London , Ontario , Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
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Su JM, Wu CY, Hong WT, Chen PS, Hung KS, Wang CJ. Application of mobile-based web app to enhance simple suturing skills of nurse practitioners. NURSE EDUCATION TODAY 2023; 131:105959. [PMID: 37713781 DOI: 10.1016/j.nedt.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Suturing is a crucial clinical skill for nurse practitioners (NPs), but the effectiveness of traditional training methods (e.g., physical suture kits combined with video content) is low. OBJECTIVE This study compared the effectiveness and usability of a mobile-based web app (MoWa) developed for NPs to learn simple suturing skills with those of traditional instructional video-based training. METHODS The MoWa system utilizes mobile devices to simulate hands-on suturing and provides learning guidance and feedback to support self-learning with a physical suturing kit. Fifty-four suturing novices (NPs) were recruited as participants, divided into an experimental group (EG: 28 participants) and a control group (CG: 26 participants), and instructed to self-learn for 3 weeks. Learning effectiveness and system usability were evaluated through a pretest and posttest. RESULTS The EG exhibited significant improvements in learning outcomes, self-confidence, self-efficacy, and learning anxiety and expressed satisfaction with the MoWa system. Furthermore, the EG also considerably enhanced learning outcomes, self-efficacy, and learning anxiety compared to the CG, with no significant difference in self-confidence. CONCLUSION The MoWa system combined with deliberate practice is an effective strategy for supporting suturing skills training.
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Affiliation(s)
- Jun-Ming Su
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Chen-Yu Wu
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Wei-Ting Hong
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Pin-Shuo Chen
- National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan.
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Laskay NMB, George JA, Knowlin L, Chang TP, Johnston JM, Godzik J. Optimizing Surgical Performance Using Preoperative Virtual Reality Planning: A Systematic Review. World J Surg 2023; 47:2367-2377. [PMID: 37204439 DOI: 10.1007/s00268-023-07064-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational efficiency or "flow." Virtual Reality (VR) represents a technology by which to rehearse complex plans and communicate precise steps to a surgical team prior to entering the operating room. The objective of this study was to evaluate the use of VR for preoperative surgical team planning and interdisciplinary communication across all surgical specialties. METHODS A systematic review of the literature was performed examining existing research on VR use for preoperative surgical team planning and interdisciplinary communication across all surgical fields in order to optimize surgical efficiency. MEDLINE, SCOPUS, CINAHL databases were searched from inception to July 31, 2022 using standardized search clauses. A qualitative data synthesis was performed with particular attention to preoperative planning, surgical efficiency optimization, and interdisciplinary collaboration/communication techniques determined a priori. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. All included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool. RESULTS One thousand and ninety-three non-duplicated articles with abstract and full text availability were identified. Thirteen articles that examined preoperative VR-based planning techniques for optimization of surgical efficiency and/or interdisciplinary communication fulfilled inclusion and exclusion criteria. These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61). CONCLUSIONS This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, 1060 Faculty Office Tower, 1720 2nd Avenue South, Birmingham, AL, 35294-3410, USA.
| | - Jordan A George
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laquanda Knowlin
- Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1060 Faculty Office Tower, 1720 2nd Avenue South, Birmingham, AL, 35294-3410, USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, 1060 Faculty Office Tower, 1720 2nd Avenue South, Birmingham, AL, 35294-3410, USA
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Mondal S, Kelkar AS, Singh R, Jayadev C, Saravanan VR, Kelkar JA. What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey. Indian J Ophthalmol 2023; 71:3064-3068. [PMID: 37530282 PMCID: PMC10538810 DOI: 10.4103/ijo.ijo_381_23] [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: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To profile vitreoretinal (VR) fellows-in-training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill-transfer curriculum. Methods A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag-Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work-hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator-based training should be made mandatory before operating room exposure. Conclusion This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows-in-training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.
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Affiliation(s)
- Sukanya Mondal
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Ramandeep Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chaitra Jayadev
- Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | | | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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12
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Chatelain LS, Khalifé M, Riouallon G, Guigui P, Ferrero E. Pedagogy in spine surgery: developing a free and open-access virtual simulator for lumbar pedicle screws placement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:712-717. [PMID: 36576538 DOI: 10.1007/s00586-022-07501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/20/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Simulators for pedicle screws placement range from basic sawbones to virtual reality. Yet, they remain expensive and often require specific devices. No free online virtual simulator has yet been developed. The goal was to design a freely accessible Web-based simulator. METHODS The computer simulator consisted of a lumbar spine, a red box hiding the pedicles and five pairs of screws. After inserting the screws, the red box was removed to assess their position. A validation study was conducted with 24 medical students randomized into a simulation and a control group. All had a basic course on pedicle screws. The 12 simulation group students performed two sessions on computer. All 24 students then conducted a final common step on sawbones. The number of misplaced screws, types of breaches, and simulation times were analyzed. RESULTS In the final sawbones simulation, 96 real screws were studied. Control group misplaced 50% of their screws compared with only 20.8% in the simulation group (p < 0.05). More careful, simulation group students were slower to insert their real screws. Over the two computer simulations, the rate of misplaced screws decreased (12.5% vs. 38.3%), showing a good handling of the simulator. Students were able to analyze and correct their pedicle breaches. CONCLUSION This tool is the first free online lumbar pedicle screws simulator. Simulation helped students to better position the final real screws on sawbones. This project showed it was possible to create a free educational tool with no special equipment. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Léonard Swann Chatelain
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou (HEGP), 20 Rue Leblanc, 75015, Paris, France.
| | - Marc Khalifé
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou (HEGP), 20 Rue Leblanc, 75015, Paris, France
| | - Guillaume Riouallon
- Department of Orthopedic Surgery, Hôpital Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Pierre Guigui
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou (HEGP), 20 Rue Leblanc, 75015, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou (HEGP), 20 Rue Leblanc, 75015, Paris, France
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Lee S, Shetty AS, Cavuoto L. Modeling of Learning Processes Using Continuous-Time Markov Chain for Virtual-Reality-Based Surgical Training in Laparoscopic Surgery. IEEE TRANSACTIONS ON LEARNING TECHNOLOGIES 2023; 17:462-473. [PMID: 38617582 PMCID: PMC11013959 DOI: 10.1109/tlt.2023.3236899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Recent usage of Virtual Reality (VR) technology in surgical training has emerged because of its cost-effectiveness, time savings, and cognition-based feedback generation. However, the quantitative evaluation of its effectiveness in training is still not studied thoroughly. This paper demonstrates the effectiveness of a VR-based surgical training simulator in laparoscopic surgery and investigates how stochastic modeling represented as Continuous-time Markov-chain (CTMC) can be used to explicit the training status of the surgeon. By comparing the training in real environments and in VR-based training simulators, the authors also explore the validity of the VR simulator in laparoscopic surgery. The study further aids in establishing learning models of surgeons, supporting continuous evaluation of training processes for the derivation of real-time feedback by CTMC-based modeling.
