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Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.
J Neurosurg Pediatr 2017; 20(1):1-9JN

Abstract

OBJECTIVE

Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus.

METHODS

A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV.

RESULTS

A combination of 3D printing technology and casting processes led to the creation of realistic surgical models that include high-fidelity reproductions of the anatomical features of hydrocephalus and allow for the performance of ETV for training purposes. The models reproduced the pulsations of the basilar artery, ventricles, and cerebrospinal fluid (CSF), thus simulating the experience of performing ETV on an actual patient. The results of the 14-item questionnaire showed limited variability among participants' scores, and the neurosurgery fellows and residents gave the models consistently high ratings for face and content validity. The mean score for the content validity questions (4.88) was higher than the mean score for face validity (4.69) (p = 0.03). On construct validity scores, the blinded observers rated performance of fellows significantly higher than that of residents, indicating that the model provided a means to distinguish between novice and expert surgical skills.

CONCLUSIONS

A plug-and-play lifelike ETV training model was developed through a combination of 3D printing and special effects techniques, providing both anatomical and haptic accuracy. Such simulators offer opportunities to accelerate the development of expertise with respect to new and novel procedures as well as iterate new surgical approaches and innovations, thus allowing novice neurosurgeons to gain valuable experience in surgical techniques without exposing patients to risk of harm.

Authors+Show Affiliations

Department of Anesthesia, Perioperative and Pain Medicine-Division of Critical Care Medicine. Simulator Program (SIMPeds). Harvard Medical School, Boston, Massachusetts; and.Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.Simulator Program (SIMPeds). Department of Radiology, and. Harvard Medical School, Boston, Massachusetts; and.Clinical Research Program, Boston Children's Hospital.Department of Anesthesia, Perioperative and Pain Medicine-Division of Critical Care Medicine. Simulator Program (SIMPeds). Harvard Medical School, Boston, Massachusetts; and.Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.

Pub Type(s)

Journal Article
Validation Studies

Language

eng

PubMed ID

28438070

Citation

Weinstock, Peter, et al. "Creation of a Novel Simulator for Minimally Invasive Neurosurgery: Fusion of 3D Printing and Special Effects." Journal of Neurosurgery. Pediatrics, vol. 20, no. 1, 2017, pp. 1-9.
Weinstock P, Rehder R, Prabhu SP, et al. Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects. J Neurosurg Pediatr. 2017;20(1):1-9.
Weinstock, P., Rehder, R., Prabhu, S. P., Forbes, P. W., Roussin, C. J., & Cohen, A. R. (2017). Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects. Journal of Neurosurgery. Pediatrics, 20(1), pp. 1-9. doi:10.3171/2017.1.PEDS16568.
Weinstock P, et al. Creation of a Novel Simulator for Minimally Invasive Neurosurgery: Fusion of 3D Printing and Special Effects. J Neurosurg Pediatr. 2017;20(1):1-9. PubMed PMID: 28438070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects. AU - Weinstock,Peter, AU - Rehder,Roberta, AU - Prabhu,Sanjay P, AU - Forbes,Peter W, AU - Roussin,Christopher J, AU - Cohen,Alan R, Y1 - 2017/04/25/ PY - 2017/4/26/pubmed PY - 2017/7/14/medline PY - 2017/4/26/entrez KW - 3D printing technology KW - ACGME = Accreditation Council of Graduate Medical Education KW - CSF = cerebrospinal fluid KW - ETV = endoscopic third ventriculostomy KW - OSATS = Objective Structured Assessment of Technical Skills KW - PGY = postgraduate year KW - endoscopic third ventriculostomy KW - hydrocephalus KW - minimally invasive neurosurgery KW - residency KW - simulation KW - surgical trainers SP - 1 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 20 IS - 1 N2 - OBJECTIVE Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus. METHODS A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV. RESULTS A combination of 3D printing technology and casting processes led to the creation of realistic surgical models that include high-fidelity reproductions of the anatomical features of hydrocephalus and allow for the performance of ETV for training purposes. The models reproduced the pulsations of the basilar artery, ventricles, and cerebrospinal fluid (CSF), thus simulating the experience of performing ETV on an actual patient. The results of the 14-item questionnaire showed limited variability among participants' scores, and the neurosurgery fellows and residents gave the models consistently high ratings for face and content validity. The mean score for the content validity questions (4.88) was higher than the mean score for face validity (4.69) (p = 0.03). On construct validity scores, the blinded observers rated performance of fellows significantly higher than that of residents, indicating that the model provided a means to distinguish between novice and expert surgical skills. CONCLUSIONS A plug-and-play lifelike ETV training model was developed through a combination of 3D printing and special effects techniques, providing both anatomical and haptic accuracy. Such simulators offer opportunities to accelerate the development of expertise with respect to new and novel procedures as well as iterate new surgical approaches and innovations, thus allowing novice neurosurgeons to gain valuable experience in surgical techniques without exposing patients to risk of harm. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/28438070/Creation_of_a_novel_simulator_for_minimally_invasive_neurosurgery:_fusion_of_3D_printing_and_special_effects_ L2 - https://thejns.org/doi/10.3171/2017.1.PEDS16568 DB - PRIME DP - Unbound Medicine ER -