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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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Hua W, Zhang X, Wang Q, Qiu T, Yang Z, Wang X, Xu H, Zhang J, Yu G, Fu M, Chen L, Zhu W, Mao Y. Neurosurgical application of pineal region tumor resection with 3D 4K exoscopy via infratentorial approach: a retrospective cohort study. Int J Surg 2023; 109:4062-4072. [PMID: 37755386 PMCID: PMC10720789 DOI: 10.1097/js9.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/13/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The pineal region tumors are challenging for neurosurgeons and can lead to secondary hydrocephalus. The introduction of the exoscope has provided clinical interventions with high image quality and an ergonomic system for pineal region tumor operations. In this study, the authors describe the exoscopic approach used to facilitate the surgical resection of pineal region tumors and relieve hydrocephalus. MATERIALS AND METHODS In this retrospective cohort study, we consecutively reviewed the clinical and radiological data of 25 patients with pineal region lesions who underwent three-dimensional exoscopic tumor resection at a single center. RESULTS The patient cohort consisted of 16 males and 9 females, with an average age of 34.6 years (range, 6-62 years; 8 cases aged ≤18). Pathological examination confirmed eight pineal gland tumors, four gliomas, nine germ cell neoplasms, two ependymomas, and two metastatic tumors. Preoperative hydrocephalus was present in 23 patients. Prior to tumor resection, external ventricular drainage (EVD) with Ommaya reservoir implantation was performed in 17 patients. Two patients received preoperative endoscopic third ventriculostomy (ETV), and five patients received a ventriculoperitoneal (VP) shunt, including one who received both procedures. Gross total resection was achieved in 19 patients (76%) in the 'head-up' park bench position using the exoscope. Eight patients (31.6%) with third ventricle invasion received subtotal resection, mainly in glioma cases, which was higher than those without invasion (0%), but not statistically significant ( P =0.278, Fisher's exact test). No new neurological dysfunction was observed after surgery. Two patients (8%) developed intracranial and pulmonary infections, and two patients (8%) suffered from pneumothorax. Hydrocephalus was significantly relieved in all patients postoperatively, and four patients with relapse hydrocephalus were cured during the long-term follow-up. Postoperative adjuvant management was recommended for indicated patients, and a mean follow-up of 24.8±14.3 months showed a satisfied outcome. CONCLUSIONS The exoscope is a useful tool for pineal region tumor resection and hydrocephalus relief, particularly with posterior third ventricle invasion, as total resection could be achieved without obvious complication. The special superiority of the exoscope for the indicated pineal region tumors should be highlighted.
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Affiliation(s)
- Wei Hua
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Qijun Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Zixiao Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Xiaowen Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Hao Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Jinsen Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Minjie Fu
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University
- National Center for Neurological Disorders
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration
- Neurosurgical Institute of Fudan University
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People’s Republic of China
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Lei F, Xie Y, Fu J, Xie Z, Zhang M. Advantages of 3-dimensional exoscope-assisted anterior cervical spine surgery: A meta-analysis. Acta Neurochir (Wien) 2023; 165:3077-3087. [PMID: 37488398 DOI: 10.1007/s00701-023-05721-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Visual instruments are essential to ensure high-quality surgical outcomes for minimally invasive procedures and have gradually become the focus of research. Recently, a novel visual auxiliary instrument, a 3-dimensional exoscope (EX), has been applied for spinal surgery. However, its advantages over other auxiliary means (OAMs) in anterior cervical surgery need to be assessed. OBJECTIVE To compare and evaluate the clinical outcomes of EX and OAMs in anterior cervical spine surgery using a meta-analysis and to provide the latest clinical evidence. METHODS PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Database were systematically reviewed for relevant literature published prior to January 21, 2023. Two researchers independently screened the literature, extracted data, and assessed bias risk in the included literature. Review Manager software (version 5.4; the Cochrane Collaboration) was used to conduct the meta-analysis. RESULTS five studies, one prospective and four retrospective cohort studies, with a total of 349 patients (154 in the EX group and 195 in the OAMs group) were included. A meta-analysis showed that compared to OAMs, EX-assisted anterior cervical spine surgery resulted in less intraoperative hemorrhage [WMD = -8.96, 95% CI (-14.21, -3.71), P = 0.0008]. Nevertheless, no significant differences in VAS scores, JOA scores, operation time, hospitalization time, and complication rate were observed between the two groups (P > 0.05). CONCLUSION EX and OAMs are equally safe and effective for anterior cervical spine surgery; however, compared to OAMs, EX results in less intraoperative hemorrhage.
