Advertisement

Virtual Reality Simulation for the Spine

  • Ben Roitberg
Chapter
Part of the Comprehensive Healthcare Simulation book series (CHS)

Abstract

The need to train surgeons to perform procedures on a model before they first operate on patients is not new. The popularity of surgical laboratory training is high; many surgical educators perceive an increasing role for formal laboratory training and for new technologies to do so. The reasons include the effect of limited duty hours on the traditional apprenticeship model of surgical training and the increased attention to patient safety.

This chapter describes a variety of surgical laboratory training methods, which can be included under the general umbrella of “simulation.” The range includes cadaver-based training with various enhancements, animal models – mostly cadaveric, artificial spine models, and mixed reality setups where an artificial or cadaver model is combined with computerized navigation or electronic sensors. The focus here is on the fully computerized end of the simulation spectrum. Some are simple image-only systems that help teach surgical anatomy and orientation, and others have taken the road of building a complete virtual reality simulation system. We describe the spine simulation developed in this partial virtual reality (or immersive simulation) so far and provide some insights into future directions. Each method of simulation has its uses and limitations, though the importance of a systematic curriculum is a uniting factor.

Keywords

Simulation Neurosurgery Spine Virtual reality Mixed reality Immersive Simulation Education in neurosurgery Resident training Mission Rehearsal Surgical laboratory 

Supplementary material

Video 18.1

Video of open pedicle screw insertion. Using anatomical landmarks and virtual X-ray, the trainee drills a small area to prepare for pedicle finder insertion. The drilling provides tactile feedback including vibration, noise, and bone removal. Then the trainee uses a pedicle finder and X-ray guidance to reach the proper depth and use correct direction. The correct screw is selected and in this simulation, is inserted automatically following the pedicle finder-created path. (Used with permission of ImmersiveTouch) (MP4 10319 kb)

