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Pongeluppi RI, Coelho G, Ballestero MFM, Aragon DC, Colli BO, Santos de Oliveira R. Development and Evaluation of a Mixed Reality Model for Training the Retrosigmoid Approach. World Neurosurg 2024:S1878-8750(24)01042-8. [PMID: 38906470 DOI: 10.1016/j.wneu.2024.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The use of simulation has the potential to accelerate the learning curves and increase the efficiency of surgeons. However, there is currently a scarcity in models dedicated to skull base surgical approaches. Thus, the objective of this study was to develop a cost-effective mixed reality system consisting of an ultrarealistic physical model and augmented reality and evaluate its use in training surgeons on the retrosigmoid approach. METHODS The virtual models were developed from images of patients with vestibular schwannoma. The tumor was mirrored to allow bilateral approaches and the model has drawers for repositioning structures, allowing reuse of the material and cost reduction. Pre and posttest assessments were applied to 10 residents and young neurosurgeons, divided into control and test groups. Only the control group was exposed to the model. The difference in scores obtained by participants before and after exposure to the models was considered for analysis and participants in the control group answered self-satisfaction questionnaires. RESULTS The mean differences were 4.80 in the control group (95% credibility intervals=1.08-9.79) and 5.43 in the test group (95% credibility intervals=1.67-8.20). The average score of the self-satisfaction questionnaires was 24.0 (23-25). CONCLUSIONS The ultrarealistic model efficiently allowed retromastoid access to the cerebellopontine angle. A tendency toward greater gains in performance in the group exposed to the model was verified. Scores from the self-satisfaction questionnaires demonstrated that participants considered the model relevant for neurosurgical training and increased confidence among surgeons.
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Affiliation(s)
- Rodrigo Inacio Pongeluppi
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil.
| | - Giselle Coelho
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
| | | | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
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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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Laskay NMB, Parr MS, Mooney J, Farber SH, Knowlin LT, Chang T, Uribe JS, Johnston JM, Godzik J. Optimizing Surgical Efficiency in Complex Spine Surgery Using Virtual Reality as a Communication Technology to Promote a Shared Mental Model: A Case Series and Review. Oper Neurosurg (Hagerstown) 2024; 26:213-221. [PMID: 37729632 DOI: 10.1227/ons.0000000000000899] [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: 03/21/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) is an emerging technology that can be used to promote a shared mental model among a surgical team. We present a case series demonstrating the use of 3-dimensional (3D) VR models to visually communicate procedural steps to a surgical team to promote a common operating objective. We also review the literature on existing uses of VR for preoperative communication and planning in spine surgery. METHODS Narrations of 3 to 4-minute walkthroughs were created in a VR visualization platform, converted, and distributed to team members through text and email the night before surgical intervention. A VR huddle was held immediately before the intervention to refine surgical goals. After the intervention, the participating team members' perceptions on the value of the tool were assessed using a survey that used a 5-point Likert scale. MEDLINE, Google Scholar, and Dimensions AI databases were queried from July 2010 to October 2022 to examine existing literature on preoperative VR use to plan spine surgery. RESULTS Three illustrative cases are presented with accompanying video. Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models. Respondents felt that preoperative VR video review was "moderately useful" or more useful in improving their understanding of the operational sequence (71%, 5/7), in enhancing their ability to understand their role (86%, 6/7), and in improving the safety or efficiency of the case (86%, 6/7). CONCLUSION We present a proof of concept of a novel preoperative communication tool used to create a shared mental model of a common operating objective for surgical team members using narrated 3D VR models. Initial survey results demonstrate positive feedback among respondents. There is a paucity of literature investigating VR technology as a means for preoperative surgical communication in spine surgery. ETHICS Institutional review board approval (IRB-300009785) was obtained before this study.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Matthew S Parr
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - Laquanda T Knowlin
- Department of Surgery, Children's Hospital Los Angeles, Los Angeles , California , USA
| | - Todd Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles , California , USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