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Affiliation(s)
- Fuhao Lei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yizhou Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Jin Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhe Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Singh R, Singh R, Suri A. Personalized 3D Printed Eye Gear for Microscopic Surgeons Amidst and beyond COVID-19. Bioengineering (Basel) 2023; 10:1129. [PMID: 37892859 PMCID: PMC10604268 DOI: 10.3390/bioengineering10101129] [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: 05/29/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic underscored the need for enhanced protective measures for healthcare workers, particularly surgeons, who face a heightened risk of exposure to infectious aerosols. However, conventional eye protection equipment such as face shields, goggles, or glasses often leads to ergonomic discomfort and a reduced field of view (FOV), impeding surgeons' ability to perform microsurgical procedures with precision and ease. To address these limitations, this study aimed to develop personalized 3D-printed eye gear for microscopic surgeons based on facial anthropometry data. 3D scanning was employed to obtain facial data from ten neurosurgery residents. Utilizing computer-aided designing, eye gears tailored to the unique facial features of each participant were developed. Finite element analysis-based contact simulation was used to assess the pressure exerted by the eye gear. Multi-material 3D printing was employed to fabricate the personalized eye gear. Participants, while donning the eye gear, engaged in simulation-based micro suturing tasks at various magnifications of the operating microscope, and marked the FOV range. They provided feedback scores (1-10) on the effectiveness of the eye gear through a Likert scale questionnaire (Q1-Q8). Finite element analysis demonstrated uniform strain distribution on the face, indicating that the edges of the customized eye gear fit exactly to the user's face. The average scores for the questionnaire Q1 to Q8 ranged from 6.8 to 8.5, with an overall mean score of 7.6. This indicates that the developed eye gear was simple to use and did not cause any discomfort. Additionally, the average reduction in the FOV was only 10.93% across the different operating microscope magnifications. These findings highlight eye gear's potential to alleviate discomfort and enhance precision in microscopic surgeries. Consequently, personalized 3D-printed eye gear offers a promising solution for providing surgeons with a safe environment while preserving the benefits of the operating microscope.
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Affiliation(s)
| | | | - Ashish Suri
- Neuro-Engineering Laboratory, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110029, India; (R.S.); (R.S.)
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Acha JL, Contreras L, Lopez K, Azurin M, Cueva M, Bellido A, Contreras S, Santos O. Neurovascular Microsurgical Experience Through 3-Dimensional Exoscopy: Case Report and Literature Review. World Neurosurg 2023; 174:63-68. [PMID: 36871654 DOI: 10.1016/j.wneu.2023.02.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The microscope is important in neurosurgery, but it is not exempt from limitations. The exoscope has emerged as an alternative because it offers better 3-dimensional (3D) visualization and better ergonomics. We present our initial experience in vascular pathology using 3D exoscopy at the Dos de Mayo National Hospital to show the viability of the 3D exoscope in vascular microsurgery. We also provide a review of the literature. METHODS In this work, the Kinevo 900 exoscope was used in 3 patients with cerebral (2) and spinal (1) vascular pathology. We evaluated the image quality, equipment management, ergonomics, educational utility, and 3D glasses and recorded the characteristics of the cases. We reviewed the experience of other authors as well. RESULTS Three patients underwent surgery: 1 occipital cavernoma, 1 cerebral dural fistula, and 1 spinal dural fistula. Excellent 3D visualization with Zeiss Kinevo 900 exoscope (Carl Zeiss, Germany), surgical comfort, and educational utility occurred, and there were no complications. CONCLUSIONS Our experience and that of other authors suggests that the 3D exoscope shows excellent visualization, better ergonomics, and an innovative educational experience. Vascular microsurgery can be performed safely and effectively.
