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  • Validation of Novel Box Trainer for Neuro-endoscopic Fundamental Technical Skills Using Objective Skills Assessment Scale

    Final Number:

    Natesan D MCh; Ashish Suri; BRITTY BABY; RAMANDEEP SINGH; VINKLE SRIVASTAV; Subhashis Banerjee; SUBODH KUMAR; PREM KALRA; SANJIVA PRASAD; KOLIN PAUL; Sneh Anand PhD; Sanjeev Kumar MD; Varun Dhiman

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: IIn neuro-endoscopy, beginners struggle to navigate in physically constrained non-stereoscopic operative field with instruments with long fulcrum. Our objective was to validate a box trainer, which teaches the fundamental skills necessary for neuro-endoscopic endonasal surgery.

    Methods: The Neuro-Endo-Trainer (NET) has an activity plate dimensionally similar to operative field of endoscopic sellar-suprasellar-parasellar surgeries. Four groups of participants (Group E (n=4): expert neuro-endoscopic surgeons, Group N (n=19) novice neurosurgeons, Groups R and T (n=11 and 27): neurosurgery residents) performed tasks using the NET and were graded on task completion time and Neurosurgery Education and Training School - Skills Assessment Scale (NETS-SAS) scores. The residents did the training with 0°, 30° and 45° endoscopes and activity plate in various tilted position. (Figure1)

    Results: Experts had lower task completion time and significantly higher NETS-SAS scores than novice and residents. (Figure 2A) Novice and resident performances were equivalent. In self-assessing neuro-endoscopic skill, they also had equally low pre-training scores (4/10) with significant improvement following NET simulation. When using the NET with an angled scope, participants had significant worsening in scores with tilted plates as compared to straight plates (30° – 12.50 vs 11.77,11.86, 45° – 12.09 vs 11.00,11.45).(Figure 2B) With a tilted plate, a significant decrease in score was also observed when comparing the 0° with the 45° endoscope (Right - 12.32 vs 11.00, Left - 13.00 vs 11.45). Following two training iterations, improvements in total score were observed with all endoscopes.(Figure 2C) Reduction in completion time was observed with angled endoscopes, but these differences were not statistically significant.

    Conclusions: The face and construct validation of the synthetic physical neuro-endoscopic simulator is established. Novice neurosurgeons and residents have insufficient skill and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle affected the endoscopic skills. The NET was found to be a useful simulator for skill building in neuro-endoscopy.

    Patient Care: This simulation model would improve rapid skills acquisition for neuro-endoscopy and thus benefit in patient care. Also, surgical training can be provided outside OR, safe guarding patient safety.

    Learning Objectives: By conclusion of this session, participants should able to understand: 1) Need for simulation for neuro-endoscopic skills acquisition during residency program. 2) Understand the factors affecting neuro-endoscopic technical skills. 3) Validation of the Neuro-Endo-Trainer (box trainer) as simulation bench model for neuro-endoscopy


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