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Affiliation(s)
- Seunghan Lee
- Industrial and Systems Engineering Department at Mississippi State University
| | | | - Lora Cavuoto
- Industrial and Systems Engineering at the University at Buffalo, Buffalo, NY, USA
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Durrani S, Onyedimma C, Jarrah R, Bhatti A, Nathani KR, Bhandarkar AR, Mualem W, Ghaith AK, Zamanian C, Michalopoulos GD, Alexander AY, Jean W, Bydon M. The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room. World Neurosurg 2022; 168:190-201. [DOI: 10.1016/j.wneu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
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Xie T, Zheng L, Liu G, Liu L. Exploring structural relations among computer self-efficacy, perceived immersion, and intention to use virtual reality training systems. VIRTUAL REALITY 2022; 26:1725-1744. [PMID: 35730035 PMCID: PMC9197332 DOI: 10.1007/s10055-022-00656-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
The use of virtual reality (VR) training systems for education has grown in popularity in recent years. Scholars have reported that self-efficacy and interactivity are important predictors of learning outcomes in virtual learning environments, but little empirical research has been conducted to explain how computer self-efficacy (as a subcategory of self-efficacy) and perceived immersion (as a correlate of interactivity) are connected to the intention to use VR training systems. The present study aims to determine which factors significantly influence behavioral intention when students are exposed to VR training systems via an updated technology acceptance frame by incorporating the constructs of computer self-efficacy and perceived immersion simultaneously. We developed a VR training system regarding circuit connection and a reliable and validated instrument including 9 subscales. The sample data were collected from 124 junior middle school students and 210 senior high school students in two schools located in western China. The samples were further processed into a structural equation model with path analysis and cohort analysis. The results showed that the intention to use VR training systems was indirectly influenced by computer self-efficacy but directly influenced by perceived immersion (β = 0.451). However, perceived immersion seemed to be influenced mostly by learner interaction (β = 0.332). Among external variables, learner interaction (β = 0.149) had the largest total effect on use intention, followed by facilitating conditions (β = 0.138), computer self-efficacy (β = 0.104), experimental fidelity (β = 0.083), and subjective norms (β = 0.077). The moderating roles of gender differences, grade level, and previous experience in structural relations were also identified. The findings of the present study highlight the ways in which factors and associations are considered in the practical development of VR training systems.
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Affiliation(s)
- Tao Xie
- Faculty of Education, Southwest University, Chongqing, 400715 China
| | - Ling Zheng
- Faculty of Education, Southwest University, Chongqing, 400715 China
- Faculty of Yibin Radio and TV University, Sichuan, China
| | - Geping Liu
- Faculty of Education, Southwest University, Chongqing, 400715 China
| | - Leping Liu
- College of Education, University of Nevada, Reno, NV 89557 USA
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16
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Simulation Training in Spine Surgery. J Am Acad Orthop Surg 2022; 30:400-408. [PMID: 35446299 DOI: 10.5435/jaaos-d-21-00756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Simulated surgery is part of a growing paradigm shift in surgical education as a whole. Various modalities from cadaver models to virtual reality have been developed and studied within the context of surgical education. Simulation training in spine surgery has an immense potential to improve education and ultimately improve patient safety. This is due to the inherent risk of operating the spine and the technical difficulty of modern techniques. Common procedures in the modern orthopaedic armamentarium, such as pedicle screw placement, can be simulated, and proficiency is rapidly achieved before application in patients. Furthermore, complications such as dural tears can be simulated and effectively managed in a safe environment with simulation. New techniques with steeper learning curves, such as minimally invasive techniques, can now be safely simulated. Hence, augmenting surgical education through simulation has great potential to benefit trainees and practicing orthopaedic surgeons in modern spine surgery techniques. Additional work will aim to improve access to such technologies and integrate them into the current orthopaedic training curriculum.
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Tudor Car L, Poon S, Kyaw BM, Cook DA, Ward V, Atun R, Majeed A, Johnston J, van der Kleij RMJJ, Molokhia M, V Wangenheim F, Lupton M, Chavannes N, Ajuebor O, Prober CG, Car J. Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda. J Med Internet Res 2022; 24:e31977. [PMID: 35297767 PMCID: PMC8972116 DOI: 10.2196/31977] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. OBJECTIVE This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. METHODS We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. RESULTS We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). CONCLUSIONS We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Selina Poon
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - David A Cook
- Office of Applied Scholarship and Education Science, School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victoria Ward
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, MA, United States
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Johnston
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Mariam Molokhia
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Florian V Wangenheim
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Lupton
- Faculty of Medicine, Imperial College London, London, United Kingdom
- The Chelsea and Westminster Hospital, Chelsea, London, United Kingdom
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Onyema Ajuebor
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Charles G Prober
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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18
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Herrera-Aliaga E, Estrada LD. Trends and Innovations of Simulation for Twenty First Century Medical Education. Front Public Health 2022; 10:619769. [PMID: 35309206 PMCID: PMC8929194 DOI: 10.3389/fpubh.2022.619769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
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Affiliation(s)
| | - Lisbell D. Estrada
- Faculty of Health Sciences, Universidad Bernardo O'Higgins, Santiago, Chile
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19
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C-arm free simultaneous OLIF51 and percutaneous pedicle screw fixation in a single lateral position: A technical note. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Zhang JK, Del Valle A, Ivankovic S, Patel N, Alexopoulos G, Khan M, Durrani S, Patel M, Tecle NE, Sujijantarat N, Jenson AV, Zammar SG, Huntoon K, Goulart CR, Wilkinson BM, Bhimireddy S, Britz GW, DiLuna M, Prevedello DM, Dinh DH, Mattei TA. Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100104. [PMID: 35224520 PMCID: PMC8856749 DOI: 10.1016/j.xnsj.2022.100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022]
Abstract
Background The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads. Methods A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions. Results When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend). Conclusions Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.
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Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Armando Del Valle
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Sven Ivankovic
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Niel Patel
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Georgios Alexopoulos
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Maheen Khan
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Sulaman Durrani
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Mayur Patel
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Najib El Tecle
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | | | - Amanda V Jenson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, 77030, US
| | - Samer G Zammar
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, 17033, US
| | - Kristin Huntoon
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Carlos R Goulart
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, 13210, US
| | - Brandon M Wilkinson
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, 13210, US
| | - Sujit Bhimireddy
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, 77030, US
| | - Michael DiLuna
- Department of Neurosurgery, Yale University, New Haven, Connecticut, 06510, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Dzung H Dinh
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Tobias A Mattei
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
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Mishra R, Narayanan MK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031719. [PMID: 35162742 PMCID: PMC8835688 DOI: 10.3390/ijerph19031719] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Background: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. Methods: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989–2021. An example of a search strategy used in PubMed Central is: “Virtual reality” [All Fields] AND (“neurosurgical procedures” [MeSH Terms] OR (“neurosurgical” [All Fields] AND “procedures” [All Fields]) OR “neurosurgical procedures” [All Fields] OR “neurosurgery” [All Fields] OR “neurosurgery” [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). Results: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. Conclusions: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in “social distancing” in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.
