Learning Retention of Thoracic Pedicle Screw Placement Using a High-Resolution Augmented Reality Simulator With Haptic Feedback

Luciano, Cristián; Banerjee, Prashant; Bellotte, Brad; Oh, G Michael; Lemole, Michael; Charbel, Fady T.; Roitberg, Ben

doi:10.1227/neu.0b013e31821954ed

Cited by 76 publications

(73 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although computer-based simulators have been developed to facilitate the acquisition of screw placement skills, it remains unclear whether this on-screen practice can translate into increased accuracy and comfort in the operating room. 5,7,13 The challenges that trainees face are, in part, related to limited clinical hands-on exposure and the need to acquire an understanding of complex 3D spinal anatomy. For non-video-assisted procedures such as spinal surgery, the incorporation of cadaveric training into the resident educational process is likely to remain a critical component.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

Sundar

Healy²,

Kshettry³

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECTIVE Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy. METHODS This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models. RESULTS A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively). CONCLUSIONS Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a didactic-only training model, using navigation simulation with cadavers and Sawbones models significantly reduced the number of screw placement errors in a laboratory setting.

show abstract

Section: Discussionmentioning

confidence: 99%

“…9,14 A number of recent studies have attempted to compare the benefits of various laboratorybased techniques, although most do not demonstrate significant benefit. 7,9,14 To date, a definitive, evidence-based, laboratory training module has not been delineated.…”

mentioning

confidence: 99%

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

Sundar

Healy²,

Kshettry³

et al. 2016

SPI

View full text Add to dashboard Cite

show abstract

“…The most commonly used simulator was ImmersiveTouch, an augmented virtual reality system that has been shown to improve performance when used for training to simulate ventriculostomy, 5,6,27,28,57 thoracic pedicle screw placement, 29 and percutaneous spinal needle placement 30 across different grades of trainees. Ventriculostomy was the commonest simulated procedure identified from this systematic review, having been reported in 6 articles.…”

Section: Data Synthesismentioning

confidence: 99%

The use of simulation in neurosurgical education and training

Kirkman

Ahmed²,

Albert³

et al. 2014

JNS

143

View full text Add to dashboard Cite

Object There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date. Methods The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations. Results Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18. Conclusions The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.

show abstract

“…Examples in neurosurgery include simulators for ventriculostomy [27,30,38], spine needle biopsy [28], pedicle screw placement [26,31], diagnostic cerebral angiography [53], and aneurysm clipping. However, there may be limitations in the ability to transfer these "virtual skills" to physical reality [20,39].…”

mentioning

confidence: 99%

The role of simulation in neurosurgery

2014

View full text Add to dashboard Cite

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].

show abstract

Learning Retention of Thoracic Pedicle Screw Placement Using a High-Resolution Augmented Reality Simulator With Haptic Feedback

Cited by 76 publications

References 23 publications

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

The use of simulation in neurosurgical education and training

The role of simulation in neurosurgery

Contact Info

Product

Resources

About