Operator experience determines performance in a simulated computer-based brain tumor resection task

Holloway, Terrell; Lorsch, Zachary S.; Chary, Michael; Sobotka, Stanislaw; Moore, Maximillian M.; Costa, Anthony; Maestro, Rolando F. Del; Bederson, Joshua B.

doi:10.1007/s11548-015-1160-y

Cited by 27 publications

(18 citation statements)

References 29 publications

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“…This communication has focused on a number of studies that provide face, content and construct validity for the NeuroTouch simulation platform utilizing neurosurgical scenarios. Some of the metrics discussed are being assessed for their usefulness in other simulated neurosurgical operations and by other surgical specialties which may aid the universality of their application [44][45][46][47]. The utility of virtual reality simulators like NeuroTouch will be limited unless concurrent validity can be demonstrated which would outline that these simulators enhance resident operating room performance [48,49].…”

Section: Discussionmentioning

confidence: 99%

Assessing Neurosurgical Psychomotor Performance: Role of Virtual Reality Simulators, Current and Future Potential

Alotaibi¹,

Zhrani²,

Bajunaid³

et al. 2015

SOJN

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Training surgeons is a dynamic process which is evolving towards more objective measures of assessing psychomotor technical skills. The current method for assessing neurosurgical trainees' technical skills is the in-training evaluation report (ITER). Despite the wide use of ITER in neurosurgical training programs, multiple authors have criticized its assessment validity. A number of other tools, designed and validated in the last two decades to assess the technical and cognitive skills of surgical procedures, will be discussed. Advances in computer-based technology have created significant opportunities for implementing new neurosurgical training paradigms focusing on improving neurosurgical bimanual psychomotor skill acquisition, better documenting surgical skills assessment and potentially enhancing procedural outcomes. A number of simulators have been developed for training residents involving a variety of neurosurgical purposes, ranging from simple procedures to full preoperative planning simulation. This communication will focus on our recent results utilizing the NeuroTouch virtual reality simulator platform which provides haptic feedback to investigate a series of questions that relate to the concept of surgical expertise.

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Section: Discussionmentioning

confidence: 99%

Assessing Neurosurgical Psychomotor Performance: Role of Virtual Reality Simulators, Current and Future Potential

Alotaibi¹,

Zhrani²,

Bajunaid³

et al. 2015

SOJN

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“…These metrics are being assessed for their usefulness in other simulated neurosurgical operations and by other surgical specialties, which may aid the universality of their application. 17,18,29,31,32 Fourth, the use of neurosurgeons, residents, and students from only 1 institution may have resulted in our inability to find more significant differences between groups. Fifth, the relationship of psychomotor performance to stress-induced physiological changes is important in the dissection of operator response to anxiety-inducing situations such as severe bleeding and will be addressed in further communications.…”

Section: Study Strengths and Limitationsmentioning

confidence: 98%

“…1C). [1][2][3]8,10,12,15,16,18,31,32 All operators were acquainted with the system since they had enrolled in a previous trial involving the resection of simulated tumors. 3 None of the participants knew that the purpose of the study was to assess the influence of acute stress and the sequence of the scenarios or had heard information related to this trial.…”