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Affiliation(s)
- Jose Luis Acha
- Vascular Neurosurgery and Skull Base Service of the Dos de Mayo National Hospital, Lima, Peru; National University of San Marcos, Lima, Peru.
| | - Luis Contreras
- Vascular Neurosurgery and Skull Base Service of the Dos de Mayo National Hospital, Lima, Peru; National University of San Marcos, Lima, Peru
| | - Keneth Lopez
- Vascular Neurosurgery and Skull Base Service of the Dos de Mayo National Hospital, Lima, Peru; National University of San Marcos, Lima, Peru
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Calloni T, Antolini L, Roumy LG, Nicolosi F, Carrabba GG, Di Cristofori A, Fontanella MM, Giussani CG. Exoscope and operative microscope for training in microneurosurgery: A laboratory investigation on a model of cranial approach. Front Surg 2023; 10:1150981. [PMID: 37056300 PMCID: PMC10089287 DOI: 10.3389/fsurg.2023.1150981] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
ObjectiveTo evaluate the viability of exoscopes in the context of neurosurgical education and compare the use of a 4k3D exoscope to a traditional operative microscope in the execution of a task of anatomic structure identification on a model of cranial approach.Material and methodsA cohort of volunteer residents performed a task of anatomical structure identification with both devices three times across an experimental period of 2 months. We timed the residents’ performances, and the times achieved were analyzed. The volunteers answered two questionnaires concerning their opinions of the two devices.ResultsAcross tries, execution speed improved for the whole cohort. When using the exoscopes, residents were quicker to identify a single anatomical structure starting from outside the surgical field when deep structures were included in the pool. In all other settings, the two devices did not differ in a statistically significant manner. The volunteers described the exoscope as superior to the microscope in all the aspects the questionnaires inquired about, besides the depth of field perception, which was felt to be better with the microscope. Volunteers furthermore showed overwhelming support for training on different devices and with models of surgical approaches.ConclusionThe exoscope appeared to be non-inferior to the microscope in the execution of a task of timed identification of anatomical structures on a model of cranial approach carried out by our cohort of residents. In the questionnaires, the residents reported the exoscope to be superior to the microscope in eight of nine investigated domains. Further studies are needed to investigate the use of the exoscope in learning of microsurgical skills.
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Affiliation(s)
- Tommaso Calloni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giorgio G. Carrabba
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Marco M. Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Carlo G. Giussani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Correspondence: Carlo G. Giussani
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Hafez A, Haeren R, Huhtakangas J, Nurminen V, Niemelä M, Lehecka M. 3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems. Life (Basel) 2023; 13:life13020584. [PMID: 36836941 PMCID: PMC9966143 DOI: 10.3390/life13020584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
Background: In recent years, three-dimensional exoscopes have been increasingly applied in neurosurgery. Multiple exoscopic systems are available, all offering specific features. In this study, we assessed practical and visualization performance of four different exoscopic systems in a highly challenging microsurgical procedure, and evaluated whether these affected the quality of work. Methods: We included four different exoscopes: Olympus ORBEYE, Zeiss KINEVO, Storz VITOM, and Aesculap AEOS. With each exoscope, ten experimental bypass procedures were carried out on chicken wing vessels at a depth of 3 cm. We evaluated the quality of the anastomoses, the practical considerations for the setup of the exoscopic systems, and the visualization quality by tracking the number of unnecessary movements. Results: All included exoscopes enabled us to perform the bypass procedures with mostly adequate or excellent results. Surgically, the most pronounced difference between the exoscopes was the duration of the procedure, which was mainly due to the number of unnecessary movements. Practically, the exoscopes differ highly which is important when considering which exoscope to apply. Conclusions: This is the first study comparing different exoscope systems while performing the same challenging microsurgical procedure. We found major practical differences between the exoscopes that determine the suitability of an exoscope based on the demands and conditions of the surgical procedure. Therefore, preprocedural practical training with the exoscope is required.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
