Anthony Costa PhD, Dr. Errol Gordon, Dr. Joshua Bederson and Zach Lorsch
Mount Sinai’s Neurosurgery team and other presenters pose a critical question: What if your surgeon already did your surgery before you came to the operating room?
Neurosurgeons, residents and researchers congregated in the historic city of Prague to discover the latest developments, innovative techniques, and advanced practices in neurosurgery at the European Association of Neurosurgical Societies (EANS). Kicking off the educational activities in this scientific arena was Joshua B. Bederson, MD, Chair of Neurosurgery, who moderated, presented at, and helmed the Virtual Reality Simulations and Augmented Reality Applications in Brain Surgery pre-course, alongside several of his team members and neurosurgery experts from around the globe. Together they sought to answer a question posed by Bernard R. Bendok, MD, Professor in Neurological Surgery at Northwestern University Feinberg School of Medicine, in his Overview of Simulation in Neurosurgery presentation, ‘What if your surgeon already did your surgery before you came to the operating room?’
Advanced technologies already make it possible to practice specific brain surgeries via simulation, but they are also moving toward patient-specific cases. Hence, a practice run-through of a specific surgery can translate directly to the operating room. In some instances – particularly with the 3-D printing of aneurysms – this is already occurring in hospitals like The Mount Sinai Hospital, but room for growth and technological refinement is ample.
Why Simulation in Brain Surgery?
Brain surgery is inherently a high-risk endeavor that requires several years to learn. Even experienced neurosurgeons can be surprised by
Zach Lorsch presented research findings utilizing NeuroTouch at EANS
intraoperative findings. Patient-specific preoperative rehearsal in a virtual reality environment can be used to practice complex procedures in a no-risk setting. As brain surgery simulation platforms evolve, it is essential for neurosurgeons to become familiar with their uses and applications. In addition to preoperative rehearsal, realistic simulations can be brought into the operating room to augment anatomical and visuospatial information provided to the surgeon.
Simulation has been utilized by various industries, such as the automotive and airline industries, as well as health care, namely in anesthesiology. ‘Augmented reality’ platforms are analogous to enhanced flight information provided to pilots during instrument approaches. Use in the neurosurgery operating room provides extremely useful information to surgeons in real time.
Benefits of Surgical Simulation
Incorporating a realistic brain surgery simulator into a training environment for neurosurgery residents can have a major impact on their education, as approaches can be developed and compared, strategies can be defined for safe resection/reconstruction and potential pitfalls can be recognized prior to an operation. In his Neurotouch Simulator: Overview and Skills Acquisition presentation, Icahn School of Medicine at Mount Sinai Graduate Assistant Zach Lorsch presented evidence from a research study entitled, “Simulation Skills Assessment Project,” that increased usage of surgical simulation improved performance over time. This conclusion was determined by having more than 90 students resect a tumor in 10 minutes with a pre, post, and re-test using the NeuroTouch virtual reality simulator.
In addition to elevating resident and surgeon learning curves, Drs. Bederson and Bendok highlighted other benefits to surgical simulation competency:
- Mastering several surgical techniques
- Experiencing diverse pathologies
- Increasing safety and speed of operations
- Decentralizing neurosurgical health care
- Reduction of malpractice cost
- Concentrated focus on error reduction and better outcomes
Dr. Bederson presented some of the work being done at Mount Sinai’s Brain Surgery Simulation program. “Preoperative simulation using virtual reality platforms is a rapidly evolving technology. The same platforms can be used to ‘augment reality’ in the operating room and are already in clinical use at Mount Sinai. These methods hold the promise of reducing complication rates and improving outcomes in some of the most challenging neurosurgical conditions.”
Surgical Simulation Technologies at EANS
Hands-on demonstrations and one-on-one training sessions with the state-of-the-art equipment were offered to participants of the course. The brain surgery simulation technology present included:
- Medtronic StealthStation Navigation System
- NeuroTouch Cranio Simulator
- Surgical Theater Platforms (Rehearsal and Navigation)
- Zeiss Surface Recognition Module and Trenion 3D Visualization Device
- Brainlab Curve
- CNS Microanastomosis Module
The course offered participants an introduction of these simulation environments used in neurosurgery, with a focus on brain surgery. During his presentation, Dr. Bederson also shared with the group how Mount Sinai uses GoPro head cameras on residents to film and review their surgeries. Measuring technical skills in residents becomes tangible when doing this because a grading evaluation can determined based on the incision, efficiency of instrument use, bleeding control, tissue handling, drilling/execution of the craniotomy, and confidence level. Upon the conclusion of the course, participants were equipped to describe the principles of simulation, applications in surgical preoperative rehearsal, intraoperative augmented reality, assessment of surgical skills, and evaluation of surgical performance.
Resident Abroad Embraces Simulation for Enhancing Surgical Expertise
Resident George Anagnostopoulos at EANS 2014
Among the residents in attendance at the course was George Anagnostopoulos, a neurosurgery resident at Salford Royal NHS Foundation Trust in the U.K. “I’ve tried a few simulators in courses in the U.K.; it’s different from reality, but it works,” he attested. “Having had that experience is why I chose to attend this seminar and discover what the future holds for this.”
“Dr. Bederson’s video presentation of two different residents with different surgical skill sets was the best part of this program, because it’s a practicality of appliance. We do not use cameras in the U.K. hospitals, because it’s not allowed, but I’d like to see this happen in my hospital. We’ve never thought of something like this – anonymously watching and discussing our performance. It’s not bias because you don’t know who is performing the operations. So this is excellent for facilitating and cultivating expertise. Hopefully it will lower malpractice costs and yield better outcomes in the future too.”