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  • Novel Metrics in Virtual Reality Simulation to Assess Technical Skills in Neurosurgery

    Final Number:

    Hamed Azarnoush PhD; Gmaan Ali Al Zhrani MD; Alexander Winkler-Schwartz; Fahad Al Otaibi MD; Rolando Del Maestro

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Conventional neurosurgical tools do not provide detailed quantitative information that are useful in the objective assessment of a resident’s technical skills. Virtual reality (VR) simulators could be excellent systems to quantitatively analyze technical skills and improve our understanding of how and why surgical errors occur. The objective of our research is to demonstrate this potential through design and evaluation of novel validation metrics that can be obtained from the state-of-the-art simulation technology.

    Methods: NeuroTouch is a VR simulator that provides the opportunity to assess neurosurgery skills with tactile feedback in a virtual world in controlled laboratory environments. We used NeuroTouch to simulate handling of CUSA when removing tumors with different visual and tactile properties in 6 different scenarios. Novel assessment metrics were developed, including, normal brain injury during simulated tumour resection, force histogram, and tool tip path length. These and other metrics were used to study individuals with different levels of expertise: 16 staff neurosurgeons and fellows, 15 neurosurgery residents, 84 medical students, and 30 postgraduate students.

    Results: Numerous metrics were obtained from the four participant groups. Based on the results, the staff neurosurgeons and fellows obtained the best average scores in all metrics in every visual and tactile scenario assessed. The residents obtained better average scores in all metrics in every scenario in comparison with the medical students and individuals with no medical training (see Figures).

    Conclusions: The critical questions that need to be addressed in simulation research include “are we measuring what needs to be measured to advance resident technical learning objectives and can we teach these metrics?” The relevance of the obtained results with neurosurgical expertise establishes preliminary validity for the use of the NeuroTouch simulator and the proposed metrics. Further detailed statistical analysis of advanced simulated metric evaluation systems is essential to advance resident learning.

    Patient Care: Currently, neurosurgery residents learn the majority of their technical skills in the operating room. This practice can be associated with an increased risk to patient safety. A VR simulator could be helpful as a training tool without these associated patient risks since training would occur in a safe laboratory setting. VR simulators also provide the flexibility of simulating hypothetical or challenging scenarios as has been done in the aerospace industry to both assess and improve particular skills and may help to decrease surgical errors by improving our understanding of how and why surgical errors occur.

    Learning Objectives: By the conclusion of this session, participants should be able to understand the advances being made in simulation technology for assessing neurosurgical performance during operative procedures. Novel methods are being developed to accurately assess expert surgical performance and these methods will need to be validated before they can be implemented into the neurosurgical resident curriculum.


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