Introduction: Recent studies have shown that, majority(90%) of microsurgical skills training is provided in operating room under apprenticeship model, resulting in lack of efficiency(by 35%). Furthermore, issues of patient safety and cost-effectiveness have drawn increasing attention to surgical skills of neurosurgeons that require elaborate and effectual training.
Microsurgical techniques play vital role in neurosurgical procedures like micro-neural anastomosis of peripheral, cranial nerves and nerve plexuses, dural repair in cranial vault, skull-base and spine, and micro-vascular anastomoses in vascular bypass(ST-MCA & Radial-MCA). However, these techniques have comparatively gradual learning curve, and their subjective assessment under current apprenticeship model cannot be completely unbiased.
Thus, an attempt has been made in the form of stereoscopy-based computerized evaluation system to provide supervised-yet-unsupervised environment, where trainees can hone their micro-neurosurgical skills gradually(and solidly).
Methods: Basic and advanced Micro-neurosurgery skills training sessions imparted at NETS, AIIMS provides trainees a platform to hone their surgical skills by practicing on synthetic and semi-synthetic modules followed by micro-neural and micro-vascular anastomosis in small laboratory animals. This gives them an opportunity to improvise different components of their surgical skills, individually and collectively.
In parallel, stereoscopic cine and still clips of activity are extracted and transmitted to CECS, UCF, where image processing and computer vision based algorithms are deployed to analyze different characteristics of micro-surgical performance, viz., dexterity, instrument-tissue manipulation, speed and effectualness.
Results: These recorded samples are then subjected to two different processes of evaluation: subjective evaluation by senior neurosurgeon and software-based objective evaluation. A comparative analysis of objective vs. subjective results, has statistically reflected on the potent of stereoscopy-based computerized evaluation of microsurgical techniques.
Conclusions: Objectivized assessment of micro-neurosurgical skills using stereoscopic technologies has shown an evident improvement in the standards of evaluation. This method of instruction helps the trainees improvise their surgical skills targeted-ly, resulting in foreshortening and strengthening their learning curve/experience.
Patient Care: Improvement in patient care is directly proportional to the surgical skills of next-gen neurosurgeons.
Learning Objectives: Stereoscopic based computerized evaluation of the micro-neurosurgery skills helps to objectivize the learning curve and formative assessment of trainee neurosurgeons.
References: 1. McWilliams A. Medical Robotics and Computer Assisted Surgery. BCC Research.
Market Research Report HLC036B. 2006. Norwalk, CT: BCC. Available at: http://www.bccresearch.com/report/HLC036B.html. Accessed January 5, 2011.
2. Babineau TJ, Becker J, Gibbons G, et al. The "cost" of operative training for surgical residents. Arch Surg. 2004;139(4):366-369.