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Boop S, Durfy S, Bass D, Lee A, Zavatchen S, Ellenbogen RG, Ravanpay AC. Neurological Surgery Resident ABNS Written Exam Scores Before and After Introduction of a Weekly Didactic Educational Intervention: A 12-Year Single-Institution Retrospective Study. Neurosurgery 2024:00006123-990000000-01323. [PMID: 39194226 DOI: 10.1227/neu.0000000000003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/19/2024] [Indexed: 08/29/2024] Open
Abstract
United States neurological surgery residency education has undergone substantive changes over the past 2 decades. Neurosurgical professional bodies have developed numerous initiatives providing standardized assessments and training opportunities for residency programs. However, there have been few studies using standardized measures to assess core components of educational programming in individual programs. We conducted a 12-year retrospective review of resident American Board of Neurological Surgery (ABNS) board scores using our institutional data from 2010 to 2021 to determine the effect of introducing a weekly didactic resident education hour (REH) on resident scores in the ABNS written in-training examination. ABNS scaled scores were analyzed before (2010-2016) and after (2017-2021) REH introduction. To account for a practice effect, we used a 2-factor linear regression model with an interaction term. We obtained ABNS scores from 43 residents representing 132 test attempts. The average ABNS scaled score significantly improved after the introduction of REH (319 vs 410, t = -3.44, P = .0008). Accounting for the practice effect revealed a significant interaction effect between the number of attempts taking the ABNS examination and whether formal didactics were taught, accounting for 46.2 points on the examination (t = 2.309, P = .023); however, REH alone did not have a significant effect on the scaled scores (t = -1.649, P = .102). ABNS written board scores represent a standardized metric by which educational initiatives within training programs may be assessed for efficacy. Further research is needed to identify educational approaches that are effective to meet the goal of demonstrated mastery of fundamental knowledge in neurosurgery across a diversity of neurological surgery residency programs.
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Affiliation(s)
- Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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De Schlichting E, Zaldivar-Jolissaint JF, Molter N, Chenevas-Paule M, Hamadmad A, Giroux L, Lazard A, Riethmuller D, Chaffanjon P, Coll G, Lechanoine F. A Comprehensive Training Model for Simulation of Intracranial Aneurysm Surgery Using a Human Placenta and a Cadaveric Head. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01243. [PMID: 38967445 DOI: 10.1227/ons.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysmal surgery is technically complex, and surgeon experience is an important factor in therapeutic success, but training young vascular neurosurgeons has become a complex paradigm. Despite new technologies and simulation models, cadaveric studies still offer an incomparable training tool with perfect anatomic accuracy, especially in neurosurgery. The use of human placenta for learning and improving microsurgical skills has been previously described. In this article, we present a comprehensive simulation model with both realistic craniotomy exposure and vascular handling consisting of a previously prepared and perfused human placenta encased in a human cadaveric specimen. METHODS Humans' placentas from the maternity and cadaveric heads from the body donation program of the anatomy laboratory were used. Placentas were prepared according to the established protocol, and aneurysms were created by catheterization of a placental artery. Ten participants, including senior residents or young attendees, completed an evaluation questionnaire after completing the simulation of conventional unruptured middle artery aneurysm clipping surgery from opening to closure. RESULTS The skin incision, muscle dissection, and craniotomy were assessed as very similar to reality. Brain tissue emulation and dissection of the lateral fissure were judged to be less realistic. Vascular management was evaluated as similar to reality as closure. Participants uniformly agreed that this method could be implemented as a standard part of their training. CONCLUSION This model could provide a good model for unruptured aneurysm clipping training.
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Affiliation(s)
- Emmanuel De Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | | | | | | | | | - Luc Giroux
- Université de Grenoble Alpes, Grenoble, France
| | - Arnaud Lazard
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
| | - Didier Riethmuller
- Université de Grenoble Alpes, Grenoble, France
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Philippe Chaffanjon
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
- Service de Chirurgie Thoracique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Guillaume Coll
- Service de Neurochirurgie, Centre hospitalier universitaire Gabriel Montpied, Clermont Ferrand, France
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Wu SS, Hsueh ML, Lin JC, Chen PC, Liu WH. Developing a piezoresistive sensor based bionic neurological intraoperative monitoring system for spine surgery skill training. BIOMICROFLUIDICS 2024; 18:044103. [PMID: 39184283 PMCID: PMC11344635 DOI: 10.1063/5.0205938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/11/2024] [Indexed: 08/27/2024]
Abstract
This research aims to tackle the limitations faced in surgical education nowadays, particularly in the complex field of spinal cord tumor removal surgery. An innovative flexible piezoresistive sensor designed to mimic a motor nerve was developed and integrated into a bionic spine surgery simulation system, allowing for the intraoperative nerve monitoring possible during simulated tumor removal surgeries. The motor nerve, fabricated using a combination of carbon nanotubes and silicone rubber, exhibited a strong correlation between applied force and resultant changes in resistance, as confirmed by experimental results. This creative system can play an important role in providing valuable feedback for training doctors, facilitating the assessment of surgical precision and success, and enabling doctors to take necessary precautions to minimize the risk of nerve damage in real surgical scenarios. Ultimately, this proposed system has the potential to elevate the standard of surgical education, foster skill development among doctors, and significantly contribute to enhanced patient care and recovery.
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Affiliation(s)
- Sin-Syuan Wu
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Meng Lun Hsueh
- Graduate Institute of Intelligent Robotics, Hwa Hsia University of Technology, New Taipei City, Taiwan
| | | | - Pin-Chuan Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Wei-Hsiu Liu
- Authors to whom correspondence should be addressed: and
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Chen PC, Chen HC, Liu WH, Lin JC. Improving medical students recognizing surgery of glioblastoma removal/decompressive craniectomy via physical lifelike brain simulator training. BMC MEDICAL EDUCATION 2024; 24:632. [PMID: 38844925 PMCID: PMC11155129 DOI: 10.1186/s12909-024-05621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND This study aims to investigate the benefits of employing a Physical Lifelike Brain (PLB) simulator for training medical students in performing craniotomy for glioblastoma removal and decompressive craniectomy. METHODS This prospective study included 30 medical clerks (fifth and sixth years in medical school) at a medical university. Before participating in the innovative lesson, all students had completed a standard gross anatomy course as part of their curriculum. The innovative lesson involved PLB Simulator training, after which participants completed the Learning Satisfaction/Confidence Perception Questionnaire and some received qualitative interviews. RESULTS The average score of students' overall satisfaction with the innovative lesson was 4.71 out of a maximum of 5 (SD = 0.34). After the lesson, students' confidence perception level improved significantly (t = 9.38, p < 0.001, effect size = 1.48), and the average score improved from 2,15 (SD = 1.02) to 3.59 (SD = 0.93). 60% of the students thought that the innovative lesson extremely helped them understand the knowledge of surgical neuroanatomy more, 70% believed it extremely helped them improve their skills in burr hole, and 63% thought it was extremely helpful in improving the patient complications of craniotomy with the removal of glioblastoma and decompressive craniectomy after completing the gross anatomy course. CONCLUSION This innovative lesson with the PLB simulator successfully improved students' craniotomy knowledge and skills.
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Affiliation(s)
- Pin-Chuan Chen
- Department of Machine Engineering, National Taiwan University of Science and Technology, Taipei, 106, Taiwan
| | - Hsin-Chueh Chen
- Department of Machine Engineering, National Taiwan University of Science and Technology, Taipei, 106, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, 114, Taiwan
- Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, 114, Taiwan
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, 106, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 106, Taiwan.
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Fanizzi C, Carone G, Rocca A, Ayadi R, Petrenko V, Casali C, Rani M, Giachino M, Falsitta LV, Gambatesa E, Galbiati TF, Orena EF, Tramacere I, Riker NI, Mocca A, Schaller K, Meling TR, DiMeco F, Perin A. Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study. BRAIN & SPINE 2024; 4:102829. [PMID: 38812880 PMCID: PMC11134543 DOI: 10.1016/j.bas.2024.102829] [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: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
Introduction Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess. Research question The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance. Material and methods Seventy-two residents were randomized into the simulation group (SG) and control group (CG). The course spanned five days, commencing with assessment of technical skills in basic procedures within a wet-lab setting on day 1. Over the subsequent core days, the SG engaged in simulated procedures, while the CG carried out routine activities in an OR. On day 5, all residents' technical competencies were evaluated. Psychometric measures of all participants were subjected to analysis. Results The SG demonstrated superior performance (p < 0.0001) in the brain tumour removal compared to the CG. Positive learning curves were evident in the SG across the three days of simulator-based training for all tumour removal tasks (all p-values <0.05). No significant differences were noted in other tasks, and no meaningful correlations were observed between performance and any psychometric parameters. Discussion and conclusion A brief and intensive training regimen utilizing 3D virtual reality simulators enhances residents' microsurgical proficiency in brain tumour removal models. Simulators emerge as a viable tool to expedite the learning curve of in-training neurosurgeons.