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Levy HA, Pinter ZW, Honig R, Salmons HI, Hobson SL, Karamian BA, Freedman BA, Elder BD, Fogelson JL, Nassr AN, Sebastian AS. A Standardized Curriculum Improves Trainee Rod Bending Proficiency in Spinal Deformity Surgery. Results of a Prospective Randomized Controlled Educational Study. J Am Acad Orthop Surg 2024; 32:e17-e25. [PMID: 37494716 DOI: 10.5435/jaaos-d-23-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Surgical simulation is increasingly being accepted as a training platform to promote skill development and a safe surgical technique. Preliminary investigations in spine surgery show that simulation paired with educational intervention can markedly improve trainee performance. This study used a newly developed thoracolumbar fusion rod bending model to assess the effect of a novel educational curriculum and simulator training on surgical trainee rod bending speed and proficiency. METHODS Junior (PGY1 to 2) and senior (PGY3-fellow) surgical trainees at a single academic institution were prospectively enrolled in a rod bending simulation using a T7-pelvis spinal fusion model. Participants completed two simulations, with 1 month between first and second attempts. Fifty percent of surgeons in each training level were randomized to receive an educational curriculum (rod bending technique videos and unlimited simulator practice) between simulation attempts. Rod bending simulation proficiency was determined by the percentage of participants who completed the task (conclusion at 20 minutes), time to task completion or conclusion, and number of incomplete set screws at task conclusion. Participants completed a preparticipation and postparticipation survey. Univariate analysis compared rod bending proficiency and survey results between education and control cohorts. RESULTS Forty trainees (20 junior and 20 senior) were enrolled, with 20 participants randomized to the education and control cohorts. No notable differences were observed in the first simulation rod bending proficiency or preparticipation survey results between the education and control cohorts. In the second simulation, the education versus the control cohort demonstrated a significantly higher completion rate ( P = 0.01), shorter task time ( P = 0.009), fewer incomplete screws ( P = 0.003), and greater experience level ( P = 0.008) and comfort level ( P = 0.002) on postparticipation survey. DISCUSSION Trainees who participated in a novel educational curriculum and simulator training relative to the control cohort improved markedly in rod bending proficiency and comfort level. Rod bending simulation could be incorporated in existing residency and fellowship surgical skills curricula. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hannah A Levy
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Levy, Pinter, Honig, Salmons, Freedman, Nassr, and Sebastian), the Department of Neurologic Surgery, Mayo Clinic, Rochester, MN (Elder and Fogelson), the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Hobson), and the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Karamian)
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Cuello JF, Bardach A, Gromadzyn G, Ruiz Johnson A, Comandé D, Aguirre E, Ruvinsky S. Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review. Neurosurg Rev 2023; 47:24. [PMID: 38159156 DOI: 10.1007/s10143-023-02263-2] [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: 10/13/2023] [Revised: 12/16/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.
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Affiliation(s)
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Guido Gromadzyn
- Neurosurgery Department, Hospital Garrahan, Buenos Aires, Argentina
| | | | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Emilio Aguirre
- Neurosurgery Department, Hospital Cordero, San Fernando, Argentina
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Farah GJ, Rogers JL, Lopez AM, Brown NJ, Pennington Z, Kuo C, Gold J, Bui NE, Koester SW, Gendreau JL, Diaz-Aguilar LD, Oh MY, Pham MH. Resident Training in Spine Surgery: A Systematic Review of Simulation-Based Educational Models. World Neurosurg 2023; 174:81-115. [PMID: 36921712 DOI: 10.1016/j.wneu.2023.03.032] [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: 12/19/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE With the increasing prevalence of spine surgery, ensuring effective resident training is becoming of increasing importance. Training safe, competent surgeons relies heavily on effective teaching of surgical indications and adequate practice to achieve a minimum level of technical proficiency before independent practice. American Council of Graduate Medical Education work-hour restrictions have complicated the latter, forcing programs to identify novel methods of surgical resident training. Simulation-based training is one such method that can be used to complement traditional training. The present review aims to evaluate the educational success of simulation-based models in the spine surgical training of residents. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Web of Science, and Google Scholar databases were systematically screened for English full-text studies examining simulation-based spine training curricula. Studies were categorized based on simulation model class, including animal-cadaveric, human-cadaveric, physical/3-dimensional, and computer-based/virtual reality. Outcomes studied included participant feedback regarding the simulator and competency metrics used to evaluate participant performance. RESULTS Seventy-two studies were identified. Simulators displayed high face validity and were useful for spine surgery training. Objective measures used to evaluate procedural performance included implant placement evaluation, procedural time, and technical skill assessment, with numerous simulators demonstrating a learning effect. CONCLUSIONS While simulation-based educational models are one potential means of training residents to perform spine surgery, traditional in-person operating room training remains pivotal. To establish the efficacy of simulators, future research should focus on improving study quality by leveraging longitudinal study designs and correlating simulation-based training with clinical outcome measures.