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Affiliation(s)
- Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India;
| | | | - Giuseppe E. Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital, Birgunj 44300, Nepal;
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India;
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22
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Topini A, Sansom W, Secciani N, Bartalucci L, Ridolfi A, Allotta B. Variable Admittance Control of a Hand Exoskeleton for Virtual Reality-Based Rehabilitation Tasks. Front Neurorobot 2022; 15:789743. [PMID: 35095457 PMCID: PMC8790045 DOI: 10.3389/fnbot.2021.789743] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/15/2021] [Indexed: 12/05/2022] Open
Abstract
Robot-based rehabilitation is consolidated as a viable and efficient practice to speed up and improve the recovery of lost functions. Several studies highlight that patients are encouraged to undergo their therapies and feel more involved in the process when collaborating with a user-friendly robotic environment. Object manipulation is a crucial element of hand rehabilitation treatments; however, as a standalone process may result in being repetitive and unstimulating in the long run. In this view, robotic devices, like hand exoskeletons, do arise as an excellent tool to boost both therapy's outcome and patient participation, especially when paired with the advantages offered by interacting with virtual reality (VR). Indeed, virtual environments can simulate real-life manipulation tasks and real-time assign a score to the patient's performance, thus providing challenging exercises while promoting training with a reward-based system. Besides, they can be easily reconfigured to match the patient's needs by manipulating exercise intensity, e.g., Assistance-As-Needed (AAN) and the required tasks. Modern VR can also render interaction forces when paired to wearable devices to give the user some sort of proprioceptive force or tactile feedback. Motivated by these considerations, a Hand Exoskeleton System (HES) has been designed to be interfaced with a variable admittance control to achieve VR-based rehabilitation tasks. The exoskeleton assists the patient's movements according to force feedback and following a reference value calculated inside the VR. Whenever the patient grasps a virtual object, the HES provides the user with a force feedback sensation. In this paper, the virtual environment, developed within the Webots framework and rendering a HES digital-twin mapping and mimicking the actual HES motion, will be described in detail. Furthermore, the admittance control strategy, which continuously varies the control parameters to best render the force sensation and adapt to the user's motion intentions, will be investigated. The proposed approach has been tested on a single subject in the framework of a pilot study.
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Affiliation(s)
- Alberto Topini
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - William Sansom
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Nicola Secciani
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Lorenzo Bartalucci
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Alessandro Ridolfi
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Benedetto Allotta
- Department of Industrial Engineering, University of Florence, Florence, Italy
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23
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Guérinot C, Marcon V, Godard C, Blanc T, Verdier H, Planchon G, Raimondi F, Boddaert N, Alonso M, Sailor K, Lledo PM, Hajj B, El Beheiry M, Masson JB. New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing. FRONTIERS IN BIOINFORMATICS 2022; 1:777101. [PMID: 36303792 PMCID: PMC9580868 DOI: 10.3389/fbinf.2021.777101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.
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Affiliation(s)
- Corentin Guérinot
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Valentin Marcon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Charlotte Godard
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Thomas Blanc
- Sorbonne Université, Collège Doctoral, Paris, France
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Histopathology and Bio-Imaging Group, Sanofi R&D, Vitry-Sur-Seine, France
- Université de Paris, UFR de Physique, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Francesca Raimondi
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Kurt Sailor
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Bassam Hajj
- Sorbonne Université, Collège Doctoral, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
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24
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Muff JL, Heye T, Thieringer FM, Brantner P. Clinical acceptance of advanced visualization methods: a comparison study of 3D-print, virtual reality glasses, and 3D-display. 3D Print Med 2022; 8:5. [PMID: 35094166 PMCID: PMC8801110 DOI: 10.1186/s41205-022-00133-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/17/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To compare different methods of three-dimensional representations, namely 3D-Print, Virtual Reality (VR)-Glasses and 3D-Display regarding the understanding of the pathology, accuracy of details, quality of the anatomical representation and technical operability and assessment of possible change in treatment in different disciplines and levels of professional experience. METHODS Interviews were conducted with twenty physicians from the disciplines of cardiology, oral and maxillofacial surgery, orthopedic surgery, and radiology between 2018 and 2020 at the University Hospital of Basel. They were all presented with three different three-dimensional clinical cases derived from CT data from their area of expertise, one case for each method. During this, the physicians were asked for their feedback written down on a pencil and paper questionnaire. RESULTS Concerning the understanding of the pathology and quality of the anatomical representation, VR-Glasses were rated best in three out of four disciplines and two out of three levels of professional experience. Regarding the accuracy of details, 3D-Display was rated best in three out of four disciplines and all levels of professional experience. As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines. Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants. Physicians with a professional experience of more than ten years reported no change in treatment using any method. CONCLUSIONS 3D-Print, VR-Glasses, and 3D-Displays are very well accepted, and a relevant percentage of participants with less than ten years of professional work experience could imagine a possible change in treatment using any of these three-dimensional methods. Our findings challenge scientists, technicians, and physicians to further develop these methods to improve the three-dimensional understanding of pathologies and to add value to the education of young and inexperienced physicians.
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Affiliation(s)
- Julian Louis Muff
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
| | - Tobias Heye
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Florian Markus Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery and 3D Print Lab, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Philipp Brantner
- Department of Radiology, Gesundheitszentrum Fricktal, Rheinfelden, Switzerland
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25
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XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis. J Clin Med 2022; 11:jcm11020470. [PMID: 35054164 PMCID: PMC8779726 DOI: 10.3390/jcm11020470] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).
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26
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Application of virtual reality in neurosurgery: Patient missing. A systematic review. J Clin Neurosci 2021; 95:55-62. [PMID: 34929652 DOI: 10.1016/j.jocn.2021.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/06/2021] [Accepted: 11/26/2021] [Indexed: 01/18/2023]
Abstract
Virtual reality (VR) technology had its earliest developments in the 1970s in the U.S. Air Force and has since evolved into a budding area of scientific research with many practical medical purposes. VR shows a high potential to benefit to learners and trainees and improve surgery through enhanced preoperative planning and efficiency in the operating room. Neurosurgery is a field of medicine in which VR has been accepted early on as a useful and promising tool for neuro-navigation planning. Through recent technological developments, VR further increased its level of immersion, accessibility and intuitive use for surgeons and students and now reveals a therapeutic potential for patients. In this paper, we systematically reviewed the neurosurgery literature regarding the use of VR as an assistance for surgery or a tool centered on patients' care. A literature search conducted according to PRISMA guidelines resulted in the screening of 125 abstracts and final inclusion of 100 original publications reviewed. The review shows that neurosurgeons are now relatively familiar with VR technologies (N = 95 articles) for their training and practice. VR technologies are useful for education, pain management and rehabilitation in neurosurgical patients. Nevertheless, the current patient-oriented use of VR remains limited (N = 5 articles). Successful surgery does not only depend on the surgeon's skills and preparation, but also on patients' education, comfort, empowerment and care. Therefore further clinical research is needed to promote the direct use of VR technologies by patients in neurosurgery.
