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Alam I, Garg K, Kumar AG, Raheja A, Shah H, Pandey K, Sharma R, Mishra S, Tandon V, Singh M, Ahmad FU, Suri A, Kale SS. Beyond Traditional Training: Exploring the Benefits of Virtual Reality Simulator in Lumbar Pedicle Screw Insertion - A Randomized Controlled Trial. World Neurosurg 2024:S1878-8750(24)00926-4. [PMID: 38825310 DOI: 10.1016/j.wneu.2024.05.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION This study compares the effectiveness of virtual reality simulators (VRS) and a saw bone model for learning lumbar pedicle screw insertion (LPSI) in neurosurgery. METHODS A single-center, cross-sectional, randomized controlled laboratory investigation was conducted involving residents and fellows from a tertiary care referral hospital. Participants were divided into two groups (A and B). Group A performed 3 LPSI tasks: the first on a saw bone model, the second on VRS, and the third on another saw bone model. Group B completed 2 LPSI tasks: the first on a saw bone model and the second on another saw bone model. The accuracy of LPSI was evaluated through noncontrast computed tomography scans for the saw bone models, while the in-built application of VRS was utilized to check for accuracy of screw placement using the simulator. RESULTS The study included 38 participants (19 in each group). Group A participants showed reduced mean entry point error (0.11 mm, P 0.024), increased mean purchase length (4.66 cm, P 0.007), and no cortical breaches (P 0.031) when placing the second saw bone model screw. Similar improvements were observed among group A participants in PGY 1-3 while placing the second saw bone model screws. CONCLUSIONS Virtual reality simulators (VRS) prove to be an invaluable tool for teaching complex neurosurgical skills, such as LPSI, to trainees. This technology investment can enhance the learning curve while maintaining patient safety.
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Affiliation(s)
- Intekhab Alam
- 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
| | - Akshay Ganesh Kumar
- 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
| | - Het Shah
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kushagra Pandey
- 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
| | - Shashwat Mishra
- 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.
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Faiz U Ahmad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - 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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Sufianov A, Ovalle CS, Cruz O, Contreras J, Begagić E, Kannan S, Rosario Rosario A, Chmutin G, Askatovna GN, Lafuente J, Sanchez JS, Nurmukhametov R, Soto García ME, Peev N, Pojskić M, Reyes-Soto G, Bozkurt I, Encarnación Ramírez MDJ. Low-Cost 3D Models for Cervical Spine Tumor Removal Training for Neurosurgery Residents. Brain Sci 2024; 14:547. [PMID: 38928547 PMCID: PMC11201732 DOI: 10.3390/brainsci14060547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. MATERIALS AND METHODS This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. RESULTS The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models' accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. CONCLUSIONS Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.
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Affiliation(s)
- Albert Sufianov
- Federal State Budgetary Institution the Federal Center of Neurosurgery of the Ministry of Health of the Russian Federation, 625062 Tyumen, Russia
- Department of Neurosurgery, State Medical University (Sechenov University), 119991 Moscow, Russia
- Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia RUDN University, 117198 Moscow, Russia
| | - Carlos Salvador Ovalle
- Department of Neurosurgery, National University of Mexico Hospital General, Durango 34030, Mexico
| | - Omar Cruz
- Department of Neurosurgery, National University of Mexico Hospital General, Durango 34030, Mexico
| | - Javier Contreras
- Department of Neurosurgery, National University of Mexico Hospital General, Durango 34030, Mexico
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina
| | - Siddarth Kannan
- School of Medicine, University of Central Lancashire, Preston PR02AG, UK
| | | | - Gennady Chmutin
- Petrovsky Russian Scientific Center of Surgery, 121359 Moscow, Russia
| | - Garifullina Nargiza Askatovna
- Federal State Budgetary Institution the Federal Center of Neurosurgery of the Ministry of Health of the Russian Federation, 625062 Tyumen, Russia
| | - Jesus Lafuente
- Spine Center Hospital del Mar, Sagrat Cor University Hospital, 08029 Barcelona, Spain
| | - Jose Soriano Sanchez
- Instituto Soriano de Cirugía de Columna Mínimamente Invasiva at ABC Hospital, Neurological Center, Santa Fe Campus, Mexico City 05100, Mexico
| | - Renat Nurmukhametov
- NCC No. 2 Federal State Budgetary Scientific Institution Russian Scientific Center Named after. Acad. B.V. Petrovsky (Central Clinical Hospital Russian Academy of Sciences), 121359 Moscow, Russia
