3-Dimensional Printed Model of the Temporal Bone for Neurosurgical Training

BACKGROUND AND OBJECTIVES

The development of neurosurgical skills stands out as a paramount objective for neurosurgery residents during their formative years. Mastery of intricate and complex procedures is a time-intensive process marked by a gradually ascending learning curve. Consequently, the study and simulation on surgical models assume significant importance. One of the most intricate neuroanatomical regions includes the petrous and mastoid portions of the temporal bone. These regions host critical, highly functional, and vital neurovascular structures, including the facial nerve, cochlea, semicircular canals, internal carotid artery, and middle ear. This fully open-source 3-dimensional (3D) model of the temporal bone, created for educational purposes, should be easily and economically reproducible using a 3D printer, offering all residents the opportunity to understand the spatial location, three-dimensional anatomical structures, and fundamental intricacies of mastoidectomy.

METHODS

A 3D model of the temporal bone was fabricated using a computed tomography (CT) scan derived from an actual human body. The CT scan of the model was meticulously juxtaposed with the reference sample CT scan. Neurosurgical residents were recruited as participants for this study. Each participant was tasked with executing a mastoidectomy on 2 separate occasions, with a 2-week interval between attempts. Throughout these sessions, various parameters, including the time taken for task completion, the volume of bone removal, and any potential complications, were systematically registered.

RESULTS

The mean volume of bone removed increased by 34.5%, and the mean task time and the mean number of complications decreased by 10.3% and 25%, respectively, during the training.

CONCLUSION

Engaging in training with cost-effective anatomical models constitutes a valuable tool for refining technical skills during residency. We posit that this type of model training should be incorporated as part of the trainee's curriculum during the residency program because of the myriad advantages evidenced by the findings of this study.

3-Dimensionally Printed Affordable Nose Model: A Reliable Start in Endoscopic Training for Young Neurosurgeons

BACKGROUND

Training neurosurgical skills is one of the most important tasks of a residency program. Techniques' complexity and pathology rarity define a long learning curve for mastering different surgical skills for which simulation on anatomic samples is extremely important. For this purpose, cadaver laboratory training is the most reliable tool. However, since access to cadaveric specimens is limited, due to costs and availability, surgical skills could be developed using inanimate models. This work aimed to develop a printable 3-dimensional model of the nasal cavity and sellar floor using an open-source downloadable file, to give residents the opportunity to improve their endoscopic surgical skills in a low-risk atmosphere with little cost.

METHODS

The 3D model was realized taking as a sample a real-case CT scan imaging from which the sellar floor was removed. A quail egg was placed underneath the printed model covering the sellar floor opening. Under endoscopic visualization, the "sellar floor" was drilled by each participant with the goal of sparing the egg's inner membrane. Once the task was achieved, surgeons were asked to participate in a satisfaction survey.

RESULTS

The total cost for printing was 6.31€ (6,72$). A satisfaction survey showed technical improvement (90%), increased confidence (80%), and bringing learned skills into the operating room (70%), leading to a 100% agreement in introducing this project into residency programs.

CONCLUSIONS

Training on affordable anatomic models represents a useful tool in technical skills improvement. We believe this model could help residents bring their technical capabilities to more sophisticated levels.

Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials

OBJECTIVE

3D printing is increasingly used to fabricate three-dimensional neurosurgical simulation models, making training more accessible and economical. 3D printing includes various technologies with different capabilities for reproducing human anatomy. This study evaluated different materials across a broad range of 3D printing technologies to identify the combination that most precisely represents the parietal region of the skull for burr hole simulation.

METHODS

Eight different materials (polyethylene terephthalate glycol, Tough PLA, FibreTuff, White Resin, BoneSTN, SkullSTN, polymide [PA12], glass-filled polyamide [PA12-GF]) across 4 different 3D printing processes (fused filament fabrication, stereolithography, material jetting, selective laser sintering) were produced as skull samples that fit into a larger head model derived from computed tomography imaging. Five neurosurgeons conducted burr holes on each sample while blinded to the details of manufacturing method and cost. Qualities of mechanical drilling, visual appearance, skull exterior, and skull interior (i.e., diploë) and overall opinion were documented, and a final ranking activity was performed along with a semistructured interview.