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27
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Uddin SA, Hanna G, Ross L, Molina C, Urakov T, Johnson P, Kim T, Drazin D. Augmented Reality in Spinal Surgery: Highlights From Augmented Reality Lectures at the Emerging Technologies Annual Meetings. Cureus 2021; 13:e19165. [PMID: 34873508 PMCID: PMC8631483 DOI: 10.7759/cureus.19165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Augmented reality (AR) is an advanced technology and emerging field that has been adopted into spine surgery to enhance care and outcomes. AR superimposes a three-dimensional computer-generated image over the normal anatomy of interest in order to facilitate visualization of deep structures without the ability to directly see them. Objective To summarize the latest literature and highlight AR from the annual “Spinal Navigation, Emerging Technologies and Systems Integration” meeting lectures presented by the Seattle Science Foundation (SSF) on the development and use of augmented reality in spinal surgery. Methods We performed a comprehensive literature review from 2016 to 2020 on PubMed to correlate with lectures given at the annual “Emerging Technologies” conferences. After the exclusion of papers that concerned non-spine surgery specialties, a total of 54 papers concerning AR in spinal applications were found. The articles were then categorized by content and focus. Results The 54 papers were divided into six major focused topics: training, proof of concept, feasibility and usability, clinical evaluation, state of technology, and nonsurgical applications. The greatest number of papers were published during 2020. Each paper discussed varied topics such as patient rehabilitation, proof of concept, workflow, applications in neurological and orthopedic spine surgery, and outcomes data. Conclusions The recent literature and SSF lectures on AR provide a solid base and demonstrate the emergence of an advanced technology that offers a platform for an advantageous technique that is superior, in that it allows the operating surgeon to focus directly on the patient rather than a guidance screen.
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Affiliation(s)
| | - George Hanna
- Neurosurgery, Cedars-Sinai Spine Center, Los Angeles, USA
| | - Lindsey Ross
- Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Camilo Molina
- Neurological Surgery, Washington University School of Medicine, St. Louis, USA
| | - Timur Urakov
- Neurological Surgery, University of Miami, Miami, USA
| | - Patrick Johnson
- Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Terrence Kim
- Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Doniel Drazin
- Medicine, Pacific Northwest University of Health Sciences, Yakima, USA
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28
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Examining the benefits of extended reality in neurosurgery: A systematic review. J Clin Neurosci 2021; 94:41-53. [PMID: 34863461 DOI: 10.1016/j.jocn.2021.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/18/2021] [Accepted: 09/25/2021] [Indexed: 01/14/2023]
Abstract
While well-established in other surgical subspecialties, the benefits of extended reality, consisting of virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies, remains underexplored in neurosurgery despite its increasing utilization. To address this gap, we conducted a systematic review of the effects of extended reality (XR) in neurosurgery with an emphasis on the perioperative period, to provide a guide for future clinical optimization. Seven primary electronic databases were screened following guidelines outlined by PRISMA and the Institute of Medicine. Reported data related to outcomes in the perioperative period and resident training were all examined, and a focused analysis of studies reporting controlled, clinical outcomes was completed. After removal of duplicates, 2548 studies were screened with 116 studies reporting measurable effects of XR in neurosurgery. The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes. A rise in high-quality studies was identified from 2017 to 2020 compared to all previous years (p = 0.004). Primary users of the technology were: 56% neurosurgeon (n = 65), 28% residents (n = 33) and 5% patients (n = 6). A final synthesis was conducted on 10 controlled studies reporting patient outcomes. XR technologies have demonstrated benefits in preoperative planning and multimodal neuronavigation especially for tumor surgery. However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data. XR platforms offer several advantages to improve patient outcomes and specifically, the patient experience for neurosurgery.
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29
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Lad M, Gupta R, Para A, Gupta A, White MD, Agarwal N, Moore JM, Heary RF. An ACGME-based comparison of neurosurgical and orthopedic resident training in adult spine surgery via a case volume and hours-based analysis. J Neurosurg Spine 2021; 35:553-563. [PMID: 34359032 DOI: 10.3171/2020.10.spine201066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In a 2014 analysis of orthopedic and neurological surgical case logs published by the Accreditation Council for Graduate Medical Education (ACGME), it was reported that graduating neurosurgery residents performed more than twice the number of spinal procedures in their training compared with graduating orthopedic residents. There has, however, been no follow-up assessment of this trend. Moreover, whether this gap in case volume equates to a similar gap in procedural hours has remained unstudied. Given the association between surgical volume and outcomes, evaluating the status of this disparity has value. Here, the authors assess trends in case volume and procedural hours in adult spine surgery for graduating orthopedic and neurological surgery residents from 2014 to 2019. METHODS A retrospective analysis of ACGME case logs from 2014 to 2019 for graduating orthopedic and neurological surgery residents was conducted for adult spine surgeries. Case volume was converted to operative hours by using periprocedural times from the 2019 Medicare/Medicaid Physician Fee Schedule. Graduating residents' spinal cases and hours, averaged over the study period, were compared between the two specialties by using 2-tailed Welch's unequal variances t-tests (α = 0.05). Longitudinal trends in each metric were assessed by linear regression followed by cross-specialty comparisons via tests for equality of slopes. RESULTS From 2014 to 2019, graduating neurosurgical residents logged 6.8 times as many spinal cases as their orthopedic counterparts, accruing 431.6 (95% CI 406.49-456.61) and 63.8 (95% CI 57.08-70.56) cases (p < 0.001), respectively. Accordingly, graduating neurosurgical residents logged 6.1 times as many spinal procedural hours as orthopedic surgery residents, accruing 1020.7 (95% CI 964.70-1076.64) and 166.6 (95% CI 147.76-185.35) hours (p < 0.001), respectively. Over these 5 years, both fields saw a linear increase in graduating residents' adult spinal case volumes and procedural hours, and these growth rates were higher for neurosurgery (+16.2 cases/year vs +4.4 cases/year, p < 0.001; +36.4 hours/year vs +12.4 hours/year, p < 0.001). CONCLUSIONS Graduating neurosurgical residents accumulated substantially greater adult spinal case volumes and procedural hours than their orthopedic counterparts from 2014 to 2019. This disparity has been widened by a higher rate of growth in adult spinal cases among neurosurgery residents. Accordingly, targeted efforts to increase spinal exposure for orthopedic surgery residents-such as using cross-specialty collaboration-should be explored.
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Affiliation(s)
- Meeki Lad
- 1Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Raghav Gupta
- 1Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey
- 2Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashok Para
- 1Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Arjun Gupta
- 1Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Michael D White
- 3Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- 3Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Justin M Moore
- 4Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Robert F Heary
- 5Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey
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30
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Donoho DA, Pangal DJ, Kugener G, Rutkowski M, Micko A, Shahrestani S, Brunswick A, Minneti M, Wrobel BB, Zada G. Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention. J Neurosurg 2021; 135:1347-1355. [PMID: 33740764 DOI: 10.3171/2020.9.jns202672] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Internal carotid artery injury (ICAI) is a rare, life-threatening complication of endoscopic endonasal approaches that will be encountered by most skull base neurosurgeons and otolaryngologists. Rates of surgical proficiency for managing ICAI are not known, and the role of simulation to improve performance has not been studied on a nationwide scale. METHODS Attending and resident neurosurgery and otorhinolaryngology surgeons (n = 177) were recruited from multicenter regional and national training courses to assess training outcomes and validity at scale of a prospective educational intervention to improve surgeon technical skills using a previously validated, perfused human cadaveric simulator. Participants attempted an initial trial (T1) of simulated ICAI control using their preferred technique. An educational intervention including personalized instruction was performed. Participants attempted a second trial (T2). Task success (dichotomous), time to hemostasis (TTH), estimated blood loss (EBL), and surgeon heart rate were measured. RESULTS Participant rating scales confirmed that the simulation retained face and construct validity across eight instructional settings. Trial success (ICAI control) improved from 56% in T1 to 90% in T2 (p < 0.0001). EBL and TTH decreased by 37% and 38%, respectively (p < 0.0001). Postintervention resident surgeon performance (TTH, EBL, and success rate) was superior to preintervention attending surgeon performance. The most improved quartile of participants achieved 62% improvement in TTH and 73% improvement in EBL, with trial success improvement from 25.6% in T1 to 100% in T2 (p < 0.0001). Baseline surgeon confidence was uncorrelated with T1 success, while posttraining confidence correlated with T2 success. Tachycardia was measured in 57% of surgeon participants, but was attenuated during T2, consistent with development of resiliency. CONCLUSIONS Prior to training, many attending and most resident surgeons could not manage the rare, life-threatening intraoperative complication of ICAI. A simulated educational intervention significantly improved surgeon performance and remained valid when deployed at scale. Simulation also promoted the development of favorable cognitive skills (accurate perception of skill and resiliency). Rare, life-threatening intraoperative complications may be optimal targets for educational interventions using surgical simulation.