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Affiliation(s)
- Claudia Fanizzi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Giovanni Carone
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandra Rocca
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Roberta Ayadi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Veronika Petrenko
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Martina Rani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Marta Giachino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Lydia Viviana Falsitta
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Enrico Gambatesa
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Tommaso Francesco Galbiati
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Eleonora Francesca Orena
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Irene Tramacere
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Nicole Irene Riker
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandro Mocca
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, Geneva, Switzerland
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, and SFITS, Geneva,
Switzerland
| | - Torstein Ragnar Meling
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Neurosurgery, The National Hospital of Denmark,
Rigshospitalet, Copenhagen, Denmark
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milano,
Milano, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School,
Baltimore, MD, USA
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Life Sciences, University of Trieste, Trieste,
Italy
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Steen CW, Söderström K, Stensrud B, Nylund IB, Siqveland J. The effectiveness of virtual reality training on knowledge, skills and attitudes of health care professionals and students in assessing and treating mental health disorders: a systematic review. BMC MEDICAL EDUCATION 2024; 24:480. [PMID: 38693509 PMCID: PMC11064237 DOI: 10.1186/s12909-024-05423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Virtual reality (VR) training can enhance health professionals' learning. However, there are ambiguous findings on the effectiveness of VR as an educational tool in mental health. We therefore reviewed the existing literature on the effectiveness of VR training on health professionals' knowledge, skills, and attitudes in assessing and treating patients with mental health disorders. METHODS We searched MEDLINE, PsycINFO (via Ovid), the Cochrane Library, ERIC, CINAHL (on EBSCOhost), Web of Science Core Collection, and the Scopus database for studies published from January 1985 to July 2023. We included all studies evaluating the effect of VR training interventions on attitudes, knowledge, and skills pertinent to the assessment and treatment of mental health disorders and published in English or Scandinavian languages. The quality of the evidence in randomized controlled trials was assessed with the Cochrane Risk of Bias Tool 2.0. For non-randomized studies, we assessed the quality of the studies with the ROBINS-I tool. RESULTS Of 4170 unique records identified, eight studies were eligible. The four randomized controlled trials were assessed as having some concern or a high risk of overall bias. The four non-randomized studies were assessed as having a moderate to serious overall risk of bias. Of the eight included studies, four used a virtual standardized patient design to simulate training situations, two studies used interactive patient scenario training designs, while two studies used a virtual patient game design. The results suggest that VR training interventions can promote knowledge and skills acquisition. CONCLUSIONS The findings indicate that VR interventions can effectively train health care personnel to acquire knowledge and skills in the assessment and treatment of mental health disorders. However, study heterogeneity, prevalence of small sample sizes, and many studies with a high or serious risk of bias suggest an uncertain evidence base. Future research on the effectiveness of VR training should include assessment of immersive VR training designs and a focus on more robust studies with larger sample sizes. TRIAL REGISTRATION This review was pre-registered in the Open Science Framework register with the ID-number Z8EDK.
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Affiliation(s)
- Cathrine W Steen
- Mental Health Department, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway.
- Inland Norway University of Applied Sciences, P.B. 400, Elverum, 2418, Norway.
| | - Kerstin Söderström
- Mental Health Department, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway
- Inland Norway University of Applied Sciences, P.B. 400, Elverum, 2418, Norway
| | - Bjørn Stensrud
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway
| | - Inger Beate Nylund
- Inland Norway University of Applied Sciences, P.B. 400, Elverum, 2418, Norway
| | - Johan Siqveland
- Akershus University Hospital, P.B 1000, Lørenskog, 1478, Norway
- National Centre for Suicide Research and Prevention, Oslo, 0372, Norway
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Bajaj J, Yadav YR, Sinha M, Kumar A, Hedaoo K, Ratre S, Parihar V, Swamy NM. A Model with Feedback Mechanism for Learning Hand-Eye Coordination: A Pilot Study. Neurol India 2024; 72:395-398. [PMID: 38817178 DOI: 10.4103/neuroindia.ni_167_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/15/2021] [Indexed: 06/01/2024]
Abstract
BACKGROUND Practicing neuroendoscopic skills like hand-eye coordination is mandatory before embarking on actual surgeries. Synthetic models are able alternatives for cadavers and animals. Presently available models in the literature are either very costly or lack a feedback mechanism, which makes training difficult. OBJECTIVE We aimed to make a basic low-cost neuroendoscopic hand-eye coordination model with a feedback mechanism. METHODS AND MATERIALS An electronic circuit in series was designed inside a clay utensil to test inadvertent contact of the working instrument with implanted steel pins, which on completion lighted a light-emitting diode (LED) and raised an alarm. Two exercises-moving-a-rubber exercise and passing copper rings of multiple sizes were made and tested by 15 neurosurgeons. RESULTS The moving-a-rubber exercise was completed by 6/15 (40%) neurosurgeons in the first attempt, 6/15 (40%) in the second, and 3/15 (20%) in the third attempt. For the 1.5 cm copper ring passing exercise, 12/15 (80%) successfully performed in the first attempt; for 1 cm copper ring, 6/15 (40%) performed in the first; and for the 0.5 cm copper ring, 1/15 (6.6%) performed in the first attempt. The time to finish all the exercises significantly decreased in the third successful attempt compared to the first. CONCLUSION The model gave excellent feedback to the trainee and examiner for basic neuroendoscopic hand-eye coordination skills.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Pérez-Cruz JC, Macías-Duvignau MA, Reyes-Soto G, Gasca-González OO, Baldoncini M, Miranda-Solís F, Delgado-Reyes L, Ovalles C, Catillo-Rangel C, Goncharov E, Nurmukhametov R, Lawton MT, Montemurro N, Encarnacion Ramirez MDJ. Latex vascular injection as method for enhanced neurosurgical training and skills. Front Surg 2024; 11:1366190. [PMID: 38464665 PMCID: PMC10920354 DOI: 10.3389/fsurg.2024.1366190] [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: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Background Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications. Methods Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection. Results Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels. Conclusions Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.
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Affiliation(s)
- Julio C. Pérez-Cruz
- Laboratorio de Técnicas Anatómicas y Material Didactico, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mario A. Macías-Duvignau
- Laboratorio de Técnicas Anatómicas y Material Didactico, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Gervith Reyes-Soto
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Oscar O. Gasca-González
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Anatomía, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Franklin Miranda-Solís
- Laboratorio de Neuroanatomía, Centro de Investigación de Anatomía y Fisiología Alto Andina, Universidad Andina del Cusco, Cusco, Peru
| | - Luis Delgado-Reyes
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos Ovalles
- Department of Neurosurgery, General Hospital, Durango, Mexico
| | - Carlos Catillo-Rangel
- Department of Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Evgeniy Goncharov
- Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Renat Nurmukhametov
- Neurological Surgery, Peoples Friendship University of Russia, Moscow, Russia
| | - Michael T. Lawton
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
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Tang L, Liu PX, Hou W. Simulation of soft tissue deformation under physiological motion based on complementary dynamic method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107851. [PMID: 37890287 DOI: 10.1016/j.cmpb.2023.107851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/12/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Physiological motions have a significant impact on soft tissue deformation and accuracy of surgical procedures, which is essential for realistic surgical simulation. While existing studies offer accurate simulation of soft tissue deformation, integrating physiological motions into deformation models of soft tissue remains a challenging task. METHODS This paper introduces a novel deformation model, based on complementary dynamics, to animate soft tissue deformation under physiological motion. The finite element method is incorporated to accurately characterize the elastic behavior of the soft tissue. Mathematical models of physiological motion are utilized and the physiological effects are converted into displacements of a predefined set of handles within the soft tissue mesh. Complementary displacements derived from the inherent dynamics of the soft tissue are calculated, enabling the simulation of physiological motions and elastic behaviors in soft tissue deformation. RESULTS Experiments were conducted to evaluate the performance and effectiveness of the proposed method in simulating soft tissue deformation under physiological motion. The simulation results show that the soft tissues exhibit physiological motion that corresponds to the rhythm of arterial pressure fluctuations, heartbeat or respiratory. Furthermore, the presented method exhibits stable performance compared with existing force-based methods. CONCLUSIONS Both elastic behaviors and physiological motions of soft tissue deformation can be governed by the proposed method. A high degree of realistic visualization is achieved for virtual surgery simulation.