References

  1. 1.
    Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg. 2014;82(5):554–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Tomlinson JE, Yiasemidou M, Watts AL, Roberts DJ, Timothy J. Cadaveric spinal surgery simulation: a comparison of cadaver types. Global Spine J. 2016;6(4):357–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Lucas SM, Zeltser IS, Bensalah K, Tuncel A, Jenkins A, Pearle MS, Cadeddu JA. Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure. J Urol. 2008;180(6):2588–91. discussion 2591CrossRefPubMedGoogle Scholar
  4. 4.
    Suslu HT, Tatarli N, Karaaslan A, Demirel NA. Practical laboratory study simulating the lumbar microdiscectomy: training model in fresh cadaveric sheep spine. J Neurol Surg A Cent Eur Neurosurg. 2014;75(3):167–9.PubMedGoogle Scholar
  5. 5.
    Walker JB, Perkins E, Harkey HLA. Novel simulation model for minimally invasive spine surgery. Neurosurgery. 2009;65(6 Suppl):188–95.PubMedGoogle Scholar
  6. 6.
    Hollensteiner M, Fuerst D, Schrempf A. Artificial muscles for a novel simulator in minimally invasive spine surgery. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:506–9.PubMedGoogle Scholar
  7. 7.
    Woodrow SI, Dubrowski A, Khokhotva M, Backstein D, Rampersaud YR, Massicotte EM. Training and evaluating spinal surgeons: the development of novel performance measures. Spine (Phila Pa 1976). 2007;32(25):2921–5.CrossRefGoogle Scholar
  8. 8.
    Mattei TA, Frank C, Bailey J, Lesle E, Macuk A, Lesniak M, Patel A, Morris MJ, Nair K, Lin JJ. Design of a synthetic simulator for pediatric lumbar spine pathologies. J Neurosurg Pediatr. 2013;12(2):192–201.CrossRefPubMedGoogle Scholar
  9. 9.
    Paiva WS, Amorim R, Bezerra DA, Masini M. Application of the stereolithography technique in complex spine surgery. Arq Neuropsiquiatr. 2007;65(2B):443–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Harrop J, Rezai AR, Hoh DJ, Ghobrial GM, Sharan A. Neurosurgical training with a novel cervical spine simulator: posterior foraminotomy and laminectomy. Neurosurgery. 2013;73(Suppl 1):94–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Ray WZ, Ganju A, Harrop JS, Hoh DJ. Developing an anterior cervical diskectomy and fusion simulator for neurosurgical resident training. Neurosurgery. 2013;73(Suppl 1):100–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Ghobrial GM, Anderson PA, Chitale R, Campbell PG, Lobel DA, Harrop J. Simulated spinal cerebrospinal fluid leak repair: an educational model with didactic and technical components. Neurosurgery. 2013;73(Suppl 1):111–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Ghobrial GM, Balsara K, Maulucci CM, Resnick DK, Selden NR, Sharan AD, Harrop JS. Simulation training curricula for neurosurgical residents: cervical Foraminotomy and Durotomy repair modules. World Neurosurg. 2015;84(3):751–5. e1-7CrossRefPubMedGoogle Scholar
  14. 14.
    Bova FJ, Rajon DA, Friedman WA, Murad GJ, Hoh DJ, Jacob RP, Lampotang S, Lizdas DE, Lombard G, Lister JR. Mixed-reality simulation for neurosurgical procedures. Neurosurgery. 2013;73(Suppl 1):138–45.CrossRefPubMedGoogle Scholar
  15. 15.
    Gottschalk MB, Yoon ST, Park DK, Rhee JM, Mitchell PM. Surgical training using three-dimensional simulation in placement of cervical lateral mass screws: a blinded randomized control trial. Spine J. 2015;15(1):168–75.  https://doi.org/10.1016/j.spinee.2014.08.444. Epub 2014 Sep 4CrossRefPubMedGoogle Scholar
  16. 16.
    Sundar SJ, Healy AT, Kshettry VR, Mroz TE, Schlenk R, Benzel EC. A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents. J Neurosurg Spine, 2016; 24(5)850–6.Google Scholar
  17. 17.
    Adermann J, Geissler N, Bernal LE, Kotzsch S, Korb W. Development and validation of an artificial wetlab training system for the lumbar discectomy. Eur Spine J. 2014;23(9):1978–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Podolsky DJ, Martin AR, Whyne CM, Massicotte EM, Hardisty MR, Ginsberg HJ. Exploring the role of 3-dimensional simulation in surgical training: feedback from a pilot study. J Spinal Disord Tech. 2010;23(8):e70–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Eftekhar B, Ghodsi M, Ketabchi E, Rasaee S. Surgical simulation software for insertion of pedicle screws. Neurosurgery. 2002;50(1):222–3. discussion 223–4PubMedGoogle Scholar
  20. 20.
    Rambani R, Ward J, Viant W. Desktop-based computer-assisted orthopedic training system for spinal surgery. J Surg Educ. 2014;71(6):805–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Halic T, Kockara S, Bayrak C, Rowe R. Mixed reality simulation of rasping procedure in artificial cervical disc replacement (ACDR) surgery. BMC Bioinformatics. 2010;11(Suppl 6):S11.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ra JB, Kwon SM, Kim JK, Yi J, Kim KH, Park HW, Kyung KU, Kwon DS, Kang HS, Kwon ST, Jiang L, Zeng J, Cleary K, Mun SK. Spine needle biopsy simulator using visual and force feedback. Comput Aided Surg. 2002;7(6):353–63.CrossRefPubMedGoogle Scholar
  23. 23.
    Ghebreab S, Smeulders AW. Combining strings and necklaces for interactive three-dimensional segmentation of spinal images using an integral deformable spine model. IEEE Trans Biomed Eng. 2004;51(10):1821–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Teo JC, Chui CK, Wang ZL, Ong SH, Yan CH, Wang SC, Wong HK, Teoh SH. Heterogeneous meshing and biomechanical modeling of human spine. Med Eng Phys. 2007;29(2):277–90.CrossRefPubMedGoogle Scholar
  25. 25.
    Luciano CJ, Banerjee PP, Bellotte B, Oh GM, Lemole M Jr, Charbel FT, Roitberg B. Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery. 2011;69(1 Suppl Operative):ons14–9.Google Scholar
  26. 26.
    Luciano CJ, Banerjee PP, Sorenson JM, Foley KT, Ansari SA, Rizzi S, Germanwala AV, Kranzler L, Chittiboina P, Roitberg BZ. Percutaneous spinal fixation simulation with virtual reality and haptics. Neurosurgery. 2013;72(Suppl 1):89–96.CrossRefPubMedGoogle Scholar
  27. 27.
    Gasco J, Patel A, Ortega-Barnett J, Branch D, Desai S, Kuo YF, Luciano C, Rizzi S, Kania P, Matuyauskas M, Banerjee P, Roitberg BZ. Virtual reality spine surgery simulation: an empirical study of its usefulness. Neurol Res. 2014;36(11):968–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Eriksson M, Wikander J. A 6 degrees-of-freedom haptic milling simulator for surgical training of vertebral operations. Stud Health Technol Inform. 2012;173:126–8.PubMedGoogle Scholar
  29. 29.
    Tsai MD, Hsieh MS. Accurate visual and haptic burring surgery simulation based on a volumetric model. J Xray Sci Technol. 2010;18(1):69–85.PubMedGoogle Scholar
  30. 30.
    Gasco J, Holbrook TJ, Patel A, Smith A, Paulson D, Muns A, Desai S, Moisi M, Kuo YF, Macdonald B, Ortega-Barnett J, Patterson JT. Neurosurgery simulation in residency training: feasibility, cost, and educational benefit. Neurosurgery. 2013;73(Suppl 1):39–45.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurological SurgeryCase Western Reserve University School of Medicine, MetroHealth CampusClevelandUSA

Personalised recommendations