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González-López P, Gómez-Revuelta C, Puchol Rizo M, Verdú Martínez I, Fernández Villa de Rey Salgado J, Lafuente J, Fernández-Jover E, Fernández-Cornejo V, Nieto-Navarro J. Development and evaluation of a 3d printed training model for endoscopic third ventriculostomy in low-income countries. BRAIN & SPINE 2023; 3:101736. [PMID: 37383453 PMCID: PMC10293302 DOI: 10.1016/j.bas.2023.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Pediatric hydrocephalus is highly prevalent and therefore a major neurosurgical problem in Africa. In addition to ventriculoperitoneal shunts, which have high cost and potential complications, endoscopic third ventriculostomy is becoming an increasingly popular technique especially in this part of the world. However, performing this procedure requires trained neurosurgeons with an optimal learning curve. For this reason, we have developed a 3D printed training model of hydrocephalus so that neurosurgeons without previous experience with endoscopic techniques can acquire these skills, especially in low-income countries, where specific techniques training as this, are relatively absent. Research Question Our research question was about the possibility to develop and produce a low-cost endoscopic training model and to evaluate the usefulness and the skills acquired after training with it. Material and Methods A neuroendoscopy simulation model was developed. A sample of last year medical students and junior neurosurgery residents without prior experience in neuroendoscopy were involved in the study. The model was evaluated by measuring several parameters, as procedure time, number of fenestration attempts, diameter of the fenestration, and number of contacts with critical structures. Results An improvement of the average score on the ETV-Training-Scale was noticed between the first and last attempt (11.6, compared to 27.5 points; p<0.0001). A statistically significant improvement in all parameters, was observed. Discussion and Conclusion This 3D printed simulator facilitates acquiring surgical skills with the neuroendoscope to treat hydrocephalus by performing an endoscopic third ventriculostomy. Furthermore, it has been shown to be useful to understand the intraventricular anatomical relationships.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Cristina Gómez-Revuelta
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Martin Puchol Rizo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Iván Verdú Martínez
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jaime Fernández Villa de Rey Salgado
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Eduardo Fernández-Jover
- Instituto de Bioingeniería, Univ. Miguel Hernández, Av. de la Universidad S/n, E-03202, Elche, Spain and CIBER-BBN, Spain
| | - Víctor Fernández-Cornejo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
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Huang J, Du BR, Qiao WG, Huang SL, Xue LF, Deng L, Liang JM, Wang J, Li JY, Chen Y. Endoscopic submucosal dissection training: evaluation of an ex vivo training model with continuous perfusion (ETM-CP) for hands-on teaching and training in China. Surg Endosc 2023:10.1007/s00464-023-09940-9. [PMID: 36914780 DOI: 10.1007/s00464-023-09940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The existing ex vivo models of endoscopic submucosal dissection (ESD) cannot simulate intraoperative hemorrhage well. We aimed to establish an ESD training method by applying an ex vivo training model with continuous perfusion (ETM-CP). METHODS Four training sessions were conducted for 25 novices under the guidance of 2 experts. Eventually, 10 novices completed ESD operations on a total of 89 patients after the training. The resection effectiveness, resection speed, complication rate, and novice performance before and after the training were compared. The data regarding the effects of the training and the model were gathered through a questionnaire survey. RESULTS In terms of the simulation effect of the model, ETM-CP was evaluated as similar to the live pig in all aspects (P > 0.05). The questionnaire analysis revealed that the ESD theoretical knowledge, skill operation, and self-confidence of novices were improved after the training (P < 0.05). The resection time per unit area had a correlation with the number of training periods (rs = - 0.232). For novice performance, the resection time per unit area was shortened (P < 0.05). There was no difference in patient performance between the novice group and the expert group after the training in terms of en bloc resection, R0 resection, complication rate, endoscopic resection bleeding (ERB) score, muscularis propria injury (MPI) score, and resection time per unit area (P > 0.05). CONCLUSION The ETM-CP is effective for ESD training.
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Affiliation(s)
- Jun Huang
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China
| | - Bing-Ran Du
- Department of Stomatology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528308, Guangdong, China
| | - Wei-Guang Qiao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Si-Lin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, China
| | - Lan-Feng Xue
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China
| | - Liang Deng
- Department of Gastroenterology, LunJiao Hospital, Shunde District, Foshan, 528244, Guangdong, China
| | - Jun-Ming Liang
- Department of Gastroenterology, Xingtan Hospital Affiliated to Shunde Hospital of Southern Medical University, Foshan, 528325, China
| | - Jun Wang
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jian-Yi Li
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yu Chen
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China.
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Thiong'o GM, Looi T, Rutka JT, Kulkarni AV, Drake JM. Design and validation of a hemispherectomy simulator for neurosurgical education. J Neurosurg 2023; 138:1-8. [PMID: 35901759 DOI: 10.3171/2022.5.jns22545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries. METHODS Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert. RESULTS Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts. CONCLUSIONS The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.
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Affiliation(s)
- Grace M Thiong'o
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
| | - Thomas Looi
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and
| | - James T Rutka
- 2Department of Surgery, University of Toronto, Ontario, Canada
| | | | - James M Drake
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
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Thiong'o GM, Bernstein M, Drake JM. 3D printing in neurosurgery education: a review. 3D Print Med 2021; 7:9. [PMID: 33759067 PMCID: PMC7989093 DOI: 10.1186/s41205-021-00099-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objectives of this manuscript were to review the literature concerning 3D printing of brain and cranial vault pathology and use these data to define the gaps in global utilization of 3D printing technology for neurosurgical education. METHODS Using specified criteria, literature searching was conducted to identify publications describing engineered neurosurgical simulators. Included in the study were manuscripts highlighting designs validated for neurosurgical skill transfer. Purely anatomical designs, lacking aspects of surgical simulation, were excluded. Eligible manuscripts were analyzed. Data on the types of simulators, representing the various modelled neurosurgical pathologies, were recorded. Authors' countries of affiliation were also recorded. RESULTS A total of thirty-six articles, representing ten countries in five continents were identified. Geographically, Africa as a continent was not represented in any of the publications. The simulation-modelling encompassed a variety of neurosurgical subspecialties including: vascular, skull base, ventriculoscopy / ventriculostomy, craniosynostosis, skull lesions / skull defects, intrinsic brain tumor and other. Finally, the vascular and skull base categories together accounted for over half (52.8 %) of the 3D printed simulated neurosurgical pathology. CONCLUSIONS Despite the growing body of literature supporting 3D printing in neurosurgical education, its full potential has not been maximized. Unexplored areas of 3D printing for neurosurgical simulation include models simulating the resection of intrinsic brain tumors or of epilepsy surgery lesions, as these require complex models to accurately simulate fine dissection techniques. 3D printed surgical phantoms offer an avenue for the advancement of global-surgery education initiatives.
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Affiliation(s)
- Grace M Thiong'o
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada.
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada.
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Toronto, Canada
| | - James M Drake
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada
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Makin G. The current landscape of 3D printing in oncological surgical interventions. Future Oncol 2019; 15:2999-3002. [PMID: 31424271 DOI: 10.2217/fon-2019-0476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Georgia Makin
- Future Science Group, Unitec House, 2 Albert Pl, Finchley, London N3 1QB
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