The Medical Legal Environment in Neurosurgery: An Informative Overview of the Stages of Litigation and Distinct Challenges

LeFever, Devon; Esfahani, Darian R.; Kandregula, Sandeep; Trosclair, Krystle; Demand, Audrey; Vega, Alexis; Stacy, Jason; Hussein, Namath; Dossani, Rimal H; Pendharkar, Arjun V; Menger, Richard; Kosty, Jennifer; Mazzola, Catherine A.; Agarwal, Nitin; Kimmell, Kristopher T.; Rosenow, Joshua M.; Cozzens, Jeffrey W.; Schirmer, Clemens M.; Guthikonda, Bharat

doi:10.1016/j.wneu.2021.03.039

Cited by 4 publications

(2 citation statements)

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“…Moreover, novel regulations on reducing working hours for residents reduce the possibilities for practical and psychophysical training, affecting the quality of the residency and prolonging the learning curve ( 108 , 109 ). These controversial aspects are also critical for the increasing medicolegal issues affecting medical practice in the last few decades ( 8 , 9 ). Accordingly, the impossibility to try or repeat surgical procedures makes neurosurgical training more difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, permanent neurosurgical laboratories are not widespread all over the world due to strict requirements and permissions, ethical and legal issues, and the high costs related to equipment, materials, and specimens. On the other hand, in the last few decades, medicolegal issues in the medical field and, in particular, neurosurgical practice have increased ( 8 , 9 ). For these reasons, neurosurgical training has become crucial, with increasing interest in it, to train the next generation of neurosurgeons before practicing on living patients to reduce perioperative complications ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: Setting up a new research anatomical laboratory and defining neuroanatomical milestones

et al. 2023

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IntroductionNeurosurgery is one of the most complex surgical disciplines where psychomotor skills and deep anatomical and neurological knowledge find their maximum expression. A long period of preparation is necessary to acquire a solid theoretical background and technical skills, improve manual dexterity and visuospatial ability, and try and refine surgical techniques. Moreover, both studying and surgical practice are necessary to deeply understand neuroanatomy, the relationships between structures, and the three-dimensional (3D) orientation that is the core of neurosurgeons' preparation. For all these reasons, a microsurgical neuroanatomy laboratory with human cadaveric specimens results in a unique and irreplaceable training tool that allows the reproduction of patients' positions, 3D anatomy, tissues' consistencies, and step-by-step surgical procedures almost identical to the real ones.MethodsWe describe our experience in setting up a new microsurgical neuroanatomy lab (IRCCS Neuromed, Pozzilli, Italy), focusing on the development of training activity programs and microsurgical milestones useful to train the next generation of surgeons. All the required materials and instruments were listed.ResultsSix competency levels were designed according to the year of residency, with training exercises and procedures defined for each competency level: (1) soft tissue dissections, bone drilling, and microsurgical suturing; (2) basic craniotomies and neurovascular anatomy; (3) white matter dissection; (4) skull base transcranial approaches; (5) endoscopic approaches; and (6) microanastomosis. A checklist with the milestones was provided.DiscussionMicrosurgical dissection of human cadaveric specimens is the optimal way to learn and train on neuroanatomy and neurosurgical procedures before performing them safely in the operating room. We provided a “neurosurgery booklet” with progressive milestones for neurosurgical residents. This step-by-step program may improve the quality of training and guarantee equal skill acquisition across countries. We believe that more efforts should be made to create new microsurgical laboratories, popularize the importance of body donation, and establish a network between universities and laboratories to introduce a compulsory operative training program.

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