RESULTS

The study found that 3D printed polyethylene terephthalate glycol (using fused filament fabrication) and White Resin (using stereolithography) were the best models to replicate the skull, surpassing advanced multimaterial samples from a Stratasys J750 Digital Anatomy Printer. The interior (e.g., infill) and exterior structures strongly influenced the overall ranking of samples. All neurosurgeons agreed that practical simulation with 3D printed models can play a vital role in neurosurgical training.

CONCLUSIONS

The study findings reveal that widely accessible desktop 3D printers and materials can play a valuable role in neurosurgical training.

Graduating from Laboratory to Operating Rooms-the Way Forward for Future Surgeons!

Background

Changing healthcare and social scenarios are reducing the learning opportunities of surgical postgraduates in our country. Majority of surgical training centers in the developed world use laboratory training as an integral part of their curricula. However, in India, most of surgical residents are still trained by traditional apprenticeship model.

Aims

To describe the role of laboratory training in improving the competency of surgical postgraduates.

Settings and Design

Laboratory dissection was used as an educational intervention for postgraduates in tertiary care teaching hospital.

Methods and Material

Thirty-five (35) trainees from various surgical subspecialties performed cadaveric dissection led by senior faculty members. The perceived knowledge and operative confidence of trainees were assessed before and three weeks after the course using a five-point Likert scale. A structured questionnaire was administered to explore the experience of training. Results were tabulated in percentage and proportion. Wilcoxon signed-rank test was applied to find any difference between pre and post perception of knowledge and operative competence of participants.

Results

Thirty four (34/35; 96%) were males; 65.7% (23/35) trainees demonstrated improvement in knowledge level after dissection (p < 0.0001) and 74.3% (26/35) in operative confidence (p < 0.0001). Majority believe that cadaveric dissection helps to improve knowledge of procedural anatomy (33/35; 94.3%) and enhances technical skill (25/35; 71.4%). Thirty participants (86%) rated cadaveric dissection as the best tool for surgical training of postgraduates better than operative manuals, surgical videos, and virtual simulators.

Conclusions

Laboratory training including cadaveric dissection is feasible, relevant, effective, and acceptable to postgraduate surgical trainees with few disadvantages, which can be taken care of. Trainees felt it should be made part of curriculum.

Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs

BACKGROUND

Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed.

OBJECTIVE

To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research.

METHODS

A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance.

RESULTS

From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described.

CONCLUSION

Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.

Acquisition of Basic Microsurgical Skills Using Low-Cost, Readily Available Models: The Orange Model

BACKGROUND

Attainment of basic microsurgical skills in neurosurgery presents a departmental challenge worldwide. Models for teaching are either not readily available or expensive and are incompatible with a resident's busy schedule, requiring lengthy and proper setup. We present a model and a set of measurable tasks, based on a fruit (orange) that is cheap, easy to set up instantly when desired, and useful for training of basic microsurgical skills.

METHODS

Basic microsurgical skills were identified, necessitating hand-eye coordination working with the microscope. The goal was to dissect an orange segment while preserving adjacent segments. Assessment was based on the number of side tears and task completion duration. The task was repeated in a sequential manner (n = 10), for validation purposes, for 3 operators at different seniority levels.

RESULTS

An improvement in the number of side tears (mean of 12.66 ± 9.01 in the first trial vs. 4 ± 4.35 in the 10th trial, P < 0.01), as well as duration of time required for task completion (mean initial duration of 28:16 ± 19:00 minutes to a duration of 16:33 ± 10:50 minutes in the last attempt, P < 0.01), was observed. Daily practice scores and time gradually improved, and the seniority level of operators was correlated with scoring between individuals.

