Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection

Abstract

Our pilot study demonstrates that the safety, quality, and efficiency of novice and expert operators can be measured using metrics derived from the NeuroTouch platform, helping to understand how specific operator performance is dependent on both psychomotor ability and cognitive input during multiple virtual reality brain tumor resections.

Operator experience determines performance in a simulated computer-based brain tumor resection task

“…In this study, Azarnoush et al [13] found that attending neurosurgeons remove the same or more tumor and less healthy brain, complete surgeries more quickly, activate the foot pedal less, and move less, than neurosurgery residents during simulated resection of a brain tumor. Furthermore, the authors noticed significant differences between attending neurosurgeons and residents on more difficult simulations, where the attending physicians, but not the residents, showed more conservative surgical behavior.…”

“…While validation of a surgical simulators requires establishment of face validity, content validity, and construct validity [18,19], we chose to focus on construct validity since this approach is more objective to the alternatives (i.e., asking surgeons if the simulator feels realistic) in that it utilizes measures recorded by the simulator (such as force employed and hand movement) that would be difficult for even an experienced operator to self-assess. Furthermore, this study also expands previous work by measuring clinically relevant variables in longer surgical tasks, assessing learning curve data by repeating the same surgical task on different days to evaluate changes in performance over time, and evaluating the effect of coaching on improving surgical performance [12,13]. In non-neurosurgical simulations, coaching and repeated trials has been shown to improve outcomes and decrease operative error [20,21].…”

“…The physical setup, VR interface, and simulated environment were constructed similar to previous studies [12,13] ( Fig. 1, Supplementary Video 1).…”

“…While most simulators provide basic output data encompassing measures such as force exerted by the operator, a quantification of instrument movement, and an assessment of how successful the VR operation was (such as how much tumor tissue was removed), recent work indicates that more detailed assessments, such as compound measures encompassing multiple variables, may be better suited to identify differences in surgical performance between groups [13]. In this study, Azarnoush et al [13] found that attending neurosurgeons remove the same or more tumor and less healthy brain, complete surgeries more quickly, activate the foot pedal less, and move less, than neurosurgery residents during simulated resection of a brain tumor.…”

Training for brain tumour resection: a realistic model with easy accessibility

“…Though this might minimise the risk of inadvertent damage, the manipulations of the tissue are untrained and therefore not optimal. Virtual reality simulations may be one alternative [1][2][3][4] but are rarely available in neurosurgical centres and might not completely replace experience with Brealĉ erebral tissue. Other alternatives which mimic brain tumour surgery realistically and are easily available and handled are required.…”