Assessing performance in brain tumor resection using a novel virtual reality simulator
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NeuroTouch is a virtual reality (VR) simulator developed for neurosurgical skill training. Validation demonstrating that the system is useful and reliable is required for formal adoption into training curriculums. Face and content validity have been demonstrated for some neurosurgical simulators, but construct validity remains difficult to establish. A pilot validation study was conducted for a NeuroTouch training exercise.
Participants completed the internal resection of a simulated convexity meningioma and filled out questionnaires to provide feedback on the experience. Performance metrics included volume of tissues removed, tool path lengths, duration of excessive forces applied and efficient use of the aspirator. Results were analyzed according to participants’ level of training, gender, handedness, surgical experience in meningioma removal and hours/week playing musical instruments or video games.
Seventy-two participants (10 medical students, 18 junior residents and 44 senior residents) were enrolled. Analyses demonstrated statistically significant increase in tumor removed and efficiency of ultrasonic aspirator use between medical students and residents, but not between junior and senior residents. After covariate adjustment for the number of meningioma cases operated on, multivariate analysis of the level of training became nonsignificant. Participants judged the exercise appropriate and realistic, desiring use of the system in current training programs.
We have conducted a pilot validation study for the NeuroTouch tumor resection scenario and demonstrated for the first time, face, content and construct validity of a VR neurosurgical simulation exercise. Future full-scale studies will be conducted in noncompetitive settings and incorporate expert participants.
KeywordsNeuroTouch Virtual reality simulation Haptic feedback Brain tumor resection Neurosurgical oncology Performance metrics
American Association of Neurological Surgeons
National Research Council
We would like to thank all the individuals at the National Research Council Canada (NRC) and all the collaborators at Canadian and international Universities involved in this project. The VR surgical simulation program has been funded by the NRC Genomics and Health Initiative. This work was also supported by the Montréal English School Board, the Franco Di Giovanni, B-Strong, the Tony Colannino Foundations and the Montreal Neurological Institute and Hospital. Dr. Gelinas-Phaneuf was funded by a generous contribution from the Harold and Audrey Fisher Brain Tumour Research Award. Dr. Del Maestro holds the William Feindel Chair of Neuro-Oncology at the Montreal Neurological Institute.
Conflict of Interest
The authors declare no conflict of interest.
- 7.Choudhury N, Gelinas-Phaneuf N, Delorme S, Del Maestro RF (2012) Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills. World Neurosurg. doi: 10.1016/j.wneu.2012.08.022
- 8.Delorme S, Laroche D, Diraddo R, Del Maestro RF (2012) NeuroTouch: a physics-based virtual simulator for cranial microneurosurgery training. Neurosurgery 71(1 Suppl Operative):ons32–ons42. doi: 10.1227/NEU.0b013e318249c744
- 12.Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA 3rd, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193(6):797–804. doi: 10.1016/j.amjsurg.2006.06.050 PubMedCrossRefGoogle Scholar
- 17.Spiotta AM, Rasmussen PA, Masaryk TJ, Benzel EC, Schlenk R (2012) Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program. J Neurointerv Surg. doi: 10.1136/neurintsurg-2012-010319