CONCLUSIONS

The orange model is an easily accessible, cheap model that enables the acquisition of basic microneurosurgical skills. In this work, we validated and defined reproducible tasks that can be scored and tracked, correlated with operator's proficiency and experience. This model can be incorporated into a resident's workflow environment and provides a platform for attainment of elementary microsurgical skills for neurosurgical residents.

Home Program for Acquisition and Maintenance of Microsurgical Skills During the Coronavirus Disease 2019 Outbreak

BACKGROUND

During the current global crisis unleashed by the severe acute respiratory syndrome coronavirus 2 outbreak, surgical departments have considerably reduced the amount of elective surgeries. This decrease leads to less time in the surgical room to develop and improve the surgical skills of residents. In this study, we developed a training program to obtain and maintain microsurgical skills at home, using a smartphone camera and low-cost materials, affordable for everyone.

METHODS

Using a smartphone camera as a magnification device, 6 participants performed 5 exercises (coloring grids, grouping colors, unraveling of a gauze, knots with suture threads, and tower of Hanoi), both with the dominant and with the nondominant hand, for 4 weeks. We compared performance at the beginning and at the end of the training process. Each participant filled out an anonymous survey.

RESULTS

When we compared the performance at the beginning and at the end of the training process, we found significant improvements (P = 0.05) with the dominant as well as the nondominant hand in all the exercises. All participants were satisfied or very satisfied with the definition of the objectives of the training process, material availability, the exercises performed, the choice of the time to train, and general satisfaction with the training program.

CONCLUSIONS

We developed a microsurgical skills training program to be performed at home, which can be easily reproduced. It allows residents to improve manual coordination skills and is regarded as a feasible adjunct for ongoing training for surgical residents.

Novel Simulation Model with Pulsatile Flow System for Microvascular Training, Research, and Improving Patient Surgical Outcomes

BACKGROUND

Simulation allows surgical trainees to acquire surgical skills in a safe environment. With the aim of reducing the use of animal experimentation, different alternative nonliving models have been pursued. However, one of the main disadvantages of these nonliving models has been the absence of arterial flow, pulsation, and the ability to integrate both during a procedure on a blood vessel. In the present report, we have introduced a microvascular surgery simulation training model that uses a fiscally responsible and replicable pulsatile flow system.

METHODS

We connected 30 human placentas to a pulsatile flow system and used them to simulate aneurysm clipping and vascular anastomosis.

RESULTS

The presence of the pulsatile flow system allowed for the simulation of a hydrodynamic mechanism similar to that found in real life. In the aneurysm simulation, the arterial flow could be evaluated before and after clipping the aneurysm using a Doppler ultrasound system. When practicing anastomosis, the use of the pulsatile flow system allowed us to assess the vascular flow through the anastomosis, with verification using the Doppler ultrasound system. Leaks were manifested as "blood" pulsatile ejections and were more frequent at the beginning of the surgical practice, showing a learning curve.

CONCLUSIONS

We have provided a step-by-step guide for the assembly of a replicable and inexpensive pulsatile flow system and its use in placentas for the simulation of, and training in, performing different types of anastomoses and intracranial aneurysms surgery.

Roadmap for Developing Complex Virtual Reality Simulation Scenarios: Subpial Neurosurgical Tumor Resection Model

BACKGROUND

Advancement and evolution of current virtual reality (VR) surgical simulation technologies are integral to improve the available armamentarium of surgical skill education. This is especially important in high-risk surgical specialties. Such fields including neurosurgery are beginning to explore the utilization of virtual reality simulation in the assessment and training of psychomotor skills. An important issue facing the available VR simulation technologies is the lack of complexity of scenarios that fail to replicate the visual and haptic realities of complex neurosurgical procedures. Therefore there is a need to create more realistic and complex scenarios with the appropriate visual and haptic realities to maximize the potential of virtual reality technology.

METHODS

We outline a roadmap for creating complex virtual reality neurosurgical simulation scenarios using a step-wise description of our team's subpial tumor resection project as a model.

RESULTS

The creation of complex neurosurgical simulations involves integrating multiple modules into a scenario-building roadmap. The components of each module are described outlining the important stages in the process of complex VR simulation creation.