| | | | - Nikolay Peev
- Department of Neurosurgery, Russian People’s Friendship University, 117198 Moscow, Russia
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldingerstr., 35033 Marburg, Germany
| | - Gervith Reyes-Soto
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Ismail Bozkurt
- Department of Neurosurgery, Medical Park Ankara Hospital, Kent Koop Mah 1868. Sok, Batıkent Blv. No:15, 06680 Ankara, Turkey
- Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, 06520 Ankara, Turkey
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Levy HA, Pinter ZW, Honig R, Salmons HI, Hobson SL, Karamian BA, Freedman BA, Elder BD, Fogelson JL, Nassr AN, Sebastian AS. A Standardized Curriculum Improves Trainee Rod Bending Proficiency in Spinal Deformity Surgery. Results of a Prospective Randomized Controlled Educational Study. J Am Acad Orthop Surg 2024; 32:e17-e25. [PMID: 37494716 DOI: 10.5435/jaaos-d-23-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Surgical simulation is increasingly being accepted as a training platform to promote skill development and a safe surgical technique. Preliminary investigations in spine surgery show that simulation paired with educational intervention can markedly improve trainee performance. This study used a newly developed thoracolumbar fusion rod bending model to assess the effect of a novel educational curriculum and simulator training on surgical trainee rod bending speed and proficiency. METHODS Junior (PGY1 to 2) and senior (PGY3-fellow) surgical trainees at a single academic institution were prospectively enrolled in a rod bending simulation using a T7-pelvis spinal fusion model. Participants completed two simulations, with 1 month between first and second attempts. Fifty percent of surgeons in each training level were randomized to receive an educational curriculum (rod bending technique videos and unlimited simulator practice) between simulation attempts. Rod bending simulation proficiency was determined by the percentage of participants who completed the task (conclusion at 20 minutes), time to task completion or conclusion, and number of incomplete set screws at task conclusion. Participants completed a preparticipation and postparticipation survey. Univariate analysis compared rod bending proficiency and survey results between education and control cohorts. RESULTS Forty trainees (20 junior and 20 senior) were enrolled, with 20 participants randomized to the education and control cohorts. No notable differences were observed in the first simulation rod bending proficiency or preparticipation survey results between the education and control cohorts. In the second simulation, the education versus the control cohort demonstrated a significantly higher completion rate ( P = 0.01), shorter task time ( P = 0.009), fewer incomplete screws ( P = 0.003), and greater experience level ( P = 0.008) and comfort level ( P = 0.002) on postparticipation survey. DISCUSSION Trainees who participated in a novel educational curriculum and simulator training relative to the control cohort improved markedly in rod bending proficiency and comfort level. Rod bending simulation could be incorporated in existing residency and fellowship surgical skills curricula. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hannah A Levy
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Levy, Pinter, Honig, Salmons, Freedman, Nassr, and Sebastian), the Department of Neurologic Surgery, Mayo Clinic, Rochester, MN (Elder and Fogelson), the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Hobson), and the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Karamian)
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Simulation Training in Spine Surgery. J Am Acad Orthop Surg 2022; 30:400-408. [PMID: 35446299 DOI: 10.5435/jaaos-d-21-00756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Simulated surgery is part of a growing paradigm shift in surgical education as a whole. Various modalities from cadaver models to virtual reality have been developed and studied within the context of surgical education. Simulation training in spine surgery has an immense potential to improve education and ultimately improve patient safety. This is due to the inherent risk of operating the spine and the technical difficulty of modern techniques. Common procedures in the modern orthopaedic armamentarium, such as pedicle screw placement, can be simulated, and proficiency is rapidly achieved before application in patients. Furthermore, complications such as dural tears can be simulated and effectively managed in a safe environment with simulation. New techniques with steeper learning curves, such as minimally invasive techniques, can now be safely simulated. Hence, augmenting surgical education through simulation has great potential to benefit trainees and practicing orthopaedic surgeons in modern spine surgery techniques. Additional work will aim to improve access to such technologies and integrate them into the current orthopaedic training curriculum.
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