Introduction: In the wake of resident duty-hour restrictions, emphasis on surgical efficiency, and patient safety concerns, virtual reality (VR) simulation is emerging as an important tool in neurosurgical training. Thus, close collaboration between designers and users is imperative, to ensure simulation platforms meet trainees’ needs. We present a simulator for endoscopic third ventriculostomy (ETV), developed by the National Research Council of Canada (NRC) through close collaboration with Canadian neurosurgeons, trainees and researchers.
Methods: A prototype ETV training environment allowing navigation of the ventricles with an endoscope was developed using NRC’s Blade software engine, NeuroTouch simulator platform, intraoperative videos and MRI data from hydrocephalic patients. To align the design process with training needs, platform content and performance metrics were based on a national needs assessment survey. The prototype was iteratively revised based on feedback from collaborators.
Results: The simulator models steps of the ETV procedure, including selection of entry site, insertion of the endoscope, navigation into the third ventricle and fenestration of the floor (Figure 1). Haptic and visual feedback is generated when the endoscope touches the ventricular surface. Critical structures (e.g. choroid plexus, foramen, recesses, basilar artery, etc.) are displayed using realistic graphical textures. Assessment metrics include accuracy of ventricular cannulation and third ventricular floor fenestration, endoscope path-length and time to completion of the task.
Conclusions: We present a VR simulator for ETV that has been developed through collaboration between designers and users. The next phase of the development process, including face, content and construct validity evaluation of the platform and assessments, is currently underway. In addition, an expert panel of neurosurgeons is constructing a curriculum for the simulator, focussing on reduction of common surgical errors. A randomized trial of VR-to-OR skill transfer will be conducted to determine the educational benefit derived through adjuvant training on the simulator in addition to standard neurosurgical training.
Patient Care: Simulation training platforms, such as the one described in this study, are free from concerns over patient safety and limited clinical resources. As such, they provide an ideal ‘no-risk’ environment where surgical skills can be developed through harmless repetition. The potential for improvement in trainees' surgical skills in advance of clinical encounters with patients may help to reduce surgical errors and improve healthcare delivery for our patients.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the importance of collaboration between neurosurgeons, neurosurgical trainees, researchers and simulation developers in the design of simulation platforms and training curricula
2) Describe the key features of a novel virtual-reality simulation platform for endoscopic third ventriculostomy
3) Describe our approach to the development and evaluation of simulation-based training in neurosurgery