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Carlos GF, Enrrique FS, Aylen Andrea TG, Sabrina MN, Silvina M, Clara M, Santiago BJ, Marcelo OC, Noel AL, Augusto RP. Introducing a Realistic, Low-Cost Simulation Model for Clipping of Brain Aneurysms. World Neurosurg 2021; 158:305-311.e1. [PMID: 34774805 DOI: 10.1016/j.wneu.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The current trend toward endovascular treatment of brain aneurysms may have a negative impact on young neurosurgeons who are less exposed to these lesions, thus affecting the acquisition of surgical skills in the field. Different training models have emerged to help cope with this issue, but these have specific pitfalls. Training models based on live animals or cadaveric specimens face increasing restrictions as regulations become a barrier in accessibility for everyday skills development. We introduce a novel, realistic, and inexpensive simulation model using a fresh bovine brain, and we assess its face and content validity as a training tool. METHODS A fresh bovine brain is used to simulate microsurgical fissure dissection. Arterial and aneurysmal components are created with arteries and veins harvested from chicken thigh. A 12-item questionnaire using the Likert numeric scale (grades 1 - 5) was used to assess the validity of model in 10 surgeons. RESULTS Ten neurosurgeons performed the simulated clipping of the aneurysm and completed a questionnaire. All surgeons surveyed responded "agree" or "strongly agree" that the simulator, and the skills trained with it, are comparable to clipping brain aneurysms. All respondents believed that this simulator could improve patient safety. CONCLUSIONS We present a novel, realistic, and inexpensive simulation model for the clipping of brain aneurysms. This model was partially validated by the opinion of field experts. We believe this model has the potential to become a useful training tool for young neurosurgeons who have little exposure to real aneurysm cases.
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Affiliation(s)
- Gallardo Federico Carlos
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - Feldman Santiago Enrrique
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Targa García Aylen Andrea
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Morales Nadia Sabrina
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Martinez Silvina
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Martin Clara
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Bottan Juan Santiago
- Division of Neurosurgery, Hospital General de Niños "Pedro De Elizalde", Buenos Aires, Argentina
| | - Orellana Cristian Marcelo
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Almerares Leandro Noel
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
| | - Rubino Pablo Augusto
- Department of Neurosurgery, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina
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Davids J, Makariou SG, Ashrafian H, Darzi A, Marcus HJ, Giannarou S. Automated Vision-Based Microsurgical Skill Analysis in Neurosurgery Using Deep Learning: Development and Preclinical Validation. World Neurosurg 2021; 149:e669-e686. [PMID: 33588081 DOI: 10.1016/j.wneu.2021.01.117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill. METHODS Videos were obtained from 1 expert, 6 intermediate, and 12 novice surgeons performing arachnoid dissection in a validated clinical model using a standard operating microscope. A mask region convolutional neural network framework was used to segment the tools present within the operative field in a recorded video frame. Tool motion analysis was achieved using novel triangulation metrics. Performance of the framework in classifying skill levels was evaluated using the area under the curve and accuracy. Objective measures of classifying the surgeons' skill level were also compared using the Mann-Whitney U test, and a value of P < 0.05 was considered statistically significant. RESULTS The area under the curve was 0.977 and the accuracy was 84.21%. A number of differences were found, which included experts having a lower median dissector velocity (P = 0.0004; 190.38 ms-1 vs. 116.38 ms-1), and a smaller inter-tool tip distance (median 46.78 vs. 75.92; P = 0.0002) compared with novices. CONCLUSIONS Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
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Affiliation(s)
- Joseph Davids
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Savvas-George Makariou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Hani J Marcus
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Stamatia Giannarou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Gough M, Solomou G, Khan DZ, Kamel M, Fountain D, Kumaria A, Ashpole R, Sinha S, Mendoza N. The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data. Acta Neurochir (Wien) 2020; 162:2323-2334. [PMID: 32358655 PMCID: PMC7496022 DOI: 10.1007/s00701-020-04325-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/02/2020] [Indexed: 11/22/2022]
Abstract
Background The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment. Methods A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates’ ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software. Results Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops. Conclusion We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.