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Affiliation(s)
- Liang Tang
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Peter Xiaoping Liu
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China; Department of Systems and Computer Engineering, Carleton University, Ottawa, ON KIS 5B6, Canada.
| | - Wenguo Hou
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China.
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Santona G, Madoglio A, Mattavelli D, Rigante M, Ferrari M, Lauretti L, Mattogno P, Parrilla C, De Bonis P, Galli J, Olivi A, Fontanella MM, Fiorentino A, Serpelloni M, Doglietto F. Training models and simulators for endoscopic transsphenoidal surgery: a systematic review. Neurosurg Rev 2023; 46:248. [PMID: 37725193 PMCID: PMC10509294 DOI: 10.1007/s10143-023-02149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no systematic review is available. To provide a systematic and critical literature review and up-to-date description of the training models or simulators dedicated to endoscopic transsphenoidal surgery. A search was performed on PubMed and Scopus databases for articles published until February 2023; Google was also searched to document commercially available. For each model, the following features were recorded: training performed, tumor/arachnoid reproduction, assessment and validation, and cost. Of the 1199 retrieved articles, 101 were included in the final analysis. The described models can be subdivided into 5 major categories: (1) enhanced cadaveric heads; (2) animal models; (3) training artificial solutions, with increasing complexity (from "box-trainers" to multi-material, ct-based models); (4) training simulators, based on virtual or augmented reality; (5) Pre-operative planning models and simulators. Each available training model has specific advantages and limitations. Costs are high for cadaver-based solutions and vary significantly for the other solutions. Cheaper solutions seem useful only for the first stages of training. Most models do not provide a simulation of the sellar tumor, and a realistic simulation of the suprasellar arachnoid. Most artificial models do not provide a realistic and cost-efficient simulation of the most delicate and relatively common phase of surgery, i.e., tumor removal with arachnoid preservation; current research should optimize this to train future neurosurgical generations efficiently and safely.
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Affiliation(s)
- Giacomo Santona
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alba Madoglio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Davide Mattavelli
- Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Mario Rigante
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Liverana Lauretti
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Mattogno
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Parrilla
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pasquale De Bonis
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Jacopo Galli
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Otorhinolaryngology, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Alessandro Olivi
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - ASST Spedali Civili di Brescia, Brescia, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Mauro Serpelloni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy.
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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11
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Zoia C, Mantovani G, Müther M, Suero Molina E, Scerrati A, De Bonis P, Cornelius J, Roche P, Tatagiba M, Jouanneau E, Manet R, Schroeder H, Cavallo L, Kasper E, Meling T, Mazzatenta D, Daniel R, Messerer M, Visocchi M, Froelich S, Bruneau M, Spena G. Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section. BRAIN & SPINE 2023; 3:102669. [PMID: 37720459 PMCID: PMC10500473 DOI: 10.1016/j.bas.2023.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery. Research question Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection. Material and methods A PRISMA based literature search was performed to select the most relevant papers on the topic. Results Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery. Discussion and conclusion This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
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Affiliation(s)
- C. Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - G. Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - M. Müther
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - E. Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - A. Scerrati
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - P. De Bonis
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - J.F. Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - P.H. Roche
- Department of Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - M. Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - E. Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - R. Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - H.W.S. Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Germany
| | - L.M. Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Policlinico Federico II University Hospital, Italy
| | - E.M. Kasper
- Department of Neurosurgery, Steward Medical Group, Brighton, USA
| | - T.R. Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D. Mazzatenta
- Department of Neurosurgery, Neurological Sciences Institut IRCCS, Bologna, Italy
| | - R.T. Daniel
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Messerer
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Visocchi
- Department of Neurosurgery, Institute of Neurosurgery Catholic University of Rome, Italy
| | - S. Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M. Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G. Spena
- Neurosurgery Unit, IRCSS San Matteo Hospital, Pavia, Italy
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Li Z, Liu PX, Hou W. Modeling fibrous soft tissue dissection with elastic-plastic deformation for simulation of brain tumor removal. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107420. [PMID: 36854236 DOI: 10.1016/j.cmpb.2023.107420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Realistic modeling the dissection of brain tissue is of key importance for simulation of brain tumor removal in virtual neurosurgery systems. However, existing methods are unable to characterize inelastic behaviors of brain tissue, such as plastic deformation and dissection evolution, making it ineffective in simulating brain tumor removal procedures. METHODS In this paper, a model of fibrous soft tissue dissection for the simulation of brain tumor removal is proposed. A dissection variable of representative volume element is used to characterize the dissection state of the fibrous soft tissue. The evolution of dissection with elastic-plastic deformation under the effects of external loads is presented. RESULTS Simulation results show that the proposed model provides realistic, stable and intuitive results in the simulation of fracture in fibrous soft tissues. As the external load increases, the fibrous soft tissue begins to crack, with the cracks growing and multiplying until they eventually merge to form a fracture. The proposed model is incorporated into the simulation of brain tumor removal. CONCLUSIONS The experimental results demonstrate the feasibility of modeling fibrous soft tissue dissection with elastic-plastic deformation. A relative high degree of realistic visual feedback is achieved.
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Affiliation(s)
- Zimeng Li
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Peter Xiaoping Liu
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China; Department of Systems and Computer Engineering, Carleton University, Ottawa, ON KIS 5B6, Canada.
| | - Wenguo Hou
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China.
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13
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Virtual Immersion into a Poorly-Managed Medical Crisis Worsens Subsequent Performance: A Randomized, Controlled Trial. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Shlobin NA, Radwanski RE, Kortz MW, Rasouli JJ, Gibbs WN, Than KD, Baaj AA, Shin JH, Dahdaleh NS. Utility of Virtual Spine Neurosurgery Education for Medical Students. World Neurosurg 2022; 163:179-186. [PMID: 35729819 DOI: 10.1016/j.wneu.2021.07.135] [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: 07/08/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Distance learning has become increasingly important to expand access to neurosurgical spine education. However, emerging online spine education initiatives have largely focused on residents, fellows, and surgeons in practice. We aimed to assess the utility of online neurosurgical spine education for medical students regarding career interests, knowledge, and technical skills. METHODS A survey assessing the demographics and effects of virtual spine education programming on the interests, knowledge, and technical skills was sent to attendees of several virtual spine lectures. The ratings were quantified using 7-point Likert scales. RESULTS A total of 36 responses were obtained, of which 15 (41.7%) were from first- or second-year medical students and 18 (50.0%) were from international students. Most respondents were interested in neurosurgery (n = 30; 80.3%), with smaller numbers interested in radiology (n = 3; 8.3%) and orthopedic surgery (n = 2; 5.6%). The rating of utility ranged from 5.69 ± 1.14 to 6.50 ± 0.81 for career, 5.83 ± 0.94 to 6.14 ± 0.80 for knowledge, and 5.22 ± 1.31 to 5.83 ± 1.06 for clinical skills. Of the 36 respondents, 26 (72.2%) preferred virtual neurosurgical spine education via intermixed lectures and interactive sessions. The most common themes regarding the utility of virtual spine education were radiology by 18 (50.0%), anatomy by 12 (33.3%), and case-based teaching by 8 (22.2%) respondents. CONCLUSIONS Virtual distance learning for neurosurgical spine education is beneficial for students by enabling career exploration and learning content and clinical skills. Although the overall benefit was lowest for clinical skills, virtual programming could serve as an adjunct to traditional in-person exposure. Distance learning could also provide an avenue to reduce disparities in medical student neurosurgical spine education locally and globally.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA.
| | - Ryan E Radwanski
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA; Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michael W Kortz
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA; Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Wende N Gibbs
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Ali A Baaj
- Department of Neurological Surgery, University of Arizona, Banner University Medical Center, Phoenix, Arizona, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
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Advanced Manufacturing in the Fabrication of a Lifelike Brain Glioblastoma Simulator for the Training of Neurosurgeons. Polymers (Basel) 2022; 14:polym14061072. [PMID: 35335403 PMCID: PMC8948645 DOI: 10.3390/polym14061072] [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: 01/30/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
Neurosurgeons require considerable expertise and practical experience to deal with the critical situations commonly encountered in complex surgical operations such as cerebral cancer; however, trainees in neurosurgery seldom have the opportunity to develop these skills in the operating room. Physical simulators can give trainees the experience they require. In this study, we adopted advanced molding and replication techniques in the fabrication of a physical simulator for use in practicing the removal of cerebral tumors. Our combination of additive manufacturing and molding technology with elastic material casting made it possible to create a simulator that realistically mimics the skull, brain stem, soft brain lobes, and cerebral cancer with cerebral tumors located precisely where they are likely to appear. Multiple and systematic experiments were conducted to prove that the elastic material used herein was appropriated for building professional medical physical simulator. One neurosurgical trainee reported that under the guidance of a senior neurosurgeon, the physical simulator helped to elucidate the overall process of cerebral cancer removal and provided a realistic impression of the tactile feelings involved in craniotomy. The trainee also learned how to make decisions when facing the infiltration of a cerebral tumor into normal brain lobes. Our results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate surgical operations.
