Development and validation of a synthetic 3D-printed simulator for training in neuroendoscopic ventricular lesion removal

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Neuroendoscopic surgery using an ultrasonic aspirator represents a valid tool with which to perform the safe resection of deep-seated ventricular lesions, but the handling of neuroendoscopic instruments is technically challenging, requiring extensive training to achieve a steep learning curve. Simulation-based methods are increasingly used to improve surgical skills, allowing neurosurgical trainees to practice in a risk-free, reproducible environment. The authors introduce a synthetic, patient-specific simulator that enables trainees to develop skills for endoscopic ventricular tumor removal, and they evaluate the model’s validity as a training instrument with regard to realism, mechanical proprieties, procedural content, and handling.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors developed a synthetic simulator based on a patient-specific CT data set. The anatomical features were segmented, and several realistic 1:1 skull models with all relevant ventricular structures were fabricated by a 3D printer. Vascular structures and the choroid plexus were included. A tumor model, composed of polyvinyl alcohol, mimicking a soft-consistency lesion, was secured in different spots of the frontal horn and within the third ventricle. Neurosurgical trainees participating in a neuroendoscopic workshop qualitatively assessed, by means of a feedback survey, the properties of the simulator as a training model that teaches neuroendoscopic ultrasonic ventricular tumor surgery; the trainees rated 10 items according to a 5-point Likert scale.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Participants appreciated the model as a valid hands-on training tool for neuroendoscopic ultrasonic aspirator tumor removal, highly rating the procedural content. Furthermore, they mostly agreed on its comparably realistic anatomical and mechanical properties. By the model’s first application, the authors were able to recognize possible improvement measures, such as the development of different tumor model textures and the possibility, for the user, of creating a realistic surgical skull approach and neuroendoscopic trajectory.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>A low-cost, patient-specific, reusable 3D-printed simulator for the training of neuroendoscopic ultrasonic aspirator tumor removal was successfully developed. The simulator is a useful tool for teaching neuroendoscopic techniques and provides support in the development of the required surgical skills.</jats:p></jats:sec>

Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

“…Clearly, a learning curve for the technically challenging use of the NUA exists, thus not excluding the successful resection of larger lesions with increasing experience. To this purpose, the development of teaching models for endoscopy and NUA use additionally supports the training without the involvement of patients [10]. So far, our recommendation would be to tailor the approach (burr hole vs. mini-craniotomy in combination with a speculum) according to the surgeon's experience, the size of the lesion, and its characteristics (Table 1).…”

Virtual Reality and Three-Dimensional Printed Models Improve the Morphological Understanding in Learning Mandibular Sagittal Split Ramus Osteotomy: A Randomized Controlled Study

“…Studies have found that 3DP models with tactile sensation play an active role in the process of learning complex structures, such as acetabular fractures, liver structures, and craniovertebral junction deformities ( 19 , 21 , 26 ). Licci et al introduced a synthetic 3DP simulator which allowed trainees to develop skills for endoscopic ventricular lesion removal ( 23 ). The authors evaluated the validity of the 3DP model in term of realism, mechanical proprieties, procedural content, and handling.…”

“…The tangible 3DP models may improve learning efficacy by providing tactile feedback. VR and 3DP models have been used in many clinical specialties for advanced teaching, preoperative planning, and simulated surgery (14,(18)(19)(20)(21)(22)(23). However, the effectiveness of VR and 3DP models in learning to perform SSRO remains unclear.…”

Structure, properties, and bioactivity of 3D printed PAEKs for implant applications: A systematic review

“…Currently, FFF technology, the most accessible AM method, is already implemented in the hospitals for the fabrication of anatomical bio‐models, customized surgical instruments, and prosthetic aids 19,20 . While these applications have typically been achieved with low temperature polymers, recent technological advancements in FFF 3D printers have made it possible to process high‐temperature thermoplastic materials such as PAEK.…”