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Filling the gap between the OR and virtual simulation: a European study on a basic neurosurgical procedure

  • Original Article - Neurosurgery Training
  • Published:
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Abstract

Background

Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies.

Methods

We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed.

Results

Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (p = .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (p = .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher’s test, for the analysis of the variances, and the Student’s T test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator.

Conclusion

The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons’ consistency in placing EVDs in the last year.

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Abbreviations

ACGME:

Accreditation Council of Medical Education

CT:

Computed tomography

EVD:

External ventricular drain

ENSSG:

European Neurosurgery Simulation Study Group

EWTD:

European Working Time Directive

OR:

Operative room

PGY:

Post graduate year

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Acknowledgments

We deeply thank Jay Benerjee and André Targino from ImmersiveTouch who gave us technical support during the EANS Training Course in Sofia (Bulgaria) in 2016. Thanks to all the members of the European Neurosurgery Simulation Study Group (ENSSG); they made this study possible, aiming at improving and unifying the way neurosurgical training is provided across Europe.

Funding

No funding was received for this research.

Author information

Author notes

  1. Alessandro Perin and Tommaso Francesco Galbiati contributed equally to this work.

Authors and Affiliations

  1. Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, via Celoria 11, 20133, Milan, Italy

    Alessandro Perin, Tommaso Francesco Galbiati, Enrico Gambatesa, Roberta Ayadi, Eleonora Francesca Orena, Lydia Viviana Falsitta, Silvia Schembari & Francesco DiMeco

  2. Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, Milan, Italy

    Alessandro Perin, Tommaso Francesco Galbiati, Enrico Gambatesa, Roberta Ayadi, Eleonora Francesca Orena, Valentina Cuomo, Nicole Irene Riker, Lydia Viviana Falsitta, Silvia Schembari, Stefano Rizzo & Francesco DiMeco

  3. Department of Life Sciences, University of Trieste, Trieste, Italy

    Alessandro Perin

  4. Department of Bioengineering and Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, USA

    Cristian Luciano

  5. Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy

    Paolo Cappabianca

  6. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Torstein Ragnar Meling

  7. EANS Training Committee, Cirencester, UK

    Torstein Ragnar Meling, Karl Schaller & Francesco DiMeco

  8. Neurosurgery Department, Hopitaux Universitaires de Genève, Geneva, Switzerland

    Karl Schaller

  9. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Francesco DiMeco

  10. Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA

    Francesco DiMeco

Authors
  1. Alessandro Perin
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  3. Enrico Gambatesa
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  4. Roberta Ayadi
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Consortia

European Neurosurgery Simulation Study Group (ENSSG)

  • Chiara Caggiano
  • , Cecilia Casali
  • , Federico Giuseppe Legnani
  • , Luca Mattei
  • , Francesco Ugo Prada
  • , Marco Saini
  • , Andrea Saladino
  • , Rosaria Viola Abbritti
  • , Dalibor Arapovic
  • , Karolis Bareikis
  • , Dominik Baschera
  • , Anna-Margarete Bohrer
  • , Bixia Chen
  • , Stavros Constantinou
  • , Attaran Pooya Daemi
  • , Violaine Delabar
  • , Janina Deyng
  • , Alberto Di Somma
  • , Claudia Fanizzi
  • , Axel Forsse
  • , Karen Huscher
  • , Tonje Okkenhaug Johansen
  • , Peter Koppal
  • , Ona Lapteva
  • , Francois Lechanoine
  • , Julia Masomi
  • , David Mestan
  • , Ararat Minasyan
  • , Samuel Orie
  • , Ahmet Ozak
  • , Mihail Petrov
  • , Oleksandr Pichkur
  • , Rui Ramos
  • , Selcuk Omer Sahin
  • , Santos Alexandra Seromenho
  • , Sesar Nikolina
  • , Priyank Sinha
  • , Mariustz Sowa
  • , Andrzej Styk
  • , Lovisa Tobieson
  • , Çağhan Tönge
  • , Dace Zvirgzdina
  • , Ridvan Alimehmeti
  • , Alexandros Andreou
  • , Toomas Asser
  • , Kaspar Auslands
  • , Burçak Bilginer
  • , Alexandre Carpentier
  • , Antonio Cerejo
  • , Hans Clusmann
  • , Bogdan Iliescu
  • , Marcel Ivanov
  • , Dariusz Jaskolski
  • , Nikolay Konovalov
  • , Aki Laakso
  • , Ivan Macuga
  • , Yerbol Makhambetov
  • , Arsim Morina
  • , Laszlo Novak
  • , Ibrahim Omerhodzic
  • , Vakis Papanastassiou
  • , Diaz Avelino Parajon
  • , Lukas Rasulic
  • , Michael Reinert
  • , Saulius Rocka
  • , Jane Skjøth-Rasmussen
  • , Volodymyr Smolanka
  • , Martin Smrčka
  • , Sergey Spektor
  • , Claudius Thomé
  • , Magnus Tisell
  • , Dirk Van Roost
  • , Henk van Santbrink
  • , Nikolay Velinov
  •  & Miroslav Vukić

Corresponding author

Correspondence to Alessandro Perin.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licencing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of the Topical Collection on Neurosurgery Training

