OBJECTIVEEndoscope-assisted repair of craniosynostosis is a safe and efficacious alternative to open techniques. However, this procedure is challenging to learn, and there is significant variation in both its execution and outcomes. Surgical simulators may allow trainees to learn and practice this procedure prior to operating on an actual patient. The purpose of this study was to develop a realistic, relatively inexpensive simulator for endoscope-assisted repair of metopic and sagittal craniosynostosis and to evaluate the models’ fidelity and teaching content.METHODSTwo separate, 3D-printed, plastic powder–based replica skulls exhibiting metopic (age 1 month) and sagittal (age 2 months) craniosynostosis were developed. These models were made into consumable skull “cartridges” that insert into a reusable base resembling an infant’s head. Each cartridge consists of a multilayer scalp (skin, subcutaneous fat, galea, and periosteum); cranial bones with accurate landmarks; and the dura mater. Data related to model construction, use, and cost were collected. Eleven novice surgeons (residents), 9 experienced surgeons (fellows), and 5 expert surgeons (attendings) performed a simulated metopic and sagittal craniosynostosis repair using a neuroendoscope, high-speed drill, rongeurs, lighted retractors, and suction/irrigation. All participants completed a 13-item questionnaire (using 5-point Likert scales) to rate the realism and utility of the models for teaching endoscope-assisted strip suturectomy.RESULTSThe simulators are compact, robust, and relatively inexpensive. They can be rapidly reset for repeated use and contain a minimal amount of consumable material while providing a realistic simulation experience. More than 80% of participants agreed or strongly agreed that the models’ anatomical features, including surface anatomy, subgaleal and subperiosteal tissue planes, anterior fontanelle, and epidural spaces, were realistic and contained appropriate detail. More than 90% of participants indicated that handling the endoscope and the instruments was realistic, and also that the steps required to perform the procedure were representative of the steps required in real life.CONCLUSIONSBoth the metopic and sagittal craniosynostosis simulators were developed using low-cost methods and were successfully designed to be reusable. The simulators were found to realistically represent the surgical procedure and can be used to develop the technical skills required for performing an endoscope-assisted craniosynostosis repair.

This work presents a novel miniature contact-aided compliant joint mechanism that can be integrated into millimeter-sized manual or robotic surgical instruments. The design aims to address the trade-off between notched-tube compliant joints' range of motion and stiffness, while also ensuring a compact form factor. The mechanism is constructed from a nitinol tube with asymmetric cutouts and is actuated in bending by a cable. The innovative feature of this design is the incorporation of a contact aid into the notched-tube topology, which acts to both increase the stiffness of the joint and change the shape that it undertakes during bending. Using finite element modeling (FEM) techniques, we present a sensitivity analysis investigating how the performance of this contact-aided compliant mechanism (CCM) is affected by its geometry, and derive a kinematics and statics model for the joint. The FEM simulations and the kinematic and static models are compared to experimental results. The design and modeling presented in this study can be used to develop new miniature dexterous instruments, with a particular emphasis on applications in minimally invasive neurosurgery.