Face, Content, and Construct Validity of Brain Tumor Microsurgery Simulation Using a Human Placenta Model

Oliveira, Marcelo Magaldi; Araújo, André Luís de; Nicolato, Arthur; Prosdocimi, André; Godinho, Joao Victor; Valle, Ana Luiza Martins; Santos, Mariana Rates Gonzaga; Reis, Augusto Barbosa; Ferreira, Mauro Tostes; Sabbagh, Abdulrahman J.; Gusmão, Sebastião; Maestro, Rolando Del

doi:10.1227/neu.0000000000001030

Cited by 24 publications

(8 citation statements)

References 18 publications

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“…17 Human cadaver aneurysm simulation has been described recently 1,2 and the human placenta has been described by our group as a high-fidelity, low-cost alternative model for cerebrovascular microsurgical training. 16,17,21 Biological brain aneurysm surgery simulators possessing the capacity for partial task similarities with real surgery were chosen for this study. 17 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Oliveira

Ferrarez²,

Ramos³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fissure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and d...

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Section: Discussionmentioning

confidence: 99%

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Oliveira

Ferrarez²,

Ramos³

et al. 2018

Journal of Neurosurgery

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“… 15 , 16 Face, content, and construct validities can effectively correlate ex vivo simulation models with specific technique-related clinical outcomes. 17 Furthermore, objective methods of assessment can be used in conjunction with qualitative and quantitative feedback provided by trainees during courses to identify areas of weakness and focus their training accordingly, for example, on intramuscular submillimeter perforator dissection.…”

Section: Discussionmentioning

confidence: 99%

Pork Belly: A Simulation Training Model for Intramuscular Perforator Dissection

Pafitanis

Veljanoski

Ghanem

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Free tissue transfer has evolved from muscle flaps to fasciocutaneous flaps. Dissection of the intramuscular course of feeding vessels is technically challenging. Simulation-based microsurgery skills acquisition is moving toward nonliving training models. Living porcine model or human cadavers are currently cost-ineffective methods for the early learning curve in teaching intramuscular dissection. The aim of this study was to validate an inexpensive ex vivo porcine model simulating harvest of the deep inferior epigastric artery perforator (DIEAP) flap, specifically including perforator intramuscular dissection.Methods:An initial needs analysis and anatomical dissections (characteristics of vascular anatomy) established the necessity and surgical design (step-by-step) of the ex vivo DIEAP flap harvesting model. A pilot study utilizing objective assessment methodology (time to complete flap raising and hand motion analysis) demonstrated the surgeons’ performance. A detailed feedback questionnaire was used to assess the participants’ perception of this model.Results:Fifty-seven participants completed the initial needs analysis. Fifteen pork bellies were dissected and the vascular anatomical characteristics of the inferior epigastric vessels are presented. Eight surgeons performed the step-by-step flap design demonstrating construct validity in flap raising and intramuscular dissection. All surgeons completed the ex vivo DIEAP harvesting and they recommend this model as the first step in training for intramuscular dissection.Conclusions:The pork belly simulation is a cheap, easy, ethically considerate, and high-fidelity simulation model for intramuscular dissection for the DIEAP free flap. This study guides future validation trials to explore if the absence of physiological blood flow affects skills acquisition in the intramuscular dissection learning curve. The pork belly could be the first step in perforators dissection before progressing to the in vivo porcine model.

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“…Placenta used for simulating tumour resection demonstrated a rating 1 for content and relations to other variables due to limited expert participant number and also using only time as a measuring tool 41 . The model also achieved a LoE of 1.…”

Section: Tumour Resectionmentioning

confidence: 99%

A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery

Patel

Aydın

Cearns³

et al. 2020

World Neurosurgery

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Face, Content, and Construct Validity of Brain Tumor Microsurgery Simulation Using a Human Placenta Model

Abstract: Human placentas are useful haptic models to simulate brain tumor microsurgical removal. Results using this model demonstrate face, content, and construct validity.

Cited by 24 publications

References 18 publications

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Pork Belly: A Simulation Training Model for Intramuscular Perforator Dissection

A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery

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