CONCLUSIONS

Our roadmap of a stepwise approach for the creation of complex VR-simulated neurosurgical procedures may also serve as a guide to aid the development of other VR scenarios in a variety of surgical fields. The generation of new VR complex simulated neurosurgical procedures, by surgeons for surgeons, with the help of computer scientists and engineers may improve the assessment and training of residents and ultimately improve patient care.

Development and Validation of a Mobile Device-based External Ventricular Drain Simulator

BACKGROUND

Multiple external ventricular drain (EVD) simulators have been created, yet their cost, bulky size, and nonreusable components limit their accessibility to residency programs.

OBJECTIVE

To create and validate an animated EVD simulator that is accessible on a mobile device.

METHODS

We developed a mobile-based EVD simulator that is compatible with iOS (Apple Inc., Cupertino, California) and Android-based devices (Google, Mountain View, California) and can be downloaded from the Apple App and Google Play Store. Our simulator consists of a learn mode, which teaches users the procedure, and a test mode, which assesses users' procedural knowledge. Twenty-eight participants, who were divided into expert and novice categories, completed the simulator in test mode and answered a postmodule survey. This was graded using a 5-point Likert scale, with 5 representing the highest score. Using the survey results, we assessed the module's face and content validity, whereas construct validity was evaluated by comparing the expert and novice test scores.

RESULTS

Participants rated individual survey questions pertaining to face and content validity a median score of 4 out of 5. When comparing test scores, generated by the participants completing the test mode, the experts scored higher than the novices (mean, 71.5; 95% confidence interval, 69.2 to 73.8 vs mean, 48; 95% confidence interval, 44.2 to 51.6; P < .001).

CONCLUSION

We created a mobile-based EVD simulator that is inexpensive, reusable, and accessible. Our results demonstrate that this simulator is face, content, and construct valid.

Simulation Training Methods in Neurological Surgery

Simulation training plays a paramount role in medicine, especially when it comes to mastering surgical skills. By simulating, students gain not only confidence, but expertise, learning to apply theory in a safe environment. As the technological arsenal improved, virtual reality and physical simulators have developed and are now an important part of the Neurosurgery training curriculum. Based on deliberate practice in a controlled space, simulation allows psychomotor skills augment without putting neither patients nor students at risk. When compared to the master-apprentice ongoing model of teaching, simutation becomes even more appealing as it is time-efficient, shortening the learning curve and ultimately leading to error reduction, which is reflected by diminished health care costs in the long run. In this chapter we will discuss the current state of neurosurgery simulation, highlight the potential benefits of this approach, assessing specific training methods and making considerations towards the future of neurosurgical simulation.

[Simulation in surgical training]

BACKGROUND

Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge.

OBJECTIVES

Are there alternatives to traditional master-apprentice learning?

MATERIALS AND METHODS

A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented.

RESULTS

Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses.

CONCLUSIONS

Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.

Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training

This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience.

Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded. Image quality was rated, and the absolute value of technically unsafe events was recorded. The trainees’ device selection, macrovascular access, microvascular access, clinical management, and the overall performance of the trainee was rated during each procedure based on a traditional Likert scale score of 1=fail, 2=poor, 3=satisfactory, 4=good, and 5=excellent. These ordinal values correspond with published assessment scales on surgical technique.

After performing five diagnostic angiograms and five embolectomies, all participants demonstrated marked decreases in procedure time, fluoroscopy doses, contrast doses, and adverse technical events; marked improvements in image quality, device selection, access scores, and overall technical performance were additionally observed (p < 0.05). Similarly, trainees demonstrated marked improvement in technical performance and clinical management after five coiling procedures (p < 0.05). However, trainees with less prior experience deploying coils continued to experience intra-procedural ruptures up to the eighth embolization procedure; this observation likely corresponded with less tactile procedural experience to an exertion of greater force than appropriate for coil placement.