- 19.Marcus H, Vakharia V, Kirkman MA, Murphy M, Nandi D (2013) Practice makes perfect? The role of simulation-based deliberate practice and script-based mental rehearsal in the acquisition and maintenance of operative neurosurgical skills. Neurosurgery 72(Suppl 1):124–130. doi: 10.1227/NEU.0b013e318270d010 PubMedCrossRefGoogle Scholar
- 20.Alaraj A, Charbel FT, Birk D, Tobin M, Luciano C, Banerjee PP, Rizzi S, Sorenson J, Foley K, Slavin K, Roitberg B (2013) Role of cranial and spinal virtual and augmented reality simulation using immersive touch modules in neurosurgical training. Neurosurgery 72(Suppl 1):115–123. doi: 10.1227/NEU.0b013e3182753093 PubMedCentralPubMedCrossRefGoogle Scholar
- 23.Luciano CJ, Banerjee PP, Bellotte B, Oh GM, Lemole Jr M, Charbel FT, Roitberg B (2011) Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery 69 (1 Suppl Operative):ons14–ons19; discussion ons19. doi: 10.1227/NEU.0b013e31821954ed
- 24.Neubauer A, Brooks R, Brouwer I, Debergue P, Laroche D (2012) Haptic collision handling for simulation of transnasal surgery. Comput Animat Virtual Worlds. doi: 10.1002/cav.1489
- 25.Borgeat L, Massicotte P, Poirier G, Godin G (2011) Layered surface fluid simulation for surgical training. Med Image Comput Comput Assist Interv MICCAI 14(Pt 1):323–330Google Scholar
- 27.Jiang D, Choudhury N, Mora V, Delorme S (2010) Characterization of suction and CUSA interaction with brain tissue. In: Paper presented at the proceedings of the 5th international conference on Biomedical simulation, Phoenix, AZ, USAGoogle Scholar
- 28.Mora V, Jiang D, Brooks R, Delorme S (2009) A computer model of soft tissue interaction with a surgical aspirator. Med Image Comput Comput Assist Interv MICCAI 12(Pt 1):51–58Google Scholar
- 29.Lemole M, Banerjee PP, Luciano C, Charbel F, Oh M (2009) Virtual ventriculostomy with ‘shifted ventricle’: neurosurgery resident surgical skill assessment using a high-fidelity haptic/graphic virtual reality simulator. Neurol Res 31(4):430–431. doi: 10.1179/174313208X353695 PubMedCrossRefGoogle Scholar
- 33.Selvander M, Asman P (2010) Virtual reality cataract surgery training: learning curves and concurrent validity. Acta Ophthalmol. doi: 10.1111/j.1755-3768.2010.02028.x
- 34.Fried MP, Sadoughi B, Weghorst SJ, Zeltsan M, Cuellar H, Uribe JI, Sasaki CT, Ross DA, Jacobs JB, Lebowitz RA, Satava RM (2007) Construct validity of the endoscopic sinus surgery simulator: II. Assessment of discriminant validity and expert benchmarking. Arch Otolaryngol Head Neck Surg 133(4):350–357. doi: 10.1001/archotol.133.4.350 PubMedCrossRefGoogle Scholar
- 37.Van Herzeele I, O’Donoghue KG, Aggarwal R, Vermassen F, Darzi A, Cheshire NJ (2010) Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator. J Vasc Surg Off Publ Soc Vasc Surg Int Soc Cardiovasc Surg N Am Chapter 51(4):1035–1042. doi: 10.1016/j.jvs.2009.11.059
- 40.Enochsson L, Isaksson B, Tour R, Kjellin A, Hedman L, Wredmark T, Tsai-Fellander L (2004) Visuospatial skills and computer game experience influence the performance of virtual endoscopy. J Gastrointest Surg Off J Soc Surg Aliment Tract 8 (7):876–882; discussion 882. doi: 10.1016/j.gassur.2004.06.015 Google Scholar
- 45.Schlickum MK, Hedman L, Enochsson L, Kjellin A, Fellander-Tsai L (2009) Systematic video game training in surgical novices improves performance in virtual reality endoscopic surgical simulators: a prospective randomized study. World J Surg 33(11):2360–2367. doi: 10.1007/s00268-009-0151-y PubMedCrossRefGoogle Scholar
- 51.Selden NR, Origitano TC, Burchiel KJ, Getch CC, Anderson VC, McCartney S, Abdulrauf SI, Barrow DL, Ehni BL, Grady MS, Hadjipanayis CG, Heilman CB, Popp AJ, Sawaya R, Schuster JM, Wu JK, Barbaro NM (2012) A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery 70 (4):971–981; discussion 981. doi: 10.1227/NEU.0b013e31823d7a45 Google Scholar