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16
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Mishra R, Narayanan MK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031719. [PMID: 35162742 PMCID: PMC8835688 DOI: 10.3390/ijerph19031719] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Background: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. Methods: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989–2021. An example of a search strategy used in PubMed Central is: “Virtual reality” [All Fields] AND (“neurosurgical procedures” [MeSH Terms] OR (“neurosurgical” [All Fields] AND “procedures” [All Fields]) OR “neurosurgical procedures” [All Fields] OR “neurosurgery” [All Fields] OR “neurosurgery” [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). Results: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. Conclusions: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in “social distancing” in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.
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Affiliation(s)
- Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India;
| | | | - Giuseppe E. Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital, Birgunj 44300, Nepal;
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India;
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Davids J, Lam K, Nimer A, Gianarrou S, Ashrafian H. AIM in Medical Education. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Examining the benefits of extended reality in neurosurgery: A systematic review. J Clin Neurosci 2021; 94:41-53. [PMID: 34863461 DOI: 10.1016/j.jocn.2021.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/18/2021] [Accepted: 09/25/2021] [Indexed: 01/14/2023]
Abstract
While well-established in other surgical subspecialties, the benefits of extended reality, consisting of virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies, remains underexplored in neurosurgery despite its increasing utilization. To address this gap, we conducted a systematic review of the effects of extended reality (XR) in neurosurgery with an emphasis on the perioperative period, to provide a guide for future clinical optimization. Seven primary electronic databases were screened following guidelines outlined by PRISMA and the Institute of Medicine. Reported data related to outcomes in the perioperative period and resident training were all examined, and a focused analysis of studies reporting controlled, clinical outcomes was completed. After removal of duplicates, 2548 studies were screened with 116 studies reporting measurable effects of XR in neurosurgery. The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes. A rise in high-quality studies was identified from 2017 to 2020 compared to all previous years (p = 0.004). Primary users of the technology were: 56% neurosurgeon (n = 65), 28% residents (n = 33) and 5% patients (n = 6). A final synthesis was conducted on 10 controlled studies reporting patient outcomes. XR technologies have demonstrated benefits in preoperative planning and multimodal neuronavigation especially for tumor surgery. However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data. XR platforms offer several advantages to improve patient outcomes and specifically, the patient experience for neurosurgery.
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Gagnon Shaigetz V, Proulx C, Cabral A, Choudhury N, Hewko M, Kohlenberg E, Segado M, Smith MSD, Debergue P. An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process. JMIR Rehabil Assist Technol 2021; 8:e26629. [PMID: 34730536 PMCID: PMC8600432 DOI: 10.2196/26629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages. OBJECTIVE The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers. METHODS The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners. RESULTS bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process. CONCLUSIONS Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool.
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Affiliation(s)
- Vincent Gagnon Shaigetz
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
| | - Catherine Proulx
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
| | - Anne Cabral
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
| | - Nusrat Choudhury
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
| | - Mark Hewko
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Winnipeg, MB, Canada
| | - Elicia Kohlenberg
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Winnipeg, MB, Canada
| | - Melanie Segado
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
| | - Michael S D Smith
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Winnipeg, MB, Canada
| | - Patricia Debergue
- Simulation and Digital Health, Medical Devices Research Centre, National Research Council Canada, Boucherville, QC, Canada
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Alkadri S, Ledwos N, Mirchi N, Reich A, Yilmaz R, Driscoll M, Del Maestro RF. Utilizing a multilayer perceptron artificial neural network to assess a virtual reality surgical procedure. Comput Biol Med 2021; 136:104770. [PMID: 34426170 DOI: 10.1016/j.compbiomed.2021.104770] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Virtual reality surgical simulators are a safe and efficient technology for the assessment and training of surgical skills. Simulators allow trainees to improve specific surgical techniques in risk-free environments. Recently, machine learning has been coupled to simulators to classify performance. However, most studies fail to extract meaningful observations behind the classifications and the impact of specific surgical metrics on the performance. One benefit from integrating machine learning algorithms, such as Artificial Neural Networks, to simulators is the ability to extract novel insights into the composites of the surgical performance that differentiate levels of expertise. OBJECTIVE This study aims to demonstrate the benefits of artificial neural network algorithms in assessing and analyzing virtual surgical performances. This study applies the algorithm on a virtual reality simulated annulus incision task during an anterior cervical discectomy and fusion scenario. DESIGN An artificial neural network algorithm was developed and integrated. Participants performed the simulated surgical procedure on the Sim-Ortho simulator. Data extracted from the annulus incision task were extracted to generate 157 surgical performance metrics that spanned three categories (motion, safety, and efficiency). SETTING Musculoskeletal Biomechanics Research Lab; Neurosurgical Simulation and Artificial Intelligence Learning Center, McGill University, Montreal, Canada. PARTICIPANTS Twenty-three participants were recruited and divided into 3 groups: 11 post-residents, 5 senior and 7 junior residents. RESULTS An artificial neural network model was trained on nine selected surgical metrics, spanning all three categories and achieved 80% testing accuracy. CONCLUSIONS This study outlines the benefits of integrating artificial neural networks to virtual reality surgical simulators in understanding composites of expertise performance.
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Affiliation(s)
- Sami Alkadri
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, H3A 2K7, QC, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Aiden Reich
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, H3A 2K7, QC, Canada.
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Room E2.89, H3A 2B4, Montreal, Quebec, Canada
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21
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Neuroendoscopic training in neurosurgery: a simple and feasible model for neurosurgical education. Childs Nerv Syst 2021; 37:2619-2624. [PMID: 33942143 DOI: 10.1007/s00381-021-05190-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The development of high levels of technical competence and excellent decision-making skills are key goals of all neurosurgical residency training programs. This acquisition of technical skills is becoming increasingly difficult due to many factors including less exposure to operative cases, demand for more time and cost-effective practices, and resident work hour restrictions. We describe a step-by-step method for how to build a low-cost and feasible model that allows residents to improve their neuroendoscopic skills. METHODS The bell pepper-based model was developed as an endoscopic training model. Using continuous irrigation, several hands-on procedures were proposed under direct endoscopic visualization. Endoscope setup, endoscopic third ventriculostomy, septostomy, and tumor biopsy procedures were simulated and video recorded for further edition and analysis. RESULTS The model can be setup in less than 15 min with minimal cost and infrastructure requirements. A single model allows simulation of all the exercises described above. The model allows exposure to the camera skills, instrument handling, and hand-eye coordination inherent to most neuroendoscopic procedures. CONCLUSION Minimal infrastructure requirements, simplicity, and easily setup models provide a proper environment for regular training. The bell pepper-based model is inexpensive, widely available, and a feasible model for routine training. Neurosurgery residents may benefit from the use of this model to accelerate their learning curve and familiarize themselves with the neuroendoscopic core principles in a risk-free environment without time or resource constraints.
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22
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Davids J, Manivannan S, Darzi A, Giannarou S, Ashrafian H, Marcus HJ. Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance. Neurosurg Rev 2021; 44:1853-1867. [PMID: 32944808 PMCID: PMC8338820 DOI: 10.1007/s10143-020-01378-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.
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Affiliation(s)
- Joseph Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK.
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK.
