Adermann Jens, Geissler Norman, Bernal Luis E, Kotzsch Susanne, Korb Werner
Krankenhaus Winsen, Orthopädie, Friedrich-Lichtenauer-Allee 1, 21423, Winsen, Germany,
Eur Spine J. 2014 Sep;23(9):1978-83. doi: 10.1007/s00586-014-3257-3. Epub 2014 Mar 5.
An initial research indicated that realistic haptic simulators with an adapted training concept are needed to enhance the training for spinal surgery.
A cognitive task analysis (CTA) was performed to define a realistic and helpful scenario-based simulation. Based on the results a simulator for lumbar discectomy was developed. Additionally, a realistic training operating room was built for a pilot. The results were validated.
The CTA showed a need for realistic scenario-based training in spine surgery. The developed simulator consists of synthetic bone structures, synthetic soft tissue and an advanced bleeding system. Due to the close interdisciplinary cooperation of surgeons between engineers and psychologists, the iterative multicentre validation showed that the simulator is visually and haptically realistic. The simulator offers integrated sensors for the evaluation of the traction being used and the compression during surgery. The participating surgeons in the pilot workshop rated the simulator and the training concept as very useful for the improvement of their surgical skills.
In the context of the present work a precise definition for the simulator and training concept was developed. The additional implementation of sensors allows the objective evaluation of the surgical training by the trainer. Compared to other training simulators and concepts, the high degree of objectivity strengthens the acceptance of the feedback. The measured data of the nerve root tension and the compression of the dura can be used for intraoperative control and a detailed postoperative evaluation.
初步研究表明，需要具有适应性训练概念的逼真触觉模拟器来加强脊柱手术训练。
进行了认知任务分析（CTA），以定义一个基于现实且有用的情景模拟。基于这些结果，开发了一种腰椎间盘切除术模拟器。此外，还为一名飞行员建造了一个逼真的训练手术室。对结果进行了验证。
CTA显示脊柱手术需要基于现实情景的训练。所开发的模拟器由合成骨骼结构、合成软组织和先进的出血系统组成。由于外科医生、工程师和心理学家之间密切的跨学科合作，迭代多中心验证表明该模拟器在视觉和触觉上都很逼真。该模拟器提供集成传感器，用于评估手术过程中使用的牵引力和压力。参与试点研讨会的外科医生将模拟器和训练概念评为对提高他们的手术技能非常有用。
在当前工作的背景下，为模拟器和训练概念制定了精确的定义。传感器的额外实施使培训师能够对手术训练进行客观评估。与其他训练模拟器和概念相比，高度的客观性增强了对反馈的接受度。测量的神经根张力和硬脑膜压力数据可用于术中控制和详细的术后评估。