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Affiliation(s)
| | | | | | | | - Alexander Micko
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Medical University Vienna, Austria; and
| | - Shane Shahrestani
- Departments of1Neurosurgery and
- 3Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | | | | | - Bozena B Wrobel
- 5Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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31
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Jung C, Wolff G, Wernly B, Bruno RR, Franz M, Schulze PC, Silva JNA, Silva JR, Bhatt DL, Kelm M. Virtual and Augmented Reality in Cardiovascular Care: State-of-the-Art and Future Perspectives. JACC Cardiovasc Imaging 2021; 15:519-532. [PMID: 34656478 DOI: 10.1016/j.jcmg.2021.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
Applications of virtual reality (VR) and augmented reality (AR) assist both health care providers and patients in cardiovascular education, complementing traditional learning methods. Interventionalists have successfully used VR to plan difficult procedures and AR to facilitate complex interventions. VR/AR has already been used to treat patients, during interventions in rehabilitation programs and in immobilized intensive care patients. There are numerous additional potential applications in the catheterization laboratory. By using AR, interventionalists could combine visual fluoroscopy information projected and registered on the patient body with data derived from preprocedural imaging and live fusion of different imaging modalities such as fluoroscopy with echocardiography. Persistent technical challenges to overcome include the integration of different imaging modalities into VR/AR and the harmonization of data flow and interfaces. Cybersickness might exclude some patients and users from the potential benefits of VR/AR. Critical ethical considerations arise in the application of VR/AR in vulnerable patients. In addition, digital applications must not distract physicians from the patient. It is our duty as physicians to participate in the development of these innovations to ensure a virtual health reality benefit for our patients in a real-world setting. The purpose of this review is to summarize the current and future role of VR and AR in different fields within cardiology, its challenges, and perspectives.
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Affiliation(s)
- Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Georg Wolff
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology and Intensive Care, Paracelsus Medical University of Salzburg, Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Medical Faculty, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Medical Faculty, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - Jennifer N Avari Silva
- Pediatric Cardiology Division, Department of Pediatrics, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA; SentiAR, Saint Louis, Missouri, USA
| | - Jonathan R Silva
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA; SentiAR, Saint Louis, Missouri, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/DLBHATTMD
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany; Cardiovascular Research Institute Duesseldorf, Düsseldorf, Germany
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Alkadri S, Ledwos N, Mirchi N, Reich A, Yilmaz R, Driscoll M, Del Maestro RF. Utilizing a multilayer perceptron artificial neural network to assess a virtual reality surgical procedure. Comput Biol Med 2021; 136:104770. [PMID: 34426170 DOI: 10.1016/j.compbiomed.2021.104770] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Virtual reality surgical simulators are a safe and efficient technology for the assessment and training of surgical skills. Simulators allow trainees to improve specific surgical techniques in risk-free environments. Recently, machine learning has been coupled to simulators to classify performance. However, most studies fail to extract meaningful observations behind the classifications and the impact of specific surgical metrics on the performance. One benefit from integrating machine learning algorithms, such as Artificial Neural Networks, to simulators is the ability to extract novel insights into the composites of the surgical performance that differentiate levels of expertise. OBJECTIVE This study aims to demonstrate the benefits of artificial neural network algorithms in assessing and analyzing virtual surgical performances. This study applies the algorithm on a virtual reality simulated annulus incision task during an anterior cervical discectomy and fusion scenario. DESIGN An artificial neural network algorithm was developed and integrated. Participants performed the simulated surgical procedure on the Sim-Ortho simulator. Data extracted from the annulus incision task were extracted to generate 157 surgical performance metrics that spanned three categories (motion, safety, and efficiency). SETTING Musculoskeletal Biomechanics Research Lab; Neurosurgical Simulation and Artificial Intelligence Learning Center, McGill University, Montreal, Canada. PARTICIPANTS Twenty-three participants were recruited and divided into 3 groups: 11 post-residents, 5 senior and 7 junior residents. RESULTS An artificial neural network model was trained on nine selected surgical metrics, spanning all three categories and achieved 80% testing accuracy. CONCLUSIONS This study outlines the benefits of integrating artificial neural networks to virtual reality surgical simulators in understanding composites of expertise performance.
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Affiliation(s)
- Sami Alkadri
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, H3A 2K7, QC, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Aiden Reich
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, H3A 2K7, QC, Canada.
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
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Ong T, Wilczewski H, Paige SR, Soni H, Welch BM, Bunnell BE. Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint. JMIR Serious Games 2021; 9:e26520. [PMID: 34227992 PMCID: PMC8315161 DOI: 10.2196/26520] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic caused widespread challenges and revealed vulnerabilities across global health care systems. In response, many health care providers turned to telehealth solutions, which have been widely embraced and are likely to become standard for modern care. Immersive extended reality (XR) technologies have the potential to enhance telehealth with greater acceptability, engagement, and presence. However, numerous technical, logistic, and clinical barriers remain to the incorporation of XR technology into telehealth practice. COVID-19 may accelerate the union of XR and telehealth as researchers explore novel solutions to close social distances. In this viewpoint, we highlight research demonstrations of XR telehealth during the COVID-19 pandemic and discuss future directions to make XR the next evolution of remote health care.
