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Cuba M, Vanluchene H, Murek M, Goldberg J, Müller MD, Montalbetti M, Janosovits K, Rhomberg T, Zhang D, Raabe A, Joseph FJ, Bervini D. Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study. Oper Neurosurg (Hagerstown) 2024; 26:01787389-990000000-01028. [PMID: 38251883 PMCID: PMC11086963 DOI: 10.1227/ons.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The value of simulation-based training in medicine and surgery has been widely demonstrated. This study investigates the introduction and use of a new mixed-reality neurosurgical simulator in aneurysm clipping surgery, focusing on the learning curve and performance improvement. METHODS Five true-scale craniotomy head models replicating patient-specific neuroanatomy, along with a mixed-reality simulator, a neurosurgical microscope, and a set of microsurgical instruments and clips, were used in the operation theater to simulate aneurysm microsurgery. Six neurosurgical residents participated in five video-recorded simulation sessions over 4 months. Complementary learning modalities were implemented between sessions. Thereafter, three blinded analysts reported on residents' use of the microscope, quality of manipulation, aneurysm occlusion, clipping techniques, and aneurysm rupture. Data were also captured regarding training time and clipping attempts. RESULTS Over the course of training, clipping time and number of clipping attempts decreased significantly (P = .018, P = .032) and the microscopic skills improved (P = .027). Quality of manipulation and aneurysm occlusion scoring improved initially although the trend was interrupted because the spacing between sessions increased. Significant differences in clipping time and attempts were observed between the most and least challenging patient models (P = .005, P = .0125). The least challenging models presented higher rates of occlusion based on indocyanine green angiography evaluation from the simulator. CONCLUSION The intracranial aneurysm clipping learning curve can be improved by implementing a new mixed-reality simulator in dedicated training programs. The simulator and the models enable comprehensive training under the guidance of a mentor.
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Affiliation(s)
- Miguel Cuba
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hanne Vanluchene
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Michael Murek
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montalbetti
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katharina Janosovits
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Rhomberg
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Zhang
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fredrick J. Joseph
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
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Williams SC, Ahmed R, Davids JD, Funnell JP, Hanrahan JG, Layard Horsfall H, Muirhead W, Nicolosi F, Thorne L, Marcus HJ, Grover P. Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score. World Neurosurg X 2023; 20:100230. [PMID: 37456690 PMCID: PMC10344945 DOI: 10.1016/j.wnsx.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Neurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). Methods Novice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model - identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. Results Fifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10-19) for novices and 22/25 (IQR 20-22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7-17) for novices compared to 19/20 (IQR 18.5-19.5) for experts (p < 0.05). Conclusion The RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.
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Affiliation(s)
- Simon C. Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Razna Ahmed
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Joseph Darlington Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, UK
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John Gerrard Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lewis Thorne
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Gasteratos K, Paladino JR, Akelina Y, Mayer HF. Superiority of living animal models in microsurgical training: beyond technical expertise. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:167-176. [PMID: 33589852 PMCID: PMC7875764 DOI: 10.1007/s00238-021-01798-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Yelena Akelina
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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Oliveira MM, Ferrarez CE, Lovato R, Costa PV, Malheiros JA, Avellar L, Granja M, Sauvageau E, Machado C, Hanel R. Quality Assurance During Brain Aneurysm Microsurgery—Operative Error Teaching. World Neurosurg 2019; 130:e112-e116. [DOI: 10.1016/j.wneu.2019.05.262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022]
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