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Affiliation(s)
- Ghassan J Farah
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alexander M Lopez
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cathleen Kuo
- Department of Neurological Surgery, University at Buffalo Jacobs SOM, Buffalo, New York, USA
| | - Justin Gold
- Department of Neurological Surgery, Cooper Medical of Rowan University, Camden, New Jersey, USA
| | - Nicholas E Bui
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA.
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Training outside of the operating room improves intern resident psychomotor skills on a validated ASSH tool. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100099] [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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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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Patel S, Alkadri S, Driscoll M. Development and Validation of a Mixed Reality Configuration of a Simulator for a Minimally Invasive Spine Surgery Using the Workspace of a Haptic Device and Simulator Users. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2435126. [PMID: 35005014 PMCID: PMC8741356 DOI: 10.1155/2021/2435126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Most surgical simulators leverage virtual or bench models to simulate reality. This study proposes and validates a method for workspace configuration of a surgical simulator which utilizes a haptic device for interaction with a virtual model and a bench model to provide additional tactile feedback based on planned surgical manoeuvers. Numerical analyses were completed to determine the workspace and position of a haptic device, relative to the bench model, used in the surgical simulator, and the determined configuration was validated using device limitations and user data from surgical and nonsurgical users. For the validation, surgeons performed an identical surgery on a cadaver prior to using the simulator, and their trajectories were then compared to the determined workspace for the haptic device. The configuration of the simulator was determined appropriate through workspace analysis and the collected user trajectories. Statistical analyses suggest differences in trajectories between the participating surgeons which were not affected by the imposed haptic workspace. This study, therefore, demonstrates a method to optimally position a haptic device with respect to a bench model while meeting the manoeuverability needs of a surgical procedure. The validation method identified workspace position and user trajectory towards ideal configuration of a mixed reality simulator.
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Affiliation(s)
- Sneha Patel
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
| | - Sami Alkadri
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
| | - Mark Driscoll
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
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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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Qu H, Zhao Y. Advances in tissue state recognition in spinal surgery: a review. Front Med 2021; 15:575-584. [PMID: 33990898 DOI: 10.1007/s11684-020-0816-3] [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: 12/09/2019] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
Spinal disease is an important cause of cervical discomfort, low back pain, radiating pain in the limbs, and neurogenic intermittent claudication, and its incidence is increasing annually. From the etiological viewpoint, these symptoms are directly caused by the compression of the spinal cord, nerve roots, and blood vessels and are most effectively treated with surgery. Spinal surgeries are primarily performed using two different techniques: spinal canal decompression and internal fixation. In the past, tactile sensation was the primary method used by surgeons to understand the state of the tissue within the operating area. However, this method has several disadvantages because of its subjectivity. Therefore, it has become the focus of spinal surgery research so as to strengthen the objectivity of tissue state recognition, improve the accuracy of safe area location, and avoid surgical injury to tissues. Aside from traditional imaging methods, surgical sensing techniques based on force, bioelectrical impedance, and other methods have been gradually developed and tested in the clinical setting. This article reviews the progress of different tissue state recognition methods in spinal surgery and summarizes their advantages and disadvantages.
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Affiliation(s)
- Hao Qu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Olson JJ, Zhang B, Zhu D, Zheng ET, Dyer GSM, Rozental TD, LaPorte DM. Do Resident Surgical Volumes and Level of Training Correlate with Improved Performance on Psychomotor Skills Tasks: Construct Validity Testing of an ASSH Training Platform (STEP)? JB JS Open Access 2021; 6:JBJSOA-D-20-00123. [PMID: 33748639 PMCID: PMC7963499 DOI: 10.2106/jbjs.oa.20.00123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The Surgical Training and Educational Platform (STEP) was developed by the American Society for Surgery of the Hand (ASSH) as a cost-effective set of surgical simulation modules designed to assess critical skills in hand surgery. Previous study demonstrated that STEP can differentiate between novice trainees and board-certified, certificate of added qualification hand surgeons. The purpose of this study was to assess construct validity of STEP by testing its ability to differentiate psychomotor skill level among intermediate trainees.