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Affiliation(s)
- Triton Ong
- Doxy.me, LLC, Rochester, NY, United States
| | | | | | - Hiral Soni
- Doxy.me, LLC, Rochester, NY, United States
| | - Brandon M Welch
- Doxy.me, LLC, Rochester, NY, United States
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brian E Bunnell
- Doxy.me, LLC, Rochester, NY, United States
- Department of Psychiatry, University of South Florida, Tampa, FL, United States
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Mao RQ, Lan L, Kay J, Lohre R, Ayeni OR, Goel DP, Sa DD. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res 2021; 268:40-58. [PMID: 34284320 DOI: 10.1016/j.jss.2021.06.045] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons. METHODS A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated. RESULTS The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I2=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control. CONCLUSIONS Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
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Affiliation(s)
- Randi Q Mao
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Lucy Lan
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Ryan Lohre
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
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Abstract
BACKGROUND Time-based training models in plastic surgery vary in exposure, resulting in low confidence levels among graduates. The evolution of postgraduate medical education into a competency-based model to address these issues requires an understanding of interventions described in the plastic surgery literature to identify gaps and guide creation of assessments to demonstrate competence. METHODS A systematic search of the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Cochrane databases from inception until December of 2017 was conducted using search terms and synonyms of educational interventions reported in plastic surgery. Full texts were retrieved following filtering and data extracted were related to intervention design and execution, involvement of competency assessment, and educational objectives and alignment to Accreditation Council for Graduate Medical Education competencies and Royal College of Physicians and Surgeons of Canada Canadian Medical Education Directives for Specialists roles. Study quality was assessed using Kirkpatrick's levels of learning evaluation, validity evidence, and the Medical Education Research Study Quality Instrument score. RESULTS Of the initial 4307 results, only 36 interventions met the inclusion criteria. Almost all interventions aligned to medical knowledge and patient care Accreditation Council for Graduate Medical Education competencies. One-fifth of the interventions involved no assessment of competency, whereas most displayed assessment at the level of design as opposed to outcomes. Quality assessment revealed low levels of learning evaluation and evidence of validity; the average Medical Education Research Study Quality Instrument score was 10.9 of 18. CONCLUSION A systematic review of educational literature in plastic surgery was conducted to assess the quality of reported educational interventions, and to help guide creating tools that ensure competency acquirement among trainees.
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Gong J, Ruan M, Yang W, Peng M, Wang Z, Ouyang L, Yang G. Application of blended learning approach in clinical skills to stimulate active learning attitudes and improve clinical practice among medical students. PeerJ 2021; 9:e11690. [PMID: 34221742 PMCID: PMC8236236 DOI: 10.7717/peerj.11690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The recent application of blended educational methods has impacted medical education and has drawn attention to a new teaching method. This teaching style presents unique opportunities and challenges. We investigated the effects of blended learning and traditional teaching methods on clinical skill development. METHODS We sorted 200 medical students from Tongji Medical College at Huazhong University of Science and Technology into a control or experimental group. The control group was taught with a traditional lecture-based learning method and the experimental group was taught using a blended learning method. The two groups were compared after training to assess their theoretical and practical differences. A student satisfaction survey was given to participants in both groups. RESULTS The results of the experimental group's theoretical and practical assessments were found to be significantly higher (p < 0.05) than that of the control group. The student satisfaction survey showed that blended learning was significantly more effective for acquiring relevant knowledge, enhancing student-centered learning and improving clinical practice. CONCLUSIONS Blended learning may address deficiencies in clinical skills, make up for limited time and space, and ensure learning efficiency and quality.
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Affiliation(s)
- Jie Gong
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manzhen Ruan
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Yang
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Miao Peng
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Wang
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lichen Ouyang
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, China
| | - Guangyao Yang
- The Clinical Skill Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hong W, Liu Y, He B, Huang S, Chen Z, Liao Z, Yi Z, Su X, Shi J. Assessment of a 3D printed simulator of a lateral ventricular puncture in interns' surgical training. Br J Neurosurg 2021; 35:597-602. [PMID: 34092175 DOI: 10.1080/02688697.2021.1922608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, a simulator for training lateral ventricular puncture (LVP) was developed using three-dimensional (3D) printing technology, and its function of improving the skills of LVP in young interns was evaluated. METHODS A virtual 3D craniocerebral simulator of a 51-year-old female patient with hydrocephalus was reconstructed with 3D printing technology. The anatomical and practical validity were assessed by all interns on a 13-item Likert scale. The usefulness of this simulator was evaluated once a week by two neurosurgeons, based on the performance of the interns, using the objective structured assessment of technical skills (OSATS) scale. RESULTS The Likert scale showed that all participants agreed with the overall appearance of the simulator. Also, the authenticity of the skull was the best, followed by the lateral ventricles, analog generation system of intraventricular pressure, cerebrum, and the scalp. This simulator could help the participants' learning about the anatomy of the lateral ventricle, effective training, and repeating the steps of LVP. During training, the interns' ratio of success in LVP elevated gradually. At each evaluation stage, all mean performance scores for each measure based on the OSATS scale were higher than the previous. CONCLUSIONS The 3D printed simulator for LVP training provided both anatomical and practical validity, and enabled young doctors to master the LVP procedures and skills.
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Affiliation(s)
- Wenyao Hong
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Yuqing Liu
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Bingwei He
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Shengyue Huang
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zhongyi Chen
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zhengjian Liao
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zongchao Yi
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Xiaohang Su
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Jiafeng Shi
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
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Katsevman GA, Greenleaf W, García-García R, Perea MV, Ladera V, Sherman JH, Rodríguez G. Virtual Reality During Brain Mapping for Awake-Patient Brain Tumor Surgery: Proposed Tasks and Domains to Test. World Neurosurg 2021; 152:e462-e466. [PMID: 34089912 DOI: 10.1016/j.wneu.2021.05.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Virtual reality (VR) use in health care has increased over the past few decades, with its utility expanding from a teaching tool to a highly reliable neuro-technology adjunct in multiple fields including neurosurgery. Generally, brain tumor surgery with the patient awake has only been performed for mapping of language and motor areas. With the rise of VR and advancing surgical techniques, neurosurgical teams are developing an increased understanding of patients' anatomo-functional connectivity. Consequently, more specific cognitive tasks are being required for the mapping and preservation of deeper layers of cognition. METHODS An extensive literature review was conducted with the inclusion criteria of manuscripts that described the use of VR during awake neurosurgery mapping. RESULTS We identified 3 recent articles that met our inclusion criteria, yet none of them addressed the specific use of VR for cognition mapping. Consequently, a cognitive task phase was performed to search and craft the tasks and domains that better filled the spotted niche of this need inside the operating room. A proposed protocol was developed with 5 potential uses of VR for brain mapping during awake neurosurgery, each of them with a specific proposed example of use. CONCLUSIONS The authors advocate for the use of a VR protocol as a feasible functional tool in awake-patient brain tumor surgery by using it as a complement during cognitive screening in addition to language testing.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Walter Greenleaf
- Virtual Human Interaction Lab, Stanford University, San Francisco, California, USA
| | - Ricardo García-García
- Basic Psychology, Psychobiology and Behavioral Science Methodology, Salamanca University, Salamanca, Spain
| | - Maria Victoria Perea
- Basic Psychology, Psychobiology and Behavioral Science Methodology, Salamanca University, Salamanca, Spain
| | - Valentina Ladera
- Basic Psychology, Psychobiology and Behavioral Science Methodology, Salamanca University, Salamanca, Spain
| | - Jonathan H Sherman
- Department of Neurosurgery, West Virginia University, Martinsburg, West Virginia, USA.