Appendix

Appendix

Contributors of the European Neurosurgery Simulation Study Group (ENSSG): Chiara Caggiano MD1, Cecilia Casali MD1, Federico Giuseppe Legnani MD1, Luca Mattei MD1, Francesco Ugo Prada MD1,11, Marco Saini MD1, Andrea Saladino MD1, Rosaria Viola Abbritti MD12, Dalibor Arapovic MD13, Karolis Bareikis MD14, Dominik Baschera MD15, Anna-Margarete Bohrer MD16, Bixia Chen MD16, Stavros Constantinou MD17, Attaran Pooya Daemi MD18, Violaine Delabar MD19, Janina Deyng MD20, Alberto Di Somma MD5, Claudia Fanizzi MD1, Axel Forsse MD21, Karen Huscher MD22, Tonje Okkenhaug Johansen MD23, Peter Koppal MD24, Ona Lapteva MD25, Francois Lechanoine MD26, Julia Masomi MD27, David Mestan MD28, Ararat Minasyan MD29, Samuel Orie MD30, Ahmet Ozak MD31, Mihail Petrov MD32, Oleksandr Pichkur MD33, Rui Ramos MD34, Selcuk Omer Sahin MD35, Santos Alexandra Seromenho MD36, Sesar Nikolina MD37, Priyank Sinha MD38, Mariustz Sowa MD39, Andrzej Styk MD40, Lovisa Tobieson MD41, Çağhan Tönge MD35, Dace Zvirgzdina MD42, Ridvan Alimehmeti MD7, Alexandros Andreou MD PhD7, Toomas Asser MD PhD7, Kaspar Auslands MD PhD7, BurÇak Bilginer MD PhD7, Alexandre Carpentier MD PhD7, Antonio Cerejo MD7, Hans Clusmann MD PhD7, Bogdan Iliescu MD PhD7, Marcel Ivanov MD PhD7, Dariusz Jaskolski MD7, Nikolay Konovalov MD PhD7, Aki Laakso MD PhD7, Ivan Macuga MD7, Yerbol Makhambetov MD7, Arsim Morina MD7, Laszlo Novak MD PhD7, Ibrahim Omerhodzic MD7, Vakis Papanastassiou MD7, Diaz Avelino Parajon MD PhD7, Lukas Rasulic MD PhD7, Michael Reinert MD PhD7, Saulius Rocka MD PhD7, Jane Skjøth-Rasmussen MD PhD7, Volodymyr Smolanka MD PhD7, Martin Smrčka MD PhD MBA7, Sergey Spektor MD PhD7, Claudius Thomé MD7, Magnus Tisell MD PhD7, Dirk Van Roost MD7, Henk van Santbrink MD PhD7, Nikolay Velinov MD PhD7, Miroslav Vukić MD PhD7.

1 Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, Milan, Italy.

2 Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, Milan, Italy.

3 Department of Life Sciences, University of Trieste, Trieste, Italy.

4 Department of Bioengineering and Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, USA.

5 Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Napoli, Italy.

6 Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

7 EANS Training Committee.

8 Neurosurgery Department, Hopitaux Universitaires de Genève, Geneva, Switzerland.

9 Department of Pathophysiology and Transplantation, University of Milan – Italy.

10 Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA.

11 Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA.

12 Department of Biomedical and Dental Sciences and Morpho-functional Imaging. University of Messina Neurosurgery, Messina, Italy.

13 Helios Hospital Krefeld, Dusseldorf, Germany.

14 Neurosurgery Department, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania.

15 Department of Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.

16 Department of Neurosurgery, University Hospital Essen, Essen, Germany.

17 Department of Neurosurgery, Royal Victoria Hospital, Belfast, United Kingdom.

18 Department of Neurosurgery, Wedau Kliniken, Duisburg, Germany.

19 Hopital Neurologique Pierre Wertheimer, Bron, France.

20 Department of Neurosurgery, Klinikum München, Munchen, Germany.

21 Department of Neurosurgery, Odense University Hospital, Odense, Denmark.

22 Department of Neurosurgery, Centre Hospitalier du Valais Romand, Sion, Switzerland.

23 St. Olav’s University Hospital, Trondheim, Norway.

24 FNsP F.D. Roosevelt, Banska Bystrica, Slovakia.

25 Department of Neurosurgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.

26 Department of Neurosurgery, Bretonneau Hospital, Tours, France.

27 Department of Neurosurgery University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany.

28 Ceske Budejovice Hospital, Budejovice, Czech Republic.

29 Klinikum Chemnitz, Chemnitz, Germany.

30 Nordstadt Hospital, Hannover, Germany.

31 Department of Neurosurgery, Akdeniz University, Antalya, Turkey.

32 Department of Neurosurgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine, Sofia, Bulgaria.

33 Klinikum Fulda, Fulda, Germany.

34 Department of Neurosurgery, Hospital de Braga, Braga, Portugal.

35 Department of Neurosurgery, Ministry Of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.

36 Department of Neurosurgery, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.

37 UHC Sister of Mercy, Zagreb, Croatia.

38 Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom.

39 Department of Neurosurgery, University of Warmia and Masuria, Olsztyn, Poland.

40 Department of Neurosurgery, Military Institute of Medicine Warsaw, Warsaw, Poland.

41 Department of Neurosurgery, Linköping University, Linköping, Sweden.

42 Department of Neurosurgery, Pauls Stradins Clinical University Hospital, Riga, Latvia.

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Perin, A., Galbiati, T.F., Gambatesa, E. et al. Filling the gap between the OR and virtual simulation: a European study on a basic neurosurgical procedure. Acta Neurochir 160, 2087–2097 (2018). https://doi.org/10.1007/s00701-018-3676-8

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