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Kondo K, Nemoto M, Harada N, Masuda H, Ando S, Kubota S, Sugo N. Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach. World Neurosurg 2019; 127:e609-e616. [DOI: 10.1016/j.wneu.2019.03.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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Krüger M, Coenen V, Egger K, Shah M, Reinacher P. Development of a Standardized Cranial Phantom for Training and Optimization of Functional Stereotactic Operations. Stereotact Funct Neurosurg 2018; 96:190-196. [DOI: 10.1159/000489581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
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Okonogi S, Kondo K, Harada N, Masuda H, Nemoto M, Sugo N. Operative simulation of anterior clinoidectomy using a rapid prototyping model molded by a three-dimensional printer. Acta Neurochir (Wien) 2017; 159:1619-1626. [PMID: 28508160 DOI: 10.1007/s00701-017-3202-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the anatomical three-dimensional (3D) positional relationship around the anterior clinoid process (ACP) is complex, experience of many surgeries is necessary to understand anterior clinoidectomy (AC). We prepared a 3D synthetic image from computed tomographic angiography (CTA) and magnetic resonance imaging (MRI) data and a rapid prototyping (RP) model from the imaging data using a 3D printer. The objective of this study was to evaluate anatomical reproduction of the 3D synthetic image and intraosseous region after AC in the RP model. In addition, the usefulness of the RP model for operative simulation was investigated. METHODS The subjects were 51 patients who were examined by CTA and MRI before surgery. The size of the ACP, thickness and length of the optic nerve and artery, and intraosseous length after AC were measured in the 3D synthetic image and RP model, and reproducibility in the RP model was evaluated. In addition, 10 neurosurgeons performed AC in the completed RP models to investigate their usefulness for operative simulation. RESULTS The RP model reproduced the region in the vicinity of the ACP in the 3D synthetic image, including the intraosseous region, at a high accuracy. In addition, drilling of the RP model was a useful operative simulation method of AC. CONCLUSIONS The RP model of the vicinity of ACP, prepared using a 3D printer, showed favorable anatomical reproducibility, including reproduction of the intraosseous region. In addition, it was concluded that this RP model is useful as a surgical education tool for drilling.
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Affiliation(s)
- Shinichi Okonogi
- Department of Neurosurgery (Omori), Toho University Graduate School of Medicine, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroyuki Masuda
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Masaaki Nemoto
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), Toho University Graduate School of Medicine, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
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Shono N, Kin T, Nomura S, Miyawaki S, Saito T, Imai H, Nakatomi H, Oyama H, Saito N. Microsurgery Simulator of Cerebral Aneurysm Clipping with Interactive Cerebral Deformation Featuring a Virtual Arachnoid. Oper Neurosurg (Hagerstown) 2017; 14:579-589. [DOI: 10.1093/ons/opx155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/07/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
A virtual reality simulator for aneurysmal clipping surgery is an attractive research target for neurosurgeons. Brain deformation is one of the most important functionalities necessary for an accurate clipping simulator and is vastly affected by the status of the supporting tissue, such as the arachnoid membrane. However, no virtual reality simulator implementing the supporting tissue of the brain has yet been developed.
OBJECTIVE
To develop a virtual reality clipping simulator possessing interactive brain deforming capability closely dependent on arachnoid dissection and apply it to clinical cases.
METHODS
Three-dimensional computer graphics models of cerebral tissue and surrounding structures were extracted from medical images. We developed a new method for modifiable cerebral tissue complex deformation by incorporating a nonmedical image-derived virtual arachnoid/trabecula in a process called multitissue integrated interactive deformation (MTIID). MTIID made it possible for cerebral tissue complexes to selectively deform at the site of dissection. Simulations for 8 cases of actual clipping surgery were performed before surgery and evaluated for their usefulness in surgical approach planning.
RESULTS
Preoperatively, each operative field was precisely reproduced and visualized with the virtual brain retraction defined by users. The clear visualization of the optimal approach to treating the aneurysm via an appropriate arachnoid incision was possible with MTIID.
CONCLUSION
A virtual clipping simulator mainly focusing on supporting tissues and less on physical properties seemed to be useful in the surgical simulation of cerebral aneurysm clipping. To our knowledge, this article is the first to report brain deformation based on supporting tissues.