- Correspondence: or ; Tel.: +358-405885513
| | - Roel Haeren
- Department of Neurosurgery, Maastricht University Medical Center, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - Justiina Huhtakangas
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
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Zoli M, Daniele B, Giovanni R, Teresa S, Cesare Z, Giuseppe Maria DP. Young Neurosurgeons and Technology: Survey of Young Neurosurgeons Section of Italian Society of Neurosurgery (SINch). World Neurosurg 2022; 162:e436-e456. [DOI: 10.1016/j.wneu.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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Bedi MS, Raheja A, Mishra S, Katiyar V, Sharma R, Narwal P, Garg K, Tandon V, Suri A, Kale SS. Telementoring Feasibility Using a Novel Low-cost Lazy Glass Microsurgical Simulator: A "Proof of Concept" Experimental Study. World Neurosurg 2022; 161:136-146. [PMID: 35176520 DOI: 10.1016/j.wneu.2022.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In order to mitigate the challenges in microsurgical skill acquisition and training, especially in the COVID-19 era, we devised a novel microsurgical telementoring protocol for imparting microsurgical skill training in a socially distanced setting. We objectively analyzed its feasibility among neurosurgical trainees. METHODS In a controlled experimental design, 8 residents at different stages of their tenure participated in a lazy glass microsurgical simulator-based telementoring exercise. Microsuturing with 4-0 silk, 10-0 nylon on silastic sheets, and eggshell peeling tasks were performed by the residents prior to and after a telementoring session by a panel of 4 neurosurgical experts. Impact of telementoring was assessed in terms of surgical accuracy, efficiency, and dexterity by providing objective (Performance score [PS]), subjective (Neurosurgery Education and Training School [NETS] score), and cumulative scores (CS). Subgroup analysis was performed to assess the impact at different stages of residency. RESULTS PS, NETS score, and CS were significantly improved by telementoring sessions for 10-0 nylon micro-suturing (P < 0.001), and egg-hell peeling tasks (P < 0.01). PS and CS improved significantly (P = 0.01) after telementoring sessions for 4-0 silk microsuturing. Both pre- and post-training CS were similar across the 2 subgroups PGY 1-4 and PGY 5-6 (P > 0.05). CONCLUSIONS Telementoring is a viable alternative for neurosurgical resident training in the COVID-19 era, where reduction in elective surgeries and social distancing norms preclude conventional teaching. Lazy glass microsurgical simulator-based structured telementoring protocol is a cost-effective tool to augment surgical proficiency and finesse, irrespective of stage of residency.
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Affiliation(s)
- Manbachan Singh Bedi
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Priya Narwal
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India.
| | - Ashish Suri
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute OF Medical Sciences, New Delhi, India
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Strickland BA, Attenello F, Ruzevick J, Cote D, Zada G. Commentary: Robotic-Assisted Digital Exoscope for Resection of Cerebral Metastases: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:e177-e178. [PMID: 35147590 DOI: 10.1227/ons.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery. J Clin Med 2021; 11:jcm11010223. [PMID: 35011964 PMCID: PMC8745525 DOI: 10.3390/jcm11010223] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/18/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students.
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Roethe AL, Picht T. Redefining standards-response to: introductions of technological innovations in neurosurgery. Acta Neurochir (Wien) 2021; 163:2095-2096. [PMID: 33948687 PMCID: PMC8270815 DOI: 10.1007/s00701-021-04853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/19/2021] [Indexed: 10/30/2022]
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Fiani B, Jarrah R, Griepp DW, Adukuzhiyil J. The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation. Cureus 2021; 13:e15878. [PMID: 34327102 PMCID: PMC8302823 DOI: 10.7759/cureus.15878] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device's ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword "exoscope" to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient's real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ryan Jarrah
- Neurosurgery, College of Arts and Sciences, University of Michigan - Flint, Flint, USA
| | - Daniel W Griepp
- Neurosurgery, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Jessica Adukuzhiyil
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
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