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton University NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Stamatia Giannarou
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hutan Ashrafian
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
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23
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Hong W, Liu Y, He B, Huang S, Chen Z, Liao Z, Yi Z, Su X, Shi J. Assessment of a 3D printed simulator of a lateral ventricular puncture in interns' surgical training. Br J Neurosurg 2021; 35:597-602. [PMID: 34092175 DOI: 10.1080/02688697.2021.1922608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, a simulator for training lateral ventricular puncture (LVP) was developed using three-dimensional (3D) printing technology, and its function of improving the skills of LVP in young interns was evaluated. METHODS A virtual 3D craniocerebral simulator of a 51-year-old female patient with hydrocephalus was reconstructed with 3D printing technology. The anatomical and practical validity were assessed by all interns on a 13-item Likert scale. The usefulness of this simulator was evaluated once a week by two neurosurgeons, based on the performance of the interns, using the objective structured assessment of technical skills (OSATS) scale. RESULTS The Likert scale showed that all participants agreed with the overall appearance of the simulator. Also, the authenticity of the skull was the best, followed by the lateral ventricles, analog generation system of intraventricular pressure, cerebrum, and the scalp. This simulator could help the participants' learning about the anatomy of the lateral ventricle, effective training, and repeating the steps of LVP. During training, the interns' ratio of success in LVP elevated gradually. At each evaluation stage, all mean performance scores for each measure based on the OSATS scale were higher than the previous. CONCLUSIONS The 3D printed simulator for LVP training provided both anatomical and practical validity, and enabled young doctors to master the LVP procedures and skills.
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Affiliation(s)
- Wenyao Hong
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Yuqing Liu
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Bingwei He
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Shengyue Huang
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zhongyi Chen
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zhengjian Liao
- Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.,Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China
| | - Zongchao Yi
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Xiaohang Su
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
| | - Jiafeng Shi
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, Fujian Province, China.,School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, Fujian Province, China
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24
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Integration of Comprehensive Metrics into the PsT1 Neuroendoscopic Training System. World Neurosurg 2021; 151:182-189. [PMID: 34033950 DOI: 10.1016/j.wneu.2021.05.049] [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: 02/23/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Metric-based surgical training can be used to quantify the level and progression of neurosurgical performance to optimize and monitor training progress. Here we applied innovative metrics to a physical neurosurgery trainer to explore whether these metrics differentiate between different levels of experience across different tasks. METHODS Twenty-four participants (9 experts, 15 novices) performed 4 tasks (dissection, spatial adaptation, depth adaptation, and the A-B-A task) using the PsT1 training system. Four performance metrics (collision, precision, dissected area, and time) and 6 kinematic metrics (dispersion, path length, depth perception, velocity, acceleration, and motion smoothness) were collected. RESULTS For all tasks, the execution time (t) of the experts was significantly lower than that of novices (P < 0.05). The experts performed significantly better in all but 2 of the other metrics, dispersion and sectional area, corresponding to the A-B-A task and dissection task, respectively, for which they showed a nonsignificant trend towards better performance (P = 0.052 and P = 0.076, respectively). CONCLUSIONS It is possible to differentiate between the skill levels of novices and experts according to parameters derived from the PsT1 platform, paving the way for the quantitative assessment of training progress using this system. During the current coronavirus disease 2019 pandemic, neurosurgical simulators that gather surgical performance metrics offer a solution to the educational needs of residents.
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25
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Byers T, Hayday EJ, Mason F, Lunga P, Headley D. Innovation for Positive Sustainable Legacy From Mega Sports Events: Virtual Reality as a Tool for Social Inclusion Legacy for Paris 2024 Paralympic Games. Front Sports Act Living 2021; 3:625677. [PMID: 33969293 PMCID: PMC8097166 DOI: 10.3389/fspor.2021.625677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
There is significant interest in how sports events and their associated legacies could act as a platform to address global challenges and engender social change. The United Nations (UN) has acknowledged the important role that sport plays in supporting the UN 2030 Agenda for Sustainable Development and the Olympic movement could be argued as central to that objective. Yet critical questions and concerns have been raised about the growing expenditure, viability, long term legacy, and impacts of mega sports events such as the Olympic Games. While much evidence has focused on the challenges of creating legacy for Olympic Games, there is considerably less literature on understanding the Paralympic context. The purpose of this paper is to discuss the role of innovation in creating legacy from MSEs and propose a theoretical and methodological plan for such research. Innovation, a key driver in organizational performance, is suggested as essential to defining, planning for and measuring legacy. We specifically examine the potential of virtual reality (VR) as a technological innovation which can help create a social inclusion legacy in the context of Paris 2024 Olympic/Paralympic Games. A conceptual model is developed, which identifies legacy as a "wicked problem", and this paper discusses the importance of innovation with regards to legacy, by suggesting a new application for VR technology in the context of legacy related to social inclusion. Information technology is a valuable facilitator of social inclusion for individuals with a disability. We specifically examine the potential of VR as a technological innovation which can help create legacy through influencing unconscious biases (symbolic ableism) toward diversity such as disability, gender, and race.
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Affiliation(s)
- Terri Byers
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, NB, Canada
| | - Emily Jane Hayday
- Institute for Sport Business, Loughborough University London, London, United Kingdom
| | - Fred Mason
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, NB, Canada
| | - Phillip Lunga
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, NB, Canada
| | - Daneka Headley
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, NB, Canada
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26
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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27
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Davids J, Lam K, Nimer A, Gianarrou S, Ashrafian H. AIM in Medical Education. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_30-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Lungu AJ, Swinkels W, Claesen L, Tu P, Egger J, Chen X. A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery. Expert Rev Med Devices 2020; 18:47-62. [PMID: 33283563 DOI: 10.1080/17434440.2021.1860750] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Research proves that the apprenticeship model, which is the gold standard for training surgical residents, is obsolete. For that reason, there is a continuing effort toward the development of high-fidelity surgical simulators to replace the apprenticeship model. Applying Virtual Reality Augmented Reality (AR) and Mixed Reality (MR) in surgical simulators increases the fidelity, level of immersion and overall experience of these simulators.Areas covered: The objective of this review is to provide a comprehensive overview of the application of VR, AR and MR for distinct surgical disciplines, including maxillofacial surgery and neurosurgery. The current developments in these areas, as well as potential future directions, are discussed.Expert opinion: The key components for incorporating VR into surgical simulators are visual and haptic rendering. These components ensure that the user is completely immersed in the virtual environment and can interact in the same way as in the physical world. The key components for the application of AR and MR into surgical simulators include the tracking system as well as the visual rendering. The advantages of these surgical simulators are the ability to perform user evaluations and increase the training frequency of surgical residents.
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Affiliation(s)
- Abel J Lungu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wout Swinkels
- Computational Sensing Systems, Department of Engineering Technology, Hasselt University, Diepenbeek, Belgium
| | - Luc Claesen
- Computational Sensing Systems, Department of Engineering Technology, Hasselt University, Diepenbeek, Belgium
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jan Egger
- Graz University of Technology, Institute of Computer Graphics and Vision, Graz, Austria.,Graz Department of Oral &maxillofacial Surgery, Medical University of Graz, Graz, Austria.,The Laboratory of Computer Algorithms for Medicine, Medical University of Graz, Graz, Austria
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
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29
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Chen PC, Lin JC, Chiang CH, Chen YC, Chen JE, Liu WH. Engineering Additive Manufacturing and Molding Techniques to Create Lifelike Willis' Circle Simulators with Aneurysms for Training Neurosurgeons. Polymers (Basel) 2020; 12:polym12122901. [PMID: 33287397 PMCID: PMC7761873 DOI: 10.3390/polym12122901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Neurosurgeons require considerable expertise and practical experience in dealing with the critical situations commonly encountered during difficult surgeries; however, neurosurgical trainees seldom have the opportunity to develop these skills in the operating room. Therefore, physical simulators are used to give trainees the experience they require. In this study, we created a physical simulator to assist in training neurosurgeons in aneurysm clipping and the handling of emergency situations during surgery. Our combination of additive manufacturing with molding technology, elastic material casting, and ultrasonication-assisted dissolution made it possible to create a simulator that realistically mimics the brain stem, soft brain lobes, cerebral arteries, and a hollow transparent Circle of Willis, in which the thickness of vascular walls can be controlled and aneurysms can be fabricated in locations where they are likely to appear. The proposed fabrication process also made it possible to limit the error in overall vascular wall thickness to just 2–5%, while achieving a Young’s Modulus closely matching the characteristics of blood vessels (~5%). One neurosurgical trainee reported that the physical simulator helped to elucidate the overall process of aneurysm clipping and provided a realistic impression of the tactile feelings involved in this delicate operation. The trainee also experienced shock and dismay at the appearance of leakage, which could not immediately be arrested using the clip. Overall, these results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate neurological surgical operations.