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Affiliation(s)
- Jeffrey J Olson
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Bo Zhang
- Johns Hopkins Orthopaedic Surgery Residency Program, Baltimore, Maryland
| | - Diana Zhu
- Johns Hopkins Orthopaedic Surgery Residency Program, Baltimore, Maryland
| | | | - George S M Dyer
- Harvard Medical School, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston Massachusetts
| | - Tamara D Rozental
- Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston Massachusetts
| | - Dawn M LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, Baltimore, Maryland
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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: 23] [Impact Index Per Article: 7.7] [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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Establishing Validity of a Comprehensive Hand Surgical Training and Educational Platform (STEP). J Hand Surg Am 2020; 45:1105-1114. [PMID: 33008694 DOI: 10.1016/j.jhsa.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and perform the initial validation for the Surgical Training and Educational Platform (STEP), a cost-effective psychomotor training and assessment instrument designed to teach and evaluate fundamental skills considered critical to competency in hand surgery. METHODS An American Society for Surgery of the Hand (ASSH) taskforce of 13 board-certified hand surgeons developed 8 skills considered fundamental to competency in hand surgery including: (1) lag screw fixation of an oblique fracture, (2) depth of plunge during bicortical drilling, (3) central axis scaphoid fixation, (4) phalangeal fracture pinning, (5) flexor tendon repair, (6) microsurgical suturing, (7) full-thickness skin graft harvest, and (8) wrist arthroscopy. The tasks were developed from commercially available, nonclinical supplies at low cost. The startup cost for the entire system was less than $600 USD, with a cost-per-trainee-assessment of approximately $25 USD. After the tasks were finalized, 2 examiners traveled to 8 sites around the country to evaluate 93 surgeons, including 57 board-certified hand surgeons and 36 first-year orthopedic and plastic surgical residents. Scoring criteria for each task were based on a combination of time and clinically relevant quality metrics. RESULTS Board-certified hand surgeons significantly outperformed surgical trainees on all 8 tasks, demonstrating that the STEP appropriately differentiates the skill level of expert and novice hand surgeons. CONCLUSIONS The STEP is an effective simulator that encompasses a wide range of fundamental psychomotor skills considered critical to competency in hand surgery. Although the STEP tasks are a valuable surgical training tool, further work is required to evaluate and refine the scoring system prior to using it as a critical evaluation of performance. CLINICAL RELEVANCE The STEP simulator is a valuable, validated instrument for resident and fellow education and evaluation in hand surgery outside of the operating room.
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Mao JZ, Mullin JP, Pollina J. Commentary: Integration of Technology Within the Spine Neurosurgical Training Paradigm. Oper Neurosurg (Hagerstown) 2020; 19:E538-E542. [DOI: 10.1093/ons/opaa248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
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17
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Chytas D, Chronopoulos E, Salmas M, Babis GC, Nikolaou VS. Letter to the Editor Regarding "Mixed Reality-Based Preoperative Planning for Training of Percutaneous Transforaminal Endoscopic Discectomy: A Feasibility Study". World Neurosurg 2020; 139:660. [PMID: 32689668 DOI: 10.1016/j.wneu.2020.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Dimitrios Chytas
- Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece.