| | - Gabriel Rodríguez
- Neuroscience Research Department, INCAE Business School, San José, Costa Rica
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Chen T, Zhang Y, Ding C, Ting K, Yoon S, Sahak H, Hope A, McLachlin S, Crawford E, Hardisty M, Larouche J, Finkelstein J. Virtual reality as a learning tool in spinal anatomy and surgical techniques. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 6:100063. [PMID: 35141628 PMCID: PMC8820051 DOI: 10.1016/j.xnsj.2021.100063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023]
Abstract
Background Surgical simulation is a valuable educational tool for trainees to practice in a safe, standardized, and controlled environment. Interactive feedback-based virtual reality (VR) has recently moved to the forefront of spine surgery training, with most commercial products focusing on instrumentation. There is a paucity of learning tools directed at decompression principles. The purpose of this study was to evaluate the efficacy of VR simulation and its educational role in learning spinal anatomy and decompressive techniques. Methods A VR simulation module was created with custom-developed software. Orthopaedic and neurosurgical trainees were prospectively enrolled and interacted with patient-specific 3D models of lumbar spinal stenosis while wearing a headset. A surgical toolkit allowed users to perform surgical decompression, specifically removing soft tissues and bone. The module allowed users to perform various techniques in posterior decompressions and comprehend anatomic areas of stenosis. Pre- and post-module testing, and utility questionnaires were administered to provide both quantitative and qualitative evaluation of the module as a learning device. Results 28 trainees were enrolled (20-orthopaedic, 8-neurosurgery) in the study. Pre-test scores on anatomic knowledge progressively improved and showed strong positive correlation with year-in-training (Pearson's r = 0.79). Following simulation, the average improvement in post-test scores was 11.4% in junior trainees (PGYI-III), and 1.0% in senior trainees (PGYIII-Fellows). Knowledge improvement approached statistical significance amongst junior trainees (p = 0.0542). 89% of participants found the VR module useful in understanding and learning the pathology of spinal stenosis. 71% found it useful in comprehending decompressive techniques. 96% believed it had utility in preoperative planning with patient-specific models. Conclusions Our original VR spinal decompression simulation has shown to be overwhelmingly positively received amongst trainees as both a learning module of patho-anatomy and patient-specific preoperative planning, with particular benefit for junior trainees.
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Affiliation(s)
- T Chen
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, United States.,Division of Spine Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Y Zhang
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - C Ding
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - K Ting
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - S Yoon
- Division of Spine Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - H Sahak
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - A Hope
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - S McLachlin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - E Crawford
- Division of Spine Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - M Hardisty
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - J Larouche
- Division of Spine Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - J Finkelstein
- Division of Spine Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Validation of a Virtual Reality Simulator for Percutaneous Pedicle Screw Insertion. Surg Technol Int 2021. [PMID: 33755938 DOI: 10.52198/21.sti.38.os1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Working-hour restrictions, rota gaps and an increasing drive for theatre efficiency have resulted in challenges to surgical training. As a result, Virtual Reality (VR) has emerged as a popular tool to augment this training. Our aim was to evaluate the validity of a VR simulator for performing percutaneous pedicle screw guidewire insertion. MATERIALS AND METHODS Twenty-four participants were divided into three equal groups depending on prior surgical experience: a novice group (<10 procedures), an intermediate group (10-50 procedures) and an expert group (>50 procedures). All subjects performed four guidewire insertions on a TraumaVision® simulator (Swemac Innovation AB, Linköping, Sweden) in a set order. Six outcome measures were recorded; total score, time, fluoroscopy exposure, wire depth, zone of placement and wall violations. RESULTS There were statistically significant differences between the groups for time taken (p<0.001) and fluoroscopy exposure (p<0.001). The novice group performed the worst, and the expert group outperformed both intermediates and novices in both categories. Other outcome results were good and less variable. There was an observed learning effect in the novice and intermediate groups between each of the attempts for both time taken and fluoroscopy exposure. CONCLUSIONS The study contributes constructive evidence to support the validity of the TraumaVision® simulator as a training tool for pedicle screw guidewire insertion. The simulator is less suitable as an assessment tool. The learning effect was evident in the less experienced groups, suggesting that VR may offer a greater benefit in the early stages of training. Further work is required to assess transferability to the clinical setting.
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Yamakawa M, Sung HC, Tungpunkom P. Virtual reality education for dementia care: a scoping review protocol. JBI Evid Synth 2021; 18:2075-2081. [PMID: 32813416 DOI: 10.11124/jbisrir-d-19-00230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to examine the content and outcome measurements of health care education programs using virtual reality for the care of people with dementia, involving, but not limited to, health science students, health care professionals, family, and unpaid caregivers INTRODUCTION:: Several studies have examined approaches for improving the care of people with dementia by both professional, family and unpaid caregivers using virtual reality. However, the content and outcomes of these interventions are disjointed, and there is currently no unified indicator to evaluate virtual reality educational programs. INCLUSION CRITERIA This review will consider studies that include educational programs using virtual reality for health science students, health care professionals, and family caregivers of people with dementia. All study designs will be considered. METHODS The proposed scoping review will be conducted following the JBI methodology for scoping reviews. The databases to be searched include MEDLINE, CINAHL, Embase, Cochrane, and JBI Evidence Synthesis; local databases in Japanese, Thai, Taiwanese, and Chinese; and sources of unpublished studies and gray literature. Studies published in English, Japanese, Chinese, and Thai languages will be included. The data extracted will include specific details about the population, concept, context, study methods, and critical findings relevant to the review objective and be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review.
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Affiliation(s)
- Miyae Yamakawa
- The Japan Centre for Evidence-Based Practice: A JBI Affiliated Group
| | - Huei-Chuan Sung
- Tzu Chi University of Science and Technology, College of Nursing, Hualien, Taiwan
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Tosi U, Chidambaram S, Schwarz J, Diaz SM, Singh S, Norman S, Radwanski R, Murthy S, Apuzzo M, Schwartz TH, Pannullo SC. The World of Neurosurgery Reimagined Post COVID-19: Crisis ↔ Opportunities. World Neurosurg 2021; 148:251-255. [PMID: 33770847 DOI: 10.1016/j.wneu.2020.11.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Justin Schwarz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Sunidhi Singh
- Weill Cornell Medical College, New York, New York, USA
| | - Sofya Norman
- Weill Cornell Medical College, New York, New York, USA
| | - Ryan Radwanski
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Santosh Murthy
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Apuzzo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
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Sayari AJ, Chen O, Harada GK, Lopez GD. Success of Surgical Simulation in Orthopedic Training and Applications in Spine Surgery. Clin Spine Surg 2021; 34:82-86. [PMID: 33044270 DOI: 10.1097/bsd.0000000000001070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE This study aimed to review the current literature on surgical simulation in orthopedics and its application to spine surgery. SUMMARY OF BACKGROUND DATA As orthopedic surgery increases in complexity, training becomes more relevant. There have been mandates in the United States for training orthopedic residents the fundamentals of surgical skills; however, few studies have examined the various training options available. Lack of funding, availability, and time are major constraints to surgical simulation options. METHODS A PubMed review of the current literature was performed on all relevant articles that examined orthopedic trainees using surgical simulation options. Studies were examined for their thoroughness and application of simulation options to orthopedic surgery. RESULTS Twenty-three studies have explored orthopedic surgical simulation in a setting that objectively assessed trainee performance, most in the field of trauma and arthroscopy. However, there was a lack of consistency in measurements made and skills tested by these simulators. There has only been one study exploring surgical simulation in spine surgery. CONCLUSIONS While there has been a growing number of surgical simulators to train orthopedic residents the fundamentals of surgical skills, most of these simulators are not feasible, reproducible, or available to the majority of training centers. Furthermore, the lack of consistency in the objective measurements of these studies makes interpretation of their results difficult. There is a need for more simulation in spine surgery, and future simulators and their respective studies should be reproducible, affordable, applicable to the surgical setting, and easily assembled by various programs across the world.