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Affiliation(s)
- Pin-Chuan Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chung-Hsuan Chiang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Yi-Chin Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Jia-En Chen
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan;
- Department of Biomedical Engineering, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87927177; Fax: +886-2-87927178
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Hou W, Liu PX, Zheng M. Modeling of connective tissue damage for blunt dissection of brain tumor in neurosurgery simulation. Comput Biol Med 2020; 120:103696. [PMID: 32421640 DOI: 10.1016/j.compbiomed.2020.103696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
We introduce a new model for connective tissue damage in blunt dissection, which is a very important process in neurosurgery simulation. Specifically, the tool-tissue interaction between the instrument and connective tissue is incorporated into the model of connective tissue damage. This damage develops with the evolution criterion due to the effect of the external load. The tetrahedral mesh in the soft tissue model is removed for the representation of rupture as the damage accumulates to the threshold value. Analysis and experiments show that the connective tissue damage model provides stable, visually realistic results for the simulation of the connective tissue rupture process. The stiffness of the connective tissue decreases as the damage accumulates. The proposed model for connective tissue damage was incorporated into the development of a neurosurgery simulator, in which blunt dissection of a brain tumor was simulated.
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Affiliation(s)
- Wenguo Hou
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China.
| | - Peter X Liu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.
| | - Minhua Zheng
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China.
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31
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Roadmap for Developing Complex Virtual Reality Simulation Scenarios: Subpial Neurosurgical Tumor Resection Model. World Neurosurg 2020; 139:e220-e229. [PMID: 32289510 DOI: 10.1016/j.wneu.2020.03.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Advancement and evolution of current virtual reality (VR) surgical simulation technologies are integral to improve the available armamentarium of surgical skill education. This is especially important in high-risk surgical specialties. Such fields including neurosurgery are beginning to explore the utilization of virtual reality simulation in the assessment and training of psychomotor skills. An important issue facing the available VR simulation technologies is the lack of complexity of scenarios that fail to replicate the visual and haptic realities of complex neurosurgical procedures. Therefore there is a need to create more realistic and complex scenarios with the appropriate visual and haptic realities to maximize the potential of virtual reality technology. METHODS We outline a roadmap for creating complex virtual reality neurosurgical simulation scenarios using a step-wise description of our team's subpial tumor resection project as a model. RESULTS The creation of complex neurosurgical simulations involves integrating multiple modules into a scenario-building roadmap. The components of each module are described outlining the important stages in the process of complex VR simulation creation. CONCLUSIONS Our roadmap of a stepwise approach for the creation of complex VR-simulated neurosurgical procedures may also serve as a guide to aid the development of other VR scenarios in a variety of surgical fields. The generation of new VR complex simulated neurosurgical procedures, by surgeons for surgeons, with the help of computer scientists and engineers may improve the assessment and training of residents and ultimately improve patient care.
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32
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Siyar S, Azarnoush H, Rashidi S, Winkler-Schwartz A, Bissonnette V, Ponnudurai N, Del Maestro RF. Machine learning distinguishes neurosurgical skill levels in a virtual reality tumor resection task. Med Biol Eng Comput 2020; 58:1357-1367. [DOI: 10.1007/s11517-020-02155-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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33
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Licci M, Thieringer FM, Guzman R, Soleman J. Development and validation of a synthetic 3D-printed simulator for training in neuroendoscopic ventricular lesion removal. Neurosurg Focus 2020; 48:E18. [DOI: 10.3171/2019.12.focus19841] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVENeuroendoscopic surgery using an ultrasonic aspirator represents a valid tool with which to perform the safe resection of deep-seated ventricular lesions, but the handling of neuroendoscopic instruments is technically challenging, requiring extensive training to achieve a steep learning curve. Simulation-based methods are increasingly used to improve surgical skills, allowing neurosurgical trainees to practice in a risk-free, reproducible environment. The authors introduce a synthetic, patient-specific simulator that enables trainees to develop skills for endoscopic ventricular tumor removal, and they evaluate the model’s validity as a training instrument with regard to realism, mechanical proprieties, procedural content, and handling.METHODSThe authors developed a synthetic simulator based on a patient-specific CT data set. The anatomical features were segmented, and several realistic 1:1 skull models with all relevant ventricular structures were fabricated by a 3D printer. Vascular structures and the choroid plexus were included. A tumor model, composed of polyvinyl alcohol, mimicking a soft-consistency lesion, was secured in different spots of the frontal horn and within the third ventricle. Neurosurgical trainees participating in a neuroendoscopic workshop qualitatively assessed, by means of a feedback survey, the properties of the simulator as a training model that teaches neuroendoscopic ultrasonic ventricular tumor surgery; the trainees rated 10 items according to a 5-point Likert scale.RESULTSParticipants appreciated the model as a valid hands-on training tool for neuroendoscopic ultrasonic aspirator tumor removal, highly rating the procedural content. Furthermore, they mostly agreed on its comparably realistic anatomical and mechanical properties. By the model’s first application, the authors were able to recognize possible improvement measures, such as the development of different tumor model textures and the possibility, for the user, of creating a realistic surgical skull approach and neuroendoscopic trajectory.CONCLUSIONSA low-cost, patient-specific, reusable 3D-printed simulator for the training of neuroendoscopic ultrasonic aspirator tumor removal was successfully developed. The simulator is a useful tool for teaching neuroendoscopic techniques and provides support in the development of the required surgical skills.
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Affiliation(s)
- Maria Licci
- 1Department of Neurosurgery, University Hospital of Basel
- 2Division of Pediatric Neurosurgery, Children’s University Hospital of Basel
| | - Florian M. Thieringer
- 3Department of Cranio-Maxillo-Facial Surgery, University Hospital Basel
- 43D Print Lab, University Hospital Basel; and
- 5University of Basel, Switzerland
| | - Raphael Guzman
- 1Department of Neurosurgery, University Hospital of Basel
- 2Division of Pediatric Neurosurgery, Children’s University Hospital of Basel
- 5University of Basel, Switzerland
| | - Jehuda Soleman
- 1Department of Neurosurgery, University Hospital of Basel
- 2Division of Pediatric Neurosurgery, Children’s University Hospital of Basel
- 5University of Basel, Switzerland
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34
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A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery. World Neurosurg 2020; 133:e850-e873. [DOI: 10.1016/j.wneu.2019.08.262] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023]
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35
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Mandal I, Ojha U. Training in Interventional Radiology: A Simulation-Based Approach. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520912744. [PMID: 32313840 PMCID: PMC7155237 DOI: 10.1177/2382120520912744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
Innovations in medical technology have revolutionised both medical and surgical practice. Indeed, with such innovations, training for specific specialties has become more advanced and streamlined. However, despite these novel approaches to train students and specialist trainees, training for interventional radiology (IR) is lagging. While the reason for this lag remains contentious, one of the primary reasons for this issue may be the lack of standardisation for IR training due to a scarcity of specific guidelines for the delivery of IR procedural training. Interventional radiologists manage a vast array of conditions and perform various procedures. However, training for each procedure is largely dependent on the centre and access to a range of cases. Recently, the use of simulation technology has allowed this issue to be addressed. Simulation technology allows trainees to participate in a range of procedures regardless of their centre and availability of cases. Specialties such as cardiology and vascular surgery have already adopted simulation-based technology for trainees and have commented positively on this approach. However, simulation-based training is still lacking in the IR training pathway. Here, we evaluate why IR training can benefit from a more simulation-based approach. We further consider the cost-effectiveness of implementing simulation-based training nationally. Finally, we outline the potential pitfalls that may arise of introducing simulation-based training for IR trainees. We conclude that despite its disadvantages, simulation training will prove to be more cost-efficient and allow standardisation of IR training.