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Affiliation(s)
- Naoyuki Shono
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Seiji Nomura
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toki Saito
- Department of Clinical Information Engineering, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, the Uni-versity of Tokyo Graduate School of Medicine, Tokyo, Japan
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Marcus HJ, Payne CJ, Kailaya-Vasa A, Griffiths S, Clark J, Yang GZ, Darzi A, Nandi D. A "Smart" Force-Limiting Instrument for Microsurgery: Laboratory and In Vivo Validation. PLoS One 2016; 11:e0162232. [PMID: 27622693 PMCID: PMC5021258 DOI: 10.1371/journal.pone.0162232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/21/2016] [Indexed: 12/20/2022] Open
Abstract
Residents are required to learn a multitude of skills during their microsurgical training. One such skill is the judicious application of force when handling delicate tissue. An instrument has been developed that indicates to the surgeon when a force threshold has been exceeded by providing vibrotactile feedback. The objective of this study was to validate the use of this “smart” force-limiting instrument for microsurgery. A laboratory and an in vivo experiment were performed to evaluate the force-limiting instrument. In the laboratory experiment, twelve novice surgeons were randomly allocated to use either the force-limiting instrument or a standard instrument. Surgeons were then asked to perform microsurgical dissection in a model. In the in vivo experiment, an intermediate surgeon performed microsurgical dissection in a stepwise fashion, alternating every 30 seconds between use of the force-limiting instrument and a standard instrument. The primary outcomes were the forces exerted and the OSATS scores. In the laboratory experiment, the maximal forces exerted by novices using the force-limiting instrument were significantly less than using a standard instrument, and were comparable to intermediate and expert surgeons (0.637N versus 4.576N; p = 0.007). In the in vivo experiment, the maximal forces exerted with the force-limiting instrument were also significantly less than with a standard instrument (0.441N versus 0.742N; p <0.001). Notably, use of the force-limiting instrument did not significantly impede the surgical workflow as measured by the OSATS score (p >0.1). In conclusion, the development and use of this force-limiting instrument in a clinical setting may improve patient safety.
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Affiliation(s)
- Hani J. Marcus
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Christopher J. Payne
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ahilan Kailaya-Vasa
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, United Kingdom
| | - Sara Griffiths
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - James Clark
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Dipankar Nandi
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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Kondo K, Harada N, Masuda H, Sugo N, Terazono S, Okonogi S, Sakaeyama Y, Fuchinoue Y, Ando S, Fukushima D, Nomoto J, Nemoto M. A neurosurgical simulation of skull base tumors using a 3D printed rapid prototyping model containing mesh structures. Acta Neurochir (Wien) 2016; 158:1213-9. [PMID: 27052513 DOI: 10.1007/s00701-016-2781-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Deep regions are not visible in three-dimensional (3D) printed rapid prototyping (RP) models prepared from opaque materials, which is not the case with translucent images. The objectives of this study were to develop an RP model in which a skull base tumor was simulated using mesh, and to investigate its usefulness for surgical simulations by evaluating the visibility of its deep regions. METHODS A 3D printer that employs binder jetting and is mainly used to prepare plaster models was used. RP models containing a solid tumor, no tumor, and a mesh tumor were prepared based on computed tomography, magnetic resonance imaging, and angiographic data for four cases of petroclival tumor. Twelve neurosurgeons graded the three types of RP model into the following four categories: 'clearly visible,' 'visible,' 'difficult to see,' and 'invisible,' based on the visibility of the internal carotid artery, basilar artery, and brain stem through a craniotomy performed via the combined transpetrosal approach. In addition, the 3D positional relationships between these structures and the tumor were assessed. RESULTS The internal carotid artery, basilar artery, and brain stem and the positional relationships of these structures with the tumor were significantly more visible in the RP models with mesh tumors than in the RP models with solid or no tumors. CONCLUSIONS The deep regions of PR models containing mesh skull base tumors were easy to visualize. This 3D printing-based method might be applicable to various surgical simulations.