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Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Mehren C, Korb W, Fenyöházi E, Iacovazzi D, Bernal L, Mayer MH. Differences in the Exposure of the Lumbar Nerve Root Between Experts and Novices: Results From a Realistic Simulation Pilot Study With Force Sensors. Global Spine J 2021; 11:224-231. [PMID: 32875893 PMCID: PMC7882829 DOI: 10.1177/2192568220917369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Nonrandomized prospective trial. OBJECTIVE Several studies could demonstrate "learning curves" in almost every single surgical procedure for unexperienced surgeons. This is in sharp contrast to the rising quality requirements in public health care to provide surgical training at patients "expense." The aim of this study was to visualize, measure, and set a baseline of the pressure load on the spinal nerve root during a simulated microdiscectomy on a standardized and validated model (RealSpine) under the influence of the level of surgical experience and individual skills. METHODS Five highly experienced spine surgeons and 5 trainees without considerable surgical experience were selected to perform a standardized microsurgical discectomy on a validated RealSpine simulator. Force-torque sensors were integrated in this simulator to measure the load on the nerve root. The forces were recorded every 125 ms. RESULTS We could identify cumulative for the total intervention as well as for defined single surgical steps of this procedure and as well in between the single subjects a significant higher tension and contusion forces on the nerve for the trainee group (Δp contusion 83-765 Nċs and Δp tension 159-1131 Nċs for the trainees. Δp contusion 16-171 Nċs and Δp tension 27-146 Nċs for the experts). CONCLUSION We could measure a difference between unexperienced and experienced surgeons regarding the manipulations of the nerve root during a standardized simulated microdiscectomy. This possibility could be the starting point for a new and innovative surgical education to improve outcome without negative side effects of "learning curves."
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Affiliation(s)
- Christoph Mehren
- Schön Klinik München Harlaching, Spine Center, Munich, Germany,Academic Teaching Hospital and Spine Research Institute, Paracelsus Medical University, Salzburg, Austria,Christoph Mehren, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547 Munich, Germany.
| | - Werner Korb
- Innovative Surgical Training Technologies (ISTT), University of Applied Sciences (HTWK), Leipzig, Germany,Vocationeers Salzburg, Hallein, Austria
| | - Esther Fenyöházi
- Innovative Surgical Training Technologies (ISTT), University of Applied Sciences (HTWK), Leipzig, Germany
| | - Davide Iacovazzi
- Innovative Surgical Training Technologies (ISTT), University of Applied Sciences (HTWK), Leipzig, Germany
| | - Luis Bernal
- Innovative Surgical Training Technologies (ISTT), University of Applied Sciences (HTWK), Leipzig, Germany
| | - Michael H. Mayer
- Schön Klinik München Harlaching, Spine Center, Munich, Germany,Academic Teaching Hospital and Spine Research Institute, Paracelsus Medical University, Salzburg, Austria
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Li H, Wang Y, Li Y, Zhang J. A novel manipulator with needle insertion forces feedback for robot-assisted lumbar puncture. Int J Med Robot 2021; 17:e2226. [PMID: 33452700 DOI: 10.1002/rcs.2226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of lumbar puncture for paediatric diagnosis and treatment, such as cerebrospinal fluid sampling and intracranial pressure measurements, is steadily increasing. However, the standard 'blind' technique makes it difficult to attain accurate needle insertion. METHODS In this study, we developed a robot-assisted system to improve the precision of needle insertion during lumbar puncture. The manipulator can perform orientation, insertion and rotation of the needle as well as linear motion at targeted locations. We focused on accurately sensing the puncture forces during the needle insertion phase and evaluated the piercing force perception of the operator. RESULTS The main features of the robot, such as backdrivable joints, physical human-robot cooperation, actuation system with low friction and remote centre of motion mechanism, can enhance overall safety. CONCLUSIONS Experimental results using a lumbar puncture phantom proved that the manipulator could position the needle tip at targeted locations with good accuracy. The data obtained from the test system also showed that the loss of resistance and peak forces for stiff tissues were accurately perceived by the operator.
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Affiliation(s)
- Hongbing Li
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyun Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuling Li
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae.
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Yuk FJ, Maragkos GA, Sato K, Steinberger J. Current innovation in virtual and augmented reality in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:94. [PMID: 33553387 PMCID: PMC7859743 DOI: 10.21037/atm-20-1132] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In spinal surgery, outcomes are directly related both to patient and procedure selection, as well as the accuracy and precision of instrumentation placed. Poorly placed instrumentation can lead to spinal cord, nerve root or vascular injury. Traditionally, spine surgery was performed by open methods and placement of instrumentation under direct visualization. However, minimally invasive surgery (MIS) has seen substantial advances in spine, with an ever-increasing range of indications and procedures. For these reasons, novel methods to visualize anatomy and precisely guide surgery, such as intraoperative navigation, are extremely useful in this field. In this review, we present the recent advances and innovations utilizing simulation methods in spine surgery. The application of these techniques is still relatively new, however quickly being integrated in and outside the operating room. These include virtual reality (VR) (where the entire simulation is virtual), mixed reality (MR) (a combination of virtual and physical components), and augmented reality (AR) (the superimposition of a virtual component onto physical reality). VR and MR have primarily found applications in a teaching and preparatory role, while AR is mainly applied in hands-on surgical settings. The present review attempts to provide an overview of the latest advances and applications of these methods in the neurosurgical spine setting.
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Affiliation(s)
- Frank J Yuk
- Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georgios A Maragkos
- Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kosuke Sato
- Hospital for Special Surgery, New York, NY, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Scullen T, Mathkour M, Dumont A. Commentary: Virtual Reality Anterior Cervical Discectomy and Fusion Simulation on the Novel Sim-Ortho Platform: Validation Studies. Oper Neurosurg (Hagerstown) 2020; 20:E17-E19. [PMID: 32970133 DOI: 10.1093/ons/opaa285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 11/13/2022] Open
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Frankel HG, Ganju A. Commentary: Virtual Reality Anterior Cervical Discectomy and Fusion Simulation on the Novel Sim-Ortho Platform: Validation Studies. Oper Neurosurg (Hagerstown) 2020; 20:E20-E21. [PMID: 32970118 DOI: 10.1093/ons/opaa288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Gregory Frankel
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Aruna Ganju
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
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Sukotjo C, Schreiber S, Yuan JC, Santoso M. Faculty perceptions of virtual reality as an alternative solution for preclinical skills during the pandemic. J Dent Educ 2020; 85:964-965. [PMID: 33216982 PMCID: PMC7753732 DOI: 10.1002/jdd.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Cortino Sukotjo
- Department of Restorative Dentistry, College of DentistryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Stephanie Schreiber
- Department of Restorative Dentistry, College of DentistryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Judy Chia‐Chun Yuan
- Department of Restorative Dentistry, College of DentistryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Markus Santoso
- Digital Worlds InstituteUniversity of FloridaGainesvilleFloridaUSA
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