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Affiliation(s)
- Indrajeet Mandal
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Utkarsh Ojha
- Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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Hafez A, Elsharkawy A, Schwartz C, Muhammad S, Laakso A, Niemelä M, Lehecka M. Comparison of Conventional Microscopic and Exoscopic Experimental Bypass Anastomosis: A Technical Analysis. World Neurosurg 2019; 135:e293-e299. [PMID: 31805406 DOI: 10.1016/j.wneu.2019.11.154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, the use of digital exoscopes has been increasingly promoted as an alternative to microscopes. The aim of this study is to compare experimental bypass quality in both visualization methods. METHODS This study used two hundred 1-mm chicken wing vessels, which were used for either exoscopic or microscopic (100 samples each) bypass procedures. All procedures were recorded between July 2018 and September 2018. The bypass quality was evaluated according to our published practical scale (time, stitch distribution, intima-intima attachment, and orifice size). RESULTS Both methods are effective in doing bypass suturing (practical scale score was good, 86% vs. 85%; P = 0.84). There were no significant differences regarding intima-intima attachment (P = 0.26) and orifice size (P = 0.25). However, suturing time (P < 0.001) was less using the microscope, whereas stitch distribution (P = 0.001) was better using the exoscope. Different suturing techniques (interrupted vs. continuous) had overall comparable results (P = 0.55). CONCLUSIONS Both methods produced equally satisfactory results in experimental bypass procedures. The exoscope has the potential for better 3-dimensional visualization and sharing the surgeon's view with others for teaching purposes.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
| | - Ahmed Elsharkawy
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Tanta University, Tanta, Egypt
| | - Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria
| | - Sajjad Muhammad
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Tomlinson SB, Hendricks BK, Cohen-Gadol A. Immersive Three-Dimensional Modeling and Virtual Reality for Enhanced Visualization of Operative Neurosurgical Anatomy. World Neurosurg 2019; 131:313-320. [DOI: 10.1016/j.wneu.2019.06.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/17/2023]
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Hou Y, Lin Y, Shi J, Chen H, Yuan W. Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study. Oper Neurosurg (Hagerstown) 2019; 15:677-685. [PMID: 29554379 DOI: 10.1093/ons/opy030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training. OBJECTIVE To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study. METHODS A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach. RESULTS The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05). CONCLUSION The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.
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Affiliation(s)
- Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanping Lin
- School of Mechanical Engineering, State Key Laboratory of Mechanical System and Vibration, Institute of Biomedical Manufacturing and Life Quality Engineering, Shanghai, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huajiang Chen
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Baby B, Singh R, Suri A, Dhanakshirur RR, Chakraborty A, Kumar S, Kalra PK, Banerjee S. A review of virtual reality simulators for neuroendoscopy. Neurosurg Rev 2019; 43:1255-1272. [PMID: 31444716 DOI: 10.1007/s10143-019-01164-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022]
Abstract
Neurosurgery is a challenging surgical specialty that demands many technical and cognitive skills. The traditional surgical training approach of having a trainee coached in the operating room by the faculty is time-consuming, costly, and involves patient risk factors. Simulation-based training methods are suitable to impart the surgical skills outside the operating room. Virtual simulators allow high-fidelity repeatable environment for surgical training. Neuroendoscopy, a minimally invasive neurosurgical technique, demands additional skills for limited maneuverability and eye-hand coordination. This study provides a review of the existing virtual reality simulators for training neuroendoscopic skills. Based on the screening, the virtual training methods developed for neuroendoscopy surgical skills were classified into endoscopic third ventriculostomy and endonasal transsphenoidal surgery trainers. The study revealed that a variety of virtual reality simulators have been developed by various institutions. Although virtual reality simulators are effective for procedure-based skills training, the simulators need to include anatomical variations and variety of cases for improved fidelity. The review reveals that there should be multi-centric prospective and retrospective cohort studies to establish concurrent and predictive validation for their incorporation in the surgical educational curriculum.
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Affiliation(s)
- Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.,Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Ramandeep Singh
- 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. .,Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India.
| | - Rohan Raju Dhanakshirur
- Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Argha Chakraborty
- Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Subodh Kumar
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Prem Kumar Kalra
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Subhashis Banerjee
- Department of Computer Science Engineering, Indian Institute of Technology Delhi, New Delhi, India
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Breimer GE, Haji FA, Cinalli G, Hoving EW, Drake JM. Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). Oper Neurosurg (Hagerstown) 2019; 13:60-68. [PMID: 28931248 DOI: 10.1227/neu.0000000000001158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/12/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Growing demand for transparent and standardized methods for evaluating surgical competence prompted the construction of the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). OBJECTIVE To provide validity evidence of the NEVAT by reporting on the tool's internal structure and its relationship with surgical expertise during simulation-based training. METHODS The NEVAT was used to assess performance of trainees and faculty at an international neuroendoscopy workshop. All participants performed an endoscopic third ventriculostomy (ETV) on a synthetic simulator. Participants were simultaneously scored by 2 raters using the NEVAT procedural checklist and global rating scale (GRS). Evidence of internal structure was collected by calculating interrater reliability and internal consistency of raters' scores. Evidence of relationships with other variables was collected by comparing the ETV performance of experts, experienced trainees, and novices using Jonckheere's test (evidence of construct validity). RESULTS Thirteen experts, 11 experienced trainees, and 10 novices participated. The interrater reliability by the intraclass correlation coefficient for the checklist and GRS was 0.82 and 0.94, respectively. Internal consistency (Cronbach's α) for the checklist and the GRS was 0.74 and 0.97, respectively. Median scores with interquartile range on the checklist and GRS for novices, experienced trainees, and experts were 0.69 (0.58-0.86), 0.85 (0.63-0.89), and 0.85 (0.81-0.91) and 3.1 (2.5-3.8), 3.7 (2.2-4.3) and 4.6 (4.4-4.9), respectively. Jonckheere's test showed that the median checklist and GRS score increased with performer expertise ( P = .04 and .002, respectively). CONCLUSION This study provides validity evidence for the NEVAT to support its use as a standardized method of evaluating neuroendoscopic competence during simulation-based training.
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Affiliation(s)
- Gerben E Breimer
- Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Faizal A Haji
- Division of Clinical Neurological Scien-ces, Western University, London, Ontario, Canada.,SickKids Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Eelco W Hoving
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - James M Drake
- Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Si WX, Liao XY, Qian YL, Sun HT, Chen XD, Wang Q, Heng PA. Assessing performance of augmented reality-based neurosurgical training. Vis Comput Ind Biomed Art 2019; 2:6. [PMID: 32240415 PMCID: PMC7099548 DOI: 10.1186/s42492-019-0015-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022] Open
Abstract
This paper presents a novel augmented reality (AR)-based neurosurgical training simulator which provides a very natural way for surgeons to learn neurosurgical skills. Surgical simulation with bimanual haptic interaction is integrated in this work to provide a simulated environment for users to achieve holographic guidance for pre-operative training. To achieve the AR guidance, the simulator should precisely overlay the 3D anatomical information of the hidden target organs in the patients in real surgery. In this regard, the patient-specific anatomy structures are reconstructed from segmented brain magnetic resonance imaging. We propose a registration method for precise mapping of the virtual and real information. In addition, the simulator provides bimanual haptic interaction in a holographic environment to mimic real brain tumor resection. In this study, we conduct AR-based guidance validation and a user study on the developed simulator, which demonstrate the high accuracy of our AR-based neurosurgery simulator, as well as the AR guidance mode’s potential to improve neurosurgery by simplifying the operation, reducing the difficulty of the operation, shortening the operation time, and increasing the precision of the operation.
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Affiliation(s)
- Wei-Xin Si
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - Xiang-Yun Liao
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - Yin-Ling Qian
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - Hai-Tao Sun
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xiang-Dong Chen
- E.N.T.department of Shenzhen University General Hospital, Shenzhen, 518055, China
| | - Qiong Wang
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China.
| | - Pheng Ann Heng
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China.,Department of Computer Science and Engineering, the Chinese University of Hong Kong, Hong Kong, China
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Hou W, Liu PX, Zheng M. A new model of soft tissue with constraints for interactive surgical simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 175:35-43. [PMID: 31104713 DOI: 10.1016/j.cmpb.2019.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES An accurate and real-time model of soft tissue is critical for surgical simulation for which a user interacts haptically and visually with simulated patients. This paper focuses on the real-time deformation model of brain tissue for the interactive surgical simulation, such as neurosurgical simulation. METHODS A new Finite Element Method (FEM) based model with constraints is proposed for the brain tissue in neurosurgical simulation. A new energy function of constraints characterizing the interaction between the virtual instrument and the soft tissue is incorporated into the optimization problem derived from the implicit integration scheme. Distance and permanent deformation constraints are introduced to describe the interaction in the convexity meningioma dissection and hemostasis. The proposed model is particularly suitable for GPU-based computing, making it possible to achieve real-time performance. RESULTS AND CONCLUSIONS Simulation results show that the simulated soft tissue exhibits the behaviors of adhesion and permanent deformation under the constraints. Experiments show that the proposed model is able to converge to the exact solution of the implicit Euler method after 96 iterations. The proposed model was implemented in the development of a neurosurgical simulator, in which surgical procedures such as dissection of convexity meningioma and hemostasis were simulated.
