Technology and Simulation to Improve Patient Safety.

Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors

Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons

Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs.

BACKGROUND: As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces double jeopardy -with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators\u27 natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. METHODS: Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. RESULTS: Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. CONCLUSIONS: With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery

Virtual reality in neurosurgery- a neurostimulator – based postgraduate residency training: a novel step towards skillful young neurosurgeons

Introduction/Objective: Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods: Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results: The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion: Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

Virtual reality and surgical oncology

More than 80% of people diagnosed with cancer will require surgery. However, less than 5% have access to safe, affordable and timely surgery in low- and middle-income countries (LMICs) settings mostly due to the lack of trained workforce. Since its creation, virtual reality (VR) has been heralded as a viable adjunct to surgical training, but its adoption in surgical oncology to date is poorly understood. We undertook a systematic review to determine the application of VR across different surgical specialties, modalities and cancer pathway globally between January 2011 and 2021. We reviewed their characteristics and respective methods of validation of 24 articles. The results revealed gaps in application and accessibility of VR with a proclivity for high-income countries and high-risk, complex oncological surgeries. There is a lack of standardisation of clinical evaluation of VR, both in terms of clinical trials and implementation science. While all VR illustrated face and content validity, only around two-third exhibited construct validity and predictive validity was lacking overall. In conclusion, the asynchrony between VR development and actual global cancer surgery demand means the technology is not effectively, efficiently and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise cost-effective VR technologies with predictive validity for high demand, open cancer surgeries required in LMICs

Augmented Reality Simulation Modules for EVD Placement Training and Planning Aids

When a novice neurosurgeon performs a psychomotor surgical task (e.g., tool navigation into brain structures), a potential risk of damaging healthy tissues and eloquent brain structures is unavoidable. When novices make multiple hits, thus a set of undesirable trajectories is created, and resulting in the potential for surgical complications. Thus, it is important that novices not only aim for a high-level of surgical mastery but also receive deliberate training in common neurosurgical procedures and underlying tasks. Surgical simulators have emerged as an adequate candidate as effective method to teach novices in safe and free-error training environments. The design of neurosurgical simulators requires a comprehensive approach to development and. In that in mind, we demonstrate a detailed case study in which two Augmented Reality (AR) training simulation modules were designed and implemented through the adoption of Model-driven Engineering. User performance evaluation is a key aspect of the surgical simulation validity. Many AR surgical simulators become obsolete; either they are not sufficient to support enough surgical scenarios, or they were validated according to subjective assessments that did not meet every need. Accordingly, we demonstrate the feasibility of the AR simulation modules through two user studies, objectively measuring novices’ performance based on quantitative metrics. Neurosurgical simulators are prone to perceptual distance underestimation. Few investigations were conducted for improving user depth perception in head-mounted display-based AR systems with perceptual motion cues. Consequently, we report our investigation’s results about whether or not head motion and perception motion cues had an influence on users’ performance