Trainees across all levels of training and prior experience demonstrated a significant performance improvement after completion of our simulator curriculum consisting of five diagnostic angiograms, five embolectomy cases, and 10 aneurysm coil embolizations.

Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial

Objective

In resource-constrained environments, appropriately employing triage in disaster situations is crucial. Although both case-based learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching disaster preparedness to adult learners, there is no substantial evidence supporting one as a more efficacious methodology. This randomized controlled trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to standard didactic instruction in knowledge attainment pertaining to disaster triage preparedness.

Methods

This RCT was performed during a one-day disaster preparedness course in Lucknow, India during October 2014. Following provision of informed consent, nursing trainees were randomized to knowledge assessment after didactic teaching (control group); didactic plus CBL (Intervention Group 1); or didactic plus SE (Intervention Group 2). The educational curriculum used the topical focus of triage processes during disaster situations. Cases for the educational intervention sessions were scripted, identical between modalities, and employed structured debriefing. Trained live actors were used for SEs. After primary assessment, the groups underwent crossover to take part in the alternative educational modality and were re-assessed. Two standardized multiple-choice question batteries, encompassing key core content, were used for assessments. A sample size of 48 participants was calculated to detect a ≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of randomization was evaluated using X2, anova, and t-tests. Mean knowledge attainment scores were compared using one- and two-sample t-tests for intergroup and intragroup analyses, respectively.

Results

Among 60 enrolled participants, 88.3% completed follow-up. No significant differences in participant characteristics existed between randomization arms. Mean baseline knowledge score in the control group was 43.8% (standard deviation=11.0%). Case-based learning training resulted in a significant increase in relative knowledge scores at 20.8% (P=0.003) and 10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared to control, SEs did not significantly alter knowledge attainment scores with an average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs were found to result in a 26.0% decrement in mean assessment score (P < .001).

Conclusions

Among nursing trainees assessed in this RCT, the CBL modality was superior to SEs in short-term disaster preparedness educational translation. Simulation exercises resulted in no detectable improvement in knowledge attainment in this population, suggesting that CBL may be utilized preferentially for adult learners in similar disaster training settings.

AluisioAR, DanielP, GrockA, FreedmanJ, SinghA, PapanagnouD, ArquillaB. Case-based learning outperformed simulation exercises in disaster preparedness education among nursing trainees in India: a randomized controlled trial. Prehosp Disaster Med. 2016;31(5):516–523.

The role of simulation in neurosurgery

PURPOSE

In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions. Several surgical simulators have been developed, ranging from physical models to sophisticated virtual reality systems. To date, there is a paucity of information describing the clinical benefits of existing simulators and the assessment strategies to help implement them into neurosurgical curricula. Here, we present a systematic review of the current models of simulation and discuss the state-of-the-art and future directions for simulation in neurosurgery.

METHODS

Retrospective literature review.

RESULTS

Multiple simulators have been developed for neurosurgical training, including those for minimally invasive procedures, vascular, skull base, pediatric, tumor resection, functional neurosurgery, and spine surgery. The pros and cons of existing systems are reviewed.

CONCLUSION

Advances in imaging and computer technology have led to the development of different simulation models to complement traditional surgical training. Sophisticated virtual reality (VR) simulators with haptic feedback and impressive imaging technology have provided novel options for training in neurosurgery. Breakthrough training simulation using 3D printing technology holds promise for future simulation practice, proving high-fidelity patient-specific models to complement residency surgical learning.

A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead

BACKGROUND

Transsphenoidal endoscopic surgery has gained popularity in the last 2 decades and is becoming a standard technique for resection of pituitary adenomas. In contrast to their ENT colleagues, neurosurgical residents have practically no endoscopic experience when they reach the training stage for transsphenoidal procedures. We have developed an affordable method for repetitive training in endoscopic (and microscopic) work in a narrow channel, allowing training of the basic movements needed for resection of pituitary adenoma.