| | - Efstathios Chronopoulos
- Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George C Babis
- Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | - Vasileios S Nikolaou
- Second Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Enhancing Reality: A Systematic Review of Augmented Reality in Neuronavigation and Education. World Neurosurg 2020; 139:186-195. [DOI: 10.1016/j.wneu.2020.04.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
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Neuroanesthesiologists as interoperative neurophysiologists: a collaborative cognitive apprenticeship model of training in a community of clinical practice. J Clin Monit Comput 2020; 34:325-330. [PMID: 30955161 DOI: 10.1007/s10877-019-00304-0] [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: 12/19/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
Directing intraoperative neurophysiologic monitoring (IONM) is a patient care activity for which no formal training programs exist, even though the need for well-trained practitioners is readily evident while caring for patients with diseases of the brain, spinal cord, spinal column, or nervous system. Here, we present the theoretical basis and institutional experience for a successful model of learning a new and complex set of skills: the medical direction of IONM. In a major academic institution, a clinical community of practice absorbed new members with professional backgrounds ranging from a recent neuroanesthesia fellowship to several decades of neuroanesthesia practice and trained them in a collaborative cognitive apprenticeship model to medically direct IONM. Our community of practice comprises experienced technicians, a diplomate of the American Board of Neurophysiologic Monitoring (DABNM), and six neuroanesthesiologists. This group forms the base of the scaffolding or structure where the apprenticeship and learning take place. The clinical community of practice has trained eight new members in the medical direction of IONM. The group has also trained four outside anesthesiologists-one of whom went on to become certified as a DABNM-who went on to develop the IONM program at a major children's hospital. This collaborative cognitive apprenticeship in anesthesiology to learn the medical direction of IONM is quite innovative as it integrates new members and expands the range of existing ones. In our model, the entire community is elevated by the reciprocal interactions of master clinicians, novice apprentices, and the community of practice.
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Abstract
STUDY DESIGN A prospective, case-based, observational study. OBJECTIVES To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. METHODS In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. RESULTS AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. CONCLUSIONS Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.
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Affiliation(s)
- Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | | | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills. World Neurosurg 2020; 133:e874-e892. [DOI: 10.1016/j.wneu.2019.08.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
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Pfandler M, Stefan P, Mehren C, Lazarovici M, Weigl M. Technical and Nontechnical Skills in Surgery: A Simulated Operating Room Environment Study. Spine (Phila Pa 1976) 2019; 44:E1396-E1400. [PMID: 31725688 DOI: 10.1097/brs.0000000000003154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational simulation study. OBJECTIVE The goal of this study was to investigate the relationship between technical and nontechnical skills (NTS) in a simulated surgical procedure. SUMMARY OF BACKGROUND DATA Although surgeons' technical and NTS during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and NTS are related is limited. METHODS A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills (TS) were assessed using Objective Structured Assessment of Technical Skill scores and senior expert-evaluated VP outcome assessment. NTS were assessed with the Observational Teamwork Assessment for Surgery. Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of previous VPs performed). RESULT Surgeons' NTS correlated significantly with their technical performance (τ = 0.63; P = 0.006) and surgical outcome scores (τ = 0.60; P = 0.007). This association was attenuated when controlling for surgeons' experience. CONCLUSION Our results suggest that spine surgeons with higher levels of TS also apply better communication, leadership, and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Philipp Stefan
- Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, Technical University of Munich, Munich, Germany
| | - Christoph Mehren
- Spine Center Schön Clinic Munich Harlaching, Munich, Germany; Academic Teaching Hospital Paracelsus Medical University (PMU), Salzburg, Austria
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Weigl
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
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24
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Kumaria A, Bateman AH, Eames N, Fehlings MG, Goldstein C, Meyer B, Paquette SJ, Yee AJM. Advancing spinal fellowship training: an international multi-centre educational perspective. 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 2019; 28:2437-2443. [PMID: 31407164 DOI: 10.1007/s00586-019-06098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/19/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery. METHODS Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training. RESULTS Contemporary learning techniques include boot camps at the start of fellowship which may reinforce previous clinical learning and help prepare fellows for their new clinical roles. There is good evidence that surgical specialty training boot camps improve clinical skills, knowledge and trainee confidence prior to embarking upon new clinical roles with increasing levels of responsibility. Furthermore, as simulation techniques and technologies take on an increasing role in medical and surgical training, we found evidence that trainees' operative skills and knowledge can improve with simulated operations, even if just carried out briefly. Finally, we found evidence to suggest a role for establishing competence-based objectives for training in specific operative and technical procedures. Competence-based objectives are helpful for trainees and trainers to highlight gaps in a trainee's skill set that may then be addressed during training. CONCLUSIONS Spinal fellowships may benefit from certain contemporary strategies that assist design and delivery of training in a safe environment. Interpersonal factors that promote healthy teamwork may contribute to an environment conducive to learning. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ashwin Kumaria