Section: Simulated Operative Resection Proceduresmentioning

confidence: 99%

Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task

Bajunaid

Mullah

Winkler-Schwartz

et al. 2017

JNS

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OBJECTIVE Severe bleeding during neurosurgical operations can result in acute stress affecting the bimanual psychomotor performance of the operator, leading to surgical error and an adverse patient outcome. Objective methods to assess the influence of acute stress on neurosurgical bimanual psychomotor performance have not been developed. Virtual reality simulators, such as NeuroTouch, allow the testing of acute stress on psychomotor performance in risk-free environments. Thus, the purpose of this study was to explore the impact of a simulated stressful virtual reality tumor resection scenario by utilizing NeuroTouch to answer 2 questions: 1) What is the impact of acute stress on bimanual psychomotor performance during the resection of simulated tumors? 2) Does acute stress influence bimanual psychomotor performance immediately following the stressful episode? METHODS Study participants included 6 neurosurgeons, 6 senior and 6 junior neurosurgical residents, and 6 medical students. Participants resected a total of 6 simulated tumors, 1 of which (Tumor 4) involved uncontrollable "intraoperative" bleeding resulting in simulated cardiac arrest and thus providing the acute stress scenario. Tier 1 metrics included extent of blood loss, percentage of tumor resected, and "normal" brain tissue volume removed. Tier 2 metrics included simulated suction device (sucker) and ultrasonic aspirator total tip path length, as well as the sum and maximum forces applied in using these instruments. Advanced Tier 2 metrics included efficiency index, coordination index, ultrasonic aspirator path length index, and ultrasonic aspirator bimanual forces ratio. All metrics were assessed before, during, and after the stressful scenario. RESULTS The stress scenario caused expected significant increases in blood loss in all participant groups. Extent of tumor resected and brain volume removed decreased in the junior resident and medical student groups. Sucker total tip path length increased in the neurosurgeon group, whereas sucker forces increased in the senior resident group. Psychomotor performance on advanced Tier 2 metrics was altered during the stress scenario in all participant groups. Performance on all advanced Tier 2 metrics returned to pre-stress levels in the post-stress scenario tumor resections. CONCLUSIONS Results demonstrated that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode. The simulated intraoperative bleeding event had no significant influence on the advanced Tier 2 metrics monitored during the immediate post-stress operative performance.

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“…The previously described NeuroTouch (now known as NeuroVR) platform was used to conduct this study. [1][2][3][4][5][6][7]10,11,14,16,20,26 Tumor removal was accomplished with a simulated virtual ultrasonic aspirator held in the participant's dominant hand (Fig. 1A).…”

Section: Neurovr Simulatormentioning

confidence: 99%

The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

Azarnoush

Siar

Sawaya

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Virtual reality simulators allow development of novel methods to analyze neurosurgical performance. The concept of a force pyramid is introduced as a Tier 3 metric with the ability to provide visual and spatial analysis of 3D force application by any instrument used during simulated tumor resection. This study was designed to answer 3 questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on the visual and haptic characteristics of simulated tumors? METHODS Using a virtual reality simulator, NeuroVR (formerly NeuroTouch), ultrasonic aspirator force application was continually assessed during resection of simulated brain tumors by neurosurgeons, residents, and medical students. The participants performed simulated resections of 18 simulated brain tumors with different visual and haptic characteristics. The raw data, namely, coordinates of the instrument tip as well as contact force values, were collected by the simulator. To provide a visual and qualitative spatial analysis of forces, the authors created a graph, called a force pyramid, representing force sum along the z-coordinate for different xy coordinates of the tool tip. RESULTS Sixteen neurosurgeons, 15 residents, and 84 medical students participated in the study. Neurosurgeon, resident and medical student groups displayed easily distinguishable 3D "force pyramid fingerprints." Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, and visual and haptic tumor characteristics resulted in distinct well-defined 3D force pyramid patterns. CONCLUSIONS Force pyramid fingerprints provide 3D spatial assessment displays of instrument force application during simulated tumor resection. Neurosurgeon force utilization and ergonomic data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

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Operator experience determines performance in a simulated computer-based brain tumor resection task

Abstract: Virtual Reality brain surgery can differentiate operators based on both recent and long-term experience and may be useful in the acquisition and assessment of neurosurgical skills. Coaching alters the learning curve of naïve inexperienced individuals.

Cited by 27 publications

References 29 publications

Assessing Neurosurgical Psychomotor Performance: Role of Virtual Reality Simulators, Current and Future Potential

Assessing Neurosurgical Psychomotor Performance: Role of Virtual Reality Simulators, Current and Future Potential

Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task

The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

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