Frameless Image-Guided Neuroendoscopy Training in Real Simulators

Coelho, Giselle; Kondageski, Charles; Filho, Francisco Vaz-Guimaraes; Ramina, Ricardo; Hunhevicz, Sonival C.; Daga, F.; Lyra, M. L.; Cavalheiro, Sérgio; Zymberg, Samuel Tau

doi:10.1055/s-0031-1283170

Cited by 20 publications

(15 citation statements)

References 5 publications

(6 reference statements)

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“…Neurosurgical Endotrainer [Sinus Model Oto-Rhino Neuro Trainer, Pro Delphus Co.]). 7,12,18 A key advantage of NeuroTouch is its ability to provide real-time feedback on important performance metrics such as tool trajectories, contact forces with critical structures, procedure time, and ventriculostomy location. 3 However, high cost, inaccessibility, the lack of a sufficiently accurate haptic interface, and unrealistic dissection of the third ventricular floor are its biggest obstacles.…”

Section: 2021mentioning

confidence: 99%

“…synthetic simulator has been shown to be highly realistic and improve surgical performance, with a 42% reduction in trainee errors after use of the simulator. 7 However, a key drawback is that the model is not patient specific and therefore it does not allow preoperative rehearsal of actual patient cases. In addition, the brain and ventricular system needs to be replaced after each use, leading to increased costs.…”

Section: 2021mentioning

confidence: 99%

“…2,3,6,14,15,17,24,25 Synthetic phantom models have shown increasing promise as effective simulators for neurosurgical training. 7,12,18 Such models are inexpensive, portable, and reusable and allow for the use of actual surgical instruments. However, they lack realistic tissue properties, are not patient specific, and cannot simulate complex and dynamic operations that require critical thinking and decision-making skills and measures to avoid and mitigate complications.…”

mentioning

confidence: 99%

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Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy

Breimer

Bodani

Looi

et al. 2015

PED

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OBJECT Endoscopic third ventriculostomy (ETV) is an effective but technically demanding procedure with significant risk. Current simulators, including human cadavers, animal models, and virtual reality systems, are expensive, relatively inaccessible, and can lack realistic sensory feedback. The purpose of this study was to construct a realistic, low-cost, reusable brain simulator for ETV and evaluate its fidelity. METHODS A brain silicone replica mimicking normal mechanical properties of a 4-month-old child with hydrocephalus was constructed, encased in the replicated skull, and immersed in water. Realistic intraventricular landmarks included the choroid plexus, veins, mammillary bodies, infundibular recess, and basilar artery. The thinned-out third ventricle floor, which dissects appropriately, is quickly replaceable. Standard neuroendoscopic equipment including irrigation is used. Bleeding scenarios are also incorporated. A total of 16 neurosurgical trainees (Postgraduate Years 1–6) and 9 pediatric and adult neurosurgeons tested the simulator. All participants filled out questionnaires (5-point Likert-type items) to rate the simulator for face and content validity. RESULTS The simulator is portable, robust, and sets up in minutes. More than 95% of participants agreed or strongly agreed that the simulator's anatomical features, tissue properties, and bleeding scenarios were a realistic representation of that seen during an ETV. Participants stated that the simulator helped develop the required hand-eye coordination and camera skills, and the training exercise was valuable. CONCLUSIONS A low-cost, reusable, silicone-based ETV simulator realistically represents the surgical procedure to trainees and neurosurgeons. It can help them develop the technical and cognitive skills for ETV including dealing with complications.

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Section: 2021mentioning

confidence: 99%

Section: 2021mentioning

confidence: 99%

mentioning

confidence: 99%

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Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy

Breimer

Bodani

Looi

et al. 2015

PED

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“…Many permit multiple uses of repetitive practice in order to reach the desired level of performance. They also provide the opportunity to obtain CT and MRI imaging to incorporate imageguided navigation into the training program [6]. Moreover, there is the possibility of developing various surgical environments (tumor appearance, consistency, bleeding, cystic content) that require the practice of different tasks with more realism and unquestionable safety [6,61].…”

mentioning

confidence: 99%

“…Additionally, to be considered a useful tool for training, a simulator should be further evaluated regarding its overall quality. Despite a variety of ways to do it, every simulator should meet three major criteria: validity, reliability, and feasibility [16,6]. Chopra et al and Filho FV et al showed that synthetic physical simulators can improve surgical performance [7,16].…”

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confidence: 99%

The role of simulation in neurosurgery

2014

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It is increasingly apparent that the standards for surgical training are shifting from time-based to criterion-based parameters that emphasize obtaining and maintaining competencies [24]. The formation of a surgeon demands significant dedication and effort, in addition to time [54]. Current, wellestablished methods of surgical training are being challenged as the environment becomes increasingly competitive and litigious with greater scrutiny of patient outcomes [14,17,40,44,50]. In order to increase patient safety and improve treatment outcomes, several strategies such as problem-based learning and objective structured clinical examinations have promoted the development of new curricula in surgical education [13,15,35,51,52].Some of these changes have been driven by events in the 1980s and 1990s such as medical misconduct and overworked, unsupervised resident staff that contributed to patient morbidity and mortality. This also coincided with a growing medical malpractice crisis. As a result, regulatory bodies began to initiate new standards of work hour restrictions and supervision for residents in training. The New York Health Code of 1989 compiled regulations restricting resident work hours (80 h per week) and one day free a week and placed limits on the number of calls [24,32]. Concerns arose about the long-established methods of training surgical residents, and solutions were sought to reduce preventable errors and perioperative complications [24,9].The airline industry, with the development of flight simulators and pilot coaching methods, proved to be an excellent precedent for innovation in surgical education. Many surgical educators believe such methods are keys to accelerating the acquisition of fundamental skills and the rate of performance improvement among surgical residents. A Yale University study demonstrated that criterion-based simulator training decreased operating time by 30 % and operative errors by 85 % [47,48].

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Neuronavigation im Kindesalter

Thomale

2018

Pädiatrische Neurochirurgie

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Frameless Image-Guided Neuroendoscopy Training in Real Simulators

Abstract: The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.

Cited by 20 publications

References 5 publications

Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy

Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy

The role of simulation in neurosurgery

Neuronavigation im Kindesalter

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