Neurosurgical performance between experts and trainees: Evidence from drilling task

Abstract

Background: Lumbar laminectomy is a common neurosurgery that requires precise manipulation of power drills. We examined the fine movement controls of novice neurosurgeons in drilling tasks and compared its accuracy to expert surgeons' performance.Methods: Four experts and three novice neurosurgeons performed a lumbar laminectomy on a three-dimensional printed spine model. Scene video and surgeons' eye movements were recorded. Independent sample t-Tests were conducted on the number of jump, total fixation durations, pre-jump fixation durations, post-jump fixation durations and jump distances over novice and expert surgeons. Results:No statistically significant differences were recorded in terms of total fixations and pre-jump fixation durations. However, novices had more jumping events, greater jump distances and longer post-jump fixation durations when compared to expert neurosurgeons. Conclusion:Differences in movement accuracy and eye measures were found between expert and novice neurosurgeons during a simulated microscopic lumbar laminectomy. A more comprehensive understanding of surgeon's fine movement control mechanism and eye-hand coordination in microsurgery is essential for us before building an enhanced training protocol for surgical residents in neurosurgery. K E Y W O R D Scompetency assessment, drill, eye tracking, microsurgery, surgical training | INTRODUCTIONDecompressive lumbar laminectomy is one of the most common orthopaedic and neurosurgical procedures performed on the spine. It is used to treat spinal stenosis, herniated discs and tumours. 1 In this procedure, the surgeon needs to drill the lamina of the vertebrae using a power tool to gain access to the spinal canal and reduce the pressure on the thecal sac and nerve roots. The power drill often generates a significant amount of mechanical vibrations. Vibrations can be challenging for the surgeon who needs precise and controlled movements to avoid damage to nearby neurological structures.Another factor that can affect the surgeon's movement accuracy is the interaction between the drill bit and the bone. This interaction is influenced by multiple elements such as the angle of contact between the bur and the bone, the speed of the drill and the bone density. Expert surgeons, through experience, have integrated these factors to avoid involuntary movements of the drill.Studies in human movement control have revealed that human fine movements are controlled primarily through visual and haptic pathways. Before our hand gets in contact with an object, our visual system collects information about the target, including distance, shape, weight, texture and so forth. Once our hand makes contact with the object, mechanoreceptors beneath our skin gather information specific to that object, whereas the sensors inside our joints

Thoracic Pedicle Screw Placement Utilizing Hands-On Training Session on Three-Dimensional Models

“…In 2015, Li et al conducted the first randomized trial for utilizing 3DP spine models in medical education to improve the identification of spinal fractures [ 10 ]. Multiple studies that followed aimed to emulate the use of 3DP models to enhance the performance of specific procedures such as facet joint injections [ 10 ], pedicle screw instrumentation [ 11 ], spinal osteotomies [ 12 ], cervical laminectomy [ 13 ], lumbar laminectomy [ 14 ], and atlanto-occipital spinal injuries [ 15 ]. Collectively, these studies recruited medical students, neurosurgery/orthopedic residents, and attending surgeons.…”

Enhancing skill learning with dual-user haptic feedback: insights from a task-specific approach

“…Can we create augmented haptic feedback to improve surgical performance? This is challenging in real surgery due to the limitations of current technology (Webb and Pentlow, 1993;Westebring -van der Putten et al, 2008;Hardison et al, 2017;Chainey et al, 2021). Nonetheless, there are emerging robotic systems designed to provide haptic assistance to surgeons in the operating room (Zhang et al, 2022b), signifying a pivotal direction for the future evolution of surgery.…”