“…Two studies were added to the category “ex vivo: cadavers” [ 13 , 14 ], one study was added to “ex vivo: human placenta” [ 15 ], and three studies were added to “ex vivo: chicken wings” [ 16 - 18 ]. “Virtual reality” contained 11 studies [ 19 - 29 ], “3D static simulators” had six [ 30 - 35 ], and “3D dynamic simulators” had three [ 9 , 36 , 37 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Different setups were used for the VR simulations. Some studies used a surgical rehearsal platform such as Surgical Theater (Cleveland, OH, USA) [ 19 , 20 , 24 , 28 ] or the patient-specific environment Dextroscope (Bracco Diagnostics, Monroe Township, NJ, USA) [ 25 , 29 ]. Marinho et al (2014) [ 27 ] created a virtual operative environment with the open-source software Blender.…”
Section: Resultsmentioning
confidence: 99%
“…The assessment method for the simulation approach varied across articles. Most articles included a subjective, descriptive questionnaire to assess the face validity, content validity, and/or feasibility [ 9 , 13 - 19 , 21 - 23 , 26 , 30 - 34 , 36 ]. Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Most articles included a subjective, descriptive questionnaire to assess the face validity, content validity, and/or feasibility [ 9 , 13 - 19 , 21 - 23 , 26 , 30 - 34 , 36 ]. Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ]. A comparison of aneurysm complexity, surgical time, and surgical outcomes was made [ 19 , 20 ], or surgical videos were recorded, which allowed for the assessment of the clipping itself by an experienced neurosurgeon [ 24 , 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ]. A comparison of aneurysm complexity, surgical time, and surgical outcomes was made [ 19 , 20 ], or surgical videos were recorded, which allowed for the assessment of the clipping itself by an experienced neurosurgeon [ 24 , 28 ]. In other studies that conducted a review, a senior neurosurgeon assessed clipping performance based on neurosurgical videos [ 13 ] or microscope videos of the simulation [ 36 ] or by watching the residents’ performance [ 33 ].…”
Background
With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping.
Methods
A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators.
Results
Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components.
Conclusions
The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety.
“…Two studies were added to the category “ex vivo: cadavers” [ 13 , 14 ], one study was added to “ex vivo: human placenta” [ 15 ], and three studies were added to “ex vivo: chicken wings” [ 16 - 18 ]. “Virtual reality” contained 11 studies [ 19 - 29 ], “3D static simulators” had six [ 30 - 35 ], and “3D dynamic simulators” had three [ 9 , 36 , 37 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Different setups were used for the VR simulations. Some studies used a surgical rehearsal platform such as Surgical Theater (Cleveland, OH, USA) [ 19 , 20 , 24 , 28 ] or the patient-specific environment Dextroscope (Bracco Diagnostics, Monroe Township, NJ, USA) [ 25 , 29 ]. Marinho et al (2014) [ 27 ] created a virtual operative environment with the open-source software Blender.…”
Section: Resultsmentioning
confidence: 99%
“…The assessment method for the simulation approach varied across articles. Most articles included a subjective, descriptive questionnaire to assess the face validity, content validity, and/or feasibility [ 9 , 13 - 19 , 21 - 23 , 26 , 30 - 34 , 36 ]. Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Most articles included a subjective, descriptive questionnaire to assess the face validity, content validity, and/or feasibility [ 9 , 13 - 19 , 21 - 23 , 26 , 30 - 34 , 36 ]. Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ]. A comparison of aneurysm complexity, surgical time, and surgical outcomes was made [ 19 , 20 ], or surgical videos were recorded, which allowed for the assessment of the clipping itself by an experienced neurosurgeon [ 24 , 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Some articles on VR simulation compared a control group with a VR group; the control group used only conventional presurgical planning tools, while the VR group used a VR simulator to perform presurgical planning [ 19 , 20 , 24 , 28 ]. A comparison of aneurysm complexity, surgical time, and surgical outcomes was made [ 19 , 20 ], or surgical videos were recorded, which allowed for the assessment of the clipping itself by an experienced neurosurgeon [ 24 , 28 ]. In other studies that conducted a review, a senior neurosurgeon assessed clipping performance based on neurosurgical videos [ 13 ] or microscope videos of the simulation [ 36 ] or by watching the residents’ performance [ 33 ].…”
Background
With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping.
Methods
A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators.
Results
Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components.
Conclusions
The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety.
The adoption of Extended Reality (XR) technologies for supporting learning processes is an increasingly popular research topic for a wide variety of domains, including medical education. Currently, within this community, the metrics applied to quantify the potential impact these technologies have on procedural knowledge acquisition are inconsistent. This paper proposes a practical definition of standard metrics for the learning goals in the application of XR to surgical training. Their value in the context of previous research in neurosurgical training is also discussed. Objective metrics of performance include: spatial accuracy and precision, time-to-task completion, number of attempts. The objective definition of what the learner’s aims are enables the creation of comparable XR systems that track progress during training. The first impact is to provide a community-wide metric of progress that allows for consistent measurements. Furthermore, a measurable target opens the possibility for automated performance assessments with constructive feedback.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