- Royal Derby Spinal Centre, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Antony H Bateman
- Royal Derby Spinal Centre, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
| | - Niall Eames
- Belfast Health and Social Care Trust, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | - Christina Goldstein
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, MO, 65212, USA
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Albert J M Yee
- Department of Surgery, University of Toronto, Toronto, Canada
- University of Toronto Spine Program, Toronto, Canada
- Marvin Tile Chair, Division Head of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Rm MG 371-B, Toronto, ON, M4N 3M5, Canada
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Carl B, Bopp M, Saß B, Pojskic M, Nimsky C. Augmented reality in intradural spinal tumor surgery. Acta Neurochir (Wien) 2019; 161:2181-2193. [PMID: 31300886 DOI: 10.1007/s00701-019-04005-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Microscope-based augmented reality (AR) is commonly used in cranial surgery; however, until recently, this technique was not implemented for spinal surgery. We prospectively investigated, how AR can be applied for intradural spinal tumor surgery. METHODS For ten patients with intradural spinal tumors (ependymoma, glioma, hemangioblastoma, meningioma, and metastasis), AR was provided by head-up displays (HUDs) of operating microscopes. User-independent automatic AR registration was established by low-dose intraoperative computed tomography. The objects visualized by AR were segmented in preoperative imaging data; non-linear image registration was applied to consider spine flexibility. RESULTS In all cases, AR supported surgery by visualizing the tumor outline and other relevant surrounding structures. The overall AR registration error was 0.72 ± 0.24 mm (mean ± standard deviation), a close matching of visible tumor outline and AR visualization was observed for all cases. Registration scanning resulted in a low effective dose of 0.22 ± 0.16 mSv for cervical and 1.68 ± 0.61 mSv for thoracic lesions. The mean HUD AR usage in relation to microscope time was 51.6 ± 36.7%. The HUD was switched off and turned on again in a range of 2 to 17 times (5.7 ± 4.4 times). Independent of the status of the HUD, the AR visualization was displayed on monitors throughout surgery. CONCLUSIONS Microscope-based AR can be reliably applied to intradural spinal tumor surgery. Automatic AR registration ensures high precision and provides an intuitive visualization of the extent of the tumor and surrounding structures. Given this setting, all advanced multi-modality options of cranial AR can also be applied to spinal surgery.
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Carl B, Bopp M, Saß B, Nimsky C. Microscope-Based Augmented Reality in Degenerative Spine Surgery: Initial Experience. World Neurosurg 2019; 128:e541-e551. [DOI: 10.1016/j.wneu.2019.04.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
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Mixed Reality-Based Preoperative Planning for Training of Percutaneous Transforaminal Endoscopic Discectomy: A Feasibility Study. World Neurosurg 2019; 129:e767-e775. [PMID: 31203062 DOI: 10.1016/j.wneu.2019.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the effect of preoperative planning using mixed reality (MR) on training of percutaneous transforaminal endoscopic discectomy (PTED). METHODS Before the training, we invited an experienced chief physician to plan the puncture path of PTED on the X-ray films of the lumbar spine model and the 3D Slicer platform, respectively, and used this as the standard to guide trainees. In the aggregate, 60 young residents were randomly divided into Group A (N = 30) and Group B (N = 30). Group A learned the 2-dimensional standard planning route, whereas Group B learned the standard route planning based on MR through the 3D Slicer platform. Then, trainees were asked to conduct PTED puncture on a lumbar spine model. Questionnaires were distributed to trainees before and after the training. During the training, puncture times, operating time (minutes), and fluoroscopy times were recorded. RESULTS After the training, it was obvious that more trainees showed their recognition of MR, believing that MR could help preoperative planning and training of PTED. Their high satisfaction with the training indicated the success of our training. Moreover, puncture times, operating time (minutes), and fluoroscopy times of Group B were significantly lower than those of Group A. CONCLUSIONS MR technology contributes to preoperative planning of PTED and is beneficial in the training of PTED. It significantly reduces puncture times and fluoroscopy times, providing a standardized method for the training of PTED.
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Brusko GD, Yoon JW, Wang MY. Through the Eyes of a Neurosurgeon - How Binocular Disparity Translates into Surgical Performance. Neurosurgery 2019; 84:E142-E143. [PMID: 30590792 DOI: 10.1093/neuros/nyy625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Damian Brusko
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
| | - Jang W Yoon
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
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