METHODS

In collaboration with colleagues in the ENT Department, Cantonal Hospital St. Gall, and the Technical University of Zurich, a three-dimensional model of the nasal cavity was developed and patented. The Egghead model consists of a 3D synthetic reconstruction of the head nasal cavity and sphenoid sinus. A boiled egg represents the sella. For validation, 17 neurosurgical residents from the Department of Neurosurgery, University Hospital of Basel, and Department of Neurosurgery, Cantonal Hospital of St. Gall, St. Gall, Switzerland, and two experts performed a standardized procedure mimicking a transsphenoidal pituitary procedure by dissecting a corridor to the egg yolk and resecting it, respecting the surrounding egg white. This procedure was performed under both microscopic and video-endoscopic visualization. A score for the precision and speed of the surgical performance was developed and used.

RESULTS

The model allows repetitive training of the resection of the egg yolk under sparing of the egg white after careful opening of the shell. The validation data showed a steeper learning curve using the endoscopic technique than performing the same task using the microscope. After three repetitions, the quality of resection was better with the endoscopic technique.

CONCLUSIONS

Our model, the Egghead, is affordable, offers tactile feedback and allows infinite repetitions in basic training for pituitary surgery. It can be used for training of advanced neurosurgical residents, who thus far have very few possibilities of acquiring endoscopic experience.

Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback

BACKGROUND

With the decrease in the number of cerebral aneurysms treated surgically and the increase of complexity of those treated surgically, there is a need for simulation-based tools to teach future neurosurgeons the operative techniques of aneurysm clipping.

OBJECTIVE

To develop and evaluate the usefulness of a new haptic-based virtual reality simulator in the training of neurosurgical residents.

METHODS

A real-time sensory haptic feedback virtual reality aneurysm clipping simulator was developed using the ImmersiveTouch platform. A prototype middle cerebral artery aneurysm simulation was created from a computed tomographic angiogram. Aneurysm and vessel volume deformation and haptic feedback are provided in a 3-dimensional immersive virtual reality environment. Intraoperative aneurysm rupture was also simulated. Seventeen neurosurgery residents from 3 residency programs tested the simulator and provided feedback on its usefulness and resemblance to real aneurysm clipping surgery.

RESULTS

Residents thought that the simulation would be useful in preparing for real-life surgery. About two-thirds of the residents thought that the 3-dimensional immersive anatomic details provided a close resemblance to real operative anatomy and accurate guidance for deciding surgical approaches. They thought the simulation was useful for preoperative surgical rehearsal and neurosurgical training. A third of the residents thought that the technology in its current form provided realistic haptic feedback for aneurysm surgery.

CONCLUSION

Neurosurgical residents thought that the novel immersive VR simulator is helpful in their training, especially because they do not get a chance to perform aneurysm clippings until late in their residency programs.

Mixed Reality Ventriculostomy Simulation: Experience in Neurosurgical Residency

BACKGROUND:

Medicine and surgery are turning toward simulation to improve on limited patient interaction during residency training. Many simulators today use virtual reality with augmented haptic feedback with little to no physical elements. In a collaborative effort, the University of Florida Department of Neurosurgery and the Center for Safety, Simulation & Advanced Learning Technologies created a novel “mixed” physical and virtual simulator to mimic the ventriculostomy procedure. The simulator contains all the physical components encountered for the procedure with superimposed 3-D virtual elements for the neuroanatomical structures.

OBJECTIVE:

To introduce the ventriculostomy simulator and its validation as a necessary training tool in neurosurgical residency.

METHODS:

We tested the simulator in more than 260 residents. An algorithm combining time and accuracy was used to grade performance. Voluntary postperformance surveys were used to evaluate the experience.

RESULTS:

Results demonstrate that more experienced residents have statistically significant better scores and completed the procedure in less time than inexperienced residents. Survey results revealed that most residents agreed that practice on the simulator would help with future ventriculostomies.

CONCLUSION:

This mixed reality simulator provides a real-life experience, and will be an instrumental tool in training the next generation of neurosurgeons. We have now implemented a standard where incoming residents must prove efficiency and skill on the simulator before their first interaction with a patient.