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Affiliation(s)
- Wenguo Hou
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China
| | - Peter X Liu
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China; Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.
| | - Minhua Zheng
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing 100044, PR China.
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Lee C, Wong GKC. Virtual reality and augmented reality in the management of intracranial tumors: A review. J Clin Neurosci 2019; 62:14-20. [PMID: 30642663 DOI: 10.1016/j.jocn.2018.12.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/22/2018] [Indexed: 01/19/2023]
Abstract
Neurosurgeons are faced with the challenge of planning, performing, and learning complex surgical procedures. With improvements in computational power and advances in visual and haptic display technologies, augmented and virtual surgical environments can offer potential benefits for tests in a safe and simulated setting, as well as improve management of real-life procedures. This systematic literature review is conducted in order to investigate the roles of such advanced computing technology in neurosurgery subspecialization of intracranial tumor removal. The study would focus on an in-depth discussion on the role of virtual reality and augmented reality in the management of intracranial tumors: the current status, foreseeable challenges, and future developments.
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Affiliation(s)
- Chester Lee
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals. ACTA ACUST UNITED AC 2019; 14:188-194. [DOI: 10.1097/sih.0000000000000347] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bugdadi A, Sawaya R, Bajunaid K, Olwi D, Winkler-Schwartz A, Ledwos N, Marwa I, Alsideiri G, Sabbagh AJ, Alotaibi FE, Al-Zhrani G, Maestro RD. Is Virtual Reality Surgical Performance Influenced by Force Feedback Device Utilized? JOURNAL OF SURGICAL EDUCATION 2019; 76:262-273. [PMID: 30072262 DOI: 10.1016/j.jsurg.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/19/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The study objectives were to assess if surgical performance and subjective assessment of a virtual reality simulator platform was influenced by changing force feedback devices. DESIGN Participants used the NeuroVR (formerly NeuroTouch) simulator to perform 5 practice scenarios and a realistic scenario involving subpial resection of a virtual reality brain tumor with simulated bleeding. The influence of force feedback was assessed by utilizing the Omni and Entact haptic systems. Tier 1, tier 2, and tier 2 advanced metrics were used to compare results. Operator subjective assessment of the haptic systems tested utilized seven Likert criteria (score 1 to 5). SETTING The study is carried out at the McGill Neurosurgical Simulation Research and Training Centre, Montreal Neurological Institute and Hospital, Montreal, Canada. PARTICIPANTS Six expert operators in the utilization of the NeuroVR simulator platform. RESULTS No significant differences in surgical performance were found between the two haptic devices. Participants significantly preferred the Entact system on all 7 Likert criteria of subjective assessment. CONCLUSIONS Our results show no statistical differences in virtual reality surgical performance utilizing the two bimanual haptic devices tested. Subjective assessments demonstrated that participants preferred the Entact system. Our results suggest that to maximize realism of the training experience educators employing virtual reality simulators may find it useful to assess expert opinion before choosing a force feedback device.
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Affiliation(s)
- Abdulgadir Bugdadi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia.
| | - Robin Sawaya
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Khalid Bajunaid
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Duaa Olwi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ibrahim Marwa
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ghusn Alsideiri
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulrahman Jafar Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad E Alotaibi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gmaan Al-Zhrani
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rolando Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
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A Multi-procedural Virtual Reality Simulator for Orthopaedic Training. VIRTUAL, AUGMENTED AND MIXED REALITY. APPLICATIONS AND CASE STUDIES 2019. [DOI: 10.1007/978-3-030-21565-1_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kim DH, Kim Y, Park JS, Kim SW. Virtual Reality Simulators for Endoscopic Sinus and Skull Base Surgery: The Present and Future. Clin Exp Otorhinolaryngol 2018; 12:12-17. [PMID: 30326700 PMCID: PMC6315210 DOI: 10.21053/ceo.2018.00906] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 01/01/2023] Open
Abstract
Endoscopic sinus and skull base surgeries are minimally invasive surgical techniques that reduce postoperative symptoms and complications and enhance patients’ quality of life. However, to ensure excellent surgical outcomes after such interventions, intimate familiarity with important landmarks and high-level endoscope manipulation skills are essential. Cadaver training is one possible option, but cadavers are expensive, scarce, and nonreusable and cadaver work requires specialized equipment and staff. In addition, it is difficult to mimic specific diseases using cadavers. Virtual reality simulators can create a computerized environment in which the patient’s anatomy is reproduced and interaction with endoscopic handling and realistic haptic feedback is possible. Moreover, they can be used to present scenarios that improve trainees’ skills and confidence. Therefore, virtual simulator training can be implemented at all levels of surgical education. This review introduces the current literature on virtual reality training for endoscopic sinus and skull base surgeons, and discusses the direction of future developments.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeonji Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Huotarinen A, Niemelä M, Hafez A. The impact of neurosurgical procedure on cognitive resources: Results of bypass training. Surg Neurol Int 2018; 9:71. [PMID: 29721350 PMCID: PMC5909093 DOI: 10.4103/sni.sni_427_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/22/2018] [Indexed: 11/11/2022] Open
Abstract
Background: Neurosurgeons are exposed to unavoidable distractions in their natural operating environment. Distractions can affect both the surgeon's concentration and the safety and duration of the surgery. Such distraction can be studied by applying a simultaneous cognitive task during a surgical procedure. Methods: We used a previously described cognitive task: a forward (DF) and backward digit (DB) repetition task to interfere with the surgeon's attention during a training bypass. A pilot study was performed to find suitable digit repetition lengths. For the main experiment, we used four-digit strings. The test task was alternated across two consecutive sutures (n = 153, 8 bypasses), followed by two consecutive control sutures without digit repetition. The duration and the number of correct answers for the digit repetition task were compared to a baseline digit repetition without simultaneous surgery. Results: During the bypass surgery, digit repetitions (especially DB) became slower (P < 0.0001). More errors were made during DB compared to DF only during simultaneous bypass (P < 0.0001). However, we found no effect of digit repetition tasks on individual suture times (P = 0.823). Conclusions: The ability to engage in simultaneous tasks while performing surgery is diminished. A surgeon with extensive training can withstand external distraction without an effect on performance; however, this is achieved by partially ignoring the simultaneous task. Our data support that during surgery other cognitive tasks should be avoided to ensure safety.
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Affiliation(s)
- Antti Huotarinen
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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McGrath JL, Taekman JM, Dev P, Danforth DR, Mohan D, Kman N, Crichlow A, Bond WF. Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners. Acad Emerg Med 2018; 25:186-195. [PMID: 28888070 DOI: 10.1111/acem.13308] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/13/2023]
Abstract
Immersive learning environments that use virtual simulation (VS) technology are increasingly relevant as medical learners train in an environment of restricted clinical training hours and a heightened focus on patient safety. We conducted a consensus process with a breakout group of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." This group examined the current uses of VS in training and assessment, including limitations and challenges in implementing VS into medical education curricula. We discuss the role of virtual environments in formative and summative assessment. Finally, we offer recommended areas of focus for future research examining VS technology for assessment, including high-stakes assessment in medical education. Specifically, we discuss needs for determination of areas of focus for VS training and assessment, development and exploration of virtual platforms, automated feedback within such platforms, and evaluation of effectiveness and validity of VS education.
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Affiliation(s)
- Jillian L. McGrath
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | | | - Parvati Dev
- Stanford University School of Medicine; Los Altos CA
| | - Douglas R. Danforth
- Department of Obstetrics and Gynecology; The Ohio State University Wexner Medical Center; Columbus OH
| | - Deepika Mohan
- Department of Surgery; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Nicholas Kman
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - Amanda Crichlow
- Department of Emergency Medicine; Drexel University College of Medicine; Philadelphia PA
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Abstract
Recent biotechnological advances, including three-dimensional microscopy and endoscopy, virtual reality, surgical simulation, surgical robotics, and advanced neuroimaging, have continued to mold the surgeon-computer relationship. For developing neurosurgeons, such tools can reduce the learning curve, improve conceptual understanding of complex anatomy, and enhance visuospatial skills. We explore the current and future roles and application of virtual reality and simulation in neurosurgical training.
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