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Giannarou S, Ye M, Gras G, Leibrandt K, Marcus HJ, Yang GZ. Vision-based deformation recovery for intraoperative force estimation of tool-tissue interaction for neurosurgery. Int J Comput Assist Radiol Surg 2016; 11:929-36. [PMID: 27008473 PMCID: PMC4893380 DOI: 10.1007/s11548-016-1361-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/23/2016] [Indexed: 11/28/2022]
Abstract
Purpose In microsurgery, accurate recovery of the deformation of the surgical environment is important for mitigating the risk of inadvertent tissue damage and avoiding instrument maneuvers that may cause injury. The analysis of intraoperative microscopic data can allow the estimation of tissue deformation and provide to the surgeon useful feedback on the instrument forces exerted on the tissue. In practice, vision-based recovery of tissue deformation during tool–tissue interaction can be challenging due to tissue elasticity and unpredictable motion. Methods The aim of this work is to propose an approach for deformation recovery based on quasi-dense 3D stereo reconstruction. The proposed framework incorporates a new stereo correspondence method for estimating the underlying 3D structure. Probabilistic tracking and surface mapping are used to estimate 3D point correspondences across time and recover localized tissue deformations in the surgical site. Results We demonstrate the application of this method to estimating forces exerted on tissue surfaces. A clinically relevant experimental setup was used to validate the proposed framework on phantom data. The quantitative and qualitative performance evaluation results show that the proposed 3D stereo reconstruction and deformation recovery methods achieve submillimeter accuracy. The force–displacement model also provides accurate estimates of the exerted forces. Conclusions A novel approach for tissue deformation recovery has been proposed based on reliable quasi-dense stereo correspondences. The proposed framework does not rely on additional equipment, allowing seamless integration with the existing surgical workflow. The performance evaluation analysis shows the potential clinical value of the technique.
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Affiliation(s)
- Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK.
| | - Menglong Ye
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Gauthier Gras
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Konrad Leibrandt
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Hani J Marcus
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
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Kondo K, Nemoto M, Masuda H, Okonogi S, Nomoto J, Harada N, Sugo N, Miyazaki C. Anatomical Reproducibility of a Head Model Molded by a Three-dimensional Printer. Neurol Med Chir (Tokyo) 2015; 55:592-8. [PMID: 26119896 PMCID: PMC4628193 DOI: 10.2176/nmc.oa.2014-0436] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We prepared rapid prototyping models of heads with unruptured cerebral aneurysm based on image data of computed tomography angiography (CTA) using a three-dimensional (3D) printer. The objective of this study was to evaluate the anatomical reproducibility and accuracy of these models by comparison with the CTA images on a monitor. The subjects were 22 patients with unruptured cerebral aneurysm who underwent preoperative CTA. Reproducibility of the microsurgical anatomy of skull bone and arteries, the length and thickness of the main arteries, and the size of cerebral aneurysm were compared between the CTA image and rapid prototyping model. The microsurgical anatomy and arteries were favorably reproduced, apart from a few minute regions, in the rapid prototyping models. No significant difference was noted in the measured lengths of the main arteries between the CTA image and rapid prototyping model, but errors were noted in their thickness (p < 0.001). A significant difference was also noted in the longitudinal diameter of the cerebral aneurysm (p < 0.01). Regarding the CTA image as the gold standard, reproducibility of the microsurgical anatomy of skull bone and main arteries was favorable in the rapid prototyping models prepared using a 3D printer. It was concluded that these models are useful tools for neurosurgical simulation. The thickness of the main arteries and size of cerebral aneurysm should be comprehensively judged including other neuroimaging in consideration of errors.
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Affiliation(s)
- Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Toho University
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Kirkman MA, Muirhead W, Nandi D, Sevdalis N. Development and Psychometric Evaluation of the “Neurosurgical Evaluation of Attitudes towards Simulation Training” (NEAT) Tool for Use in Neurosurgical Education and Training. World Neurosurg 2014; 82:284-91. [DOI: 10.1016/j.wneu.2014.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/03/2014] [Accepted: 05/07/2014] [Indexed: 11/24/2022]
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Kirkman MA, Ahmed M, Albert AF, Wilson MH, Nandi D, Sevdalis N. The use of simulation in neurosurgical education and training. J Neurosurg 2014; 121:228-46. [DOI: 10.3171/2014.5.jns131766] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Object
There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date.
Methods
The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations.
Results
Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18.
Conclusions
The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.
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Affiliation(s)
- Matthew A. Kirkman
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square
- 2Department of Surgery and Cancer and
| | | | | | - Mark H. Wilson
- 3The Traumatic Brain Injury Centre, Imperial College London, St. Mary's Hospital
- 4London's Air Ambulance (HEMS), The Royal London Hospital; and
| | - Dipankar Nandi
- 5Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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