Alotaibi Fahad E, AlZhrani Gmaan A, Mullah Muhammad A S, Sabbagh Abdulrahman J, Azarnoush Hamed, Winkler-Schwartz Alexander, Del Maestro Rolando F
*Neurosurgical Simulation Research Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; ‡Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; §Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; ¶Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia; ‖Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran.
Neurosurgery. 2015 Mar;11 Suppl 2:89-98; discussion 98. doi: 10.1227/NEU.0000000000000631.
Validated procedures to objectively measure neurosurgical bimanual psychomotor skills are unavailable. The NeuroTouch simulator provides metrics to determine bimanual performance, but validation is essential before implementation of this platform into neurosurgical training, assessment, and curriculum development.
To develop, evaluate, and validate neurosurgical bimanual performance metrics for resection of simulated brain tumors with NeuroTouch.
Bimanual resection of 8 simulated brain tumors with differing color, stiffness, and border complexity was evaluated. Metrics assessed included blood loss, tumor percentage resected, total simulated normal brain volume removed, total tip path lengths, maximum and sum of forces used by instruments, efficiency index, ultrasonic aspirator path length index, coordination index, and ultrasonic aspirator bimanual forces ratio. Six neurosurgeons and 12 residents (6 senior and 6 junior) were evaluated.
Increasing tumor complexity impaired resident bimanual performance significantly more than neurosurgeons. Operating on black vs glioma-colored tumors resulted in significantly higher blood loss and lower tumor percentage, whereas altering tactile cues from hard to soft decreased resident tumor resection. Regardless of tumor complexity, significant differences were found between neurosurgeons, senior residents, and junior residents in efficiency index and ultrasonic aspirator path length index. Ultrasonic aspirator bimanual force ratio outlined significant differences between senior and junior residents, whereas coordination index demonstrated significant differences between junior residents and neurosurgeons.
The NeuroTouch platform incorporating the simulated scenarios and metrics used differentiates novice from expert neurosurgical performance, demonstrating NeuroTouch face, content, and construct validity and the possibility of developing brain tumor resection proficiency performance benchmarks.
目前尚无经过验证的客观测量神经外科双手操作心理运动技能的方法。NeuroTouch模拟器可提供用于确定双手操作表现的指标，但在将该平台应用于神经外科培训、评估和课程开发之前，验证至关重要。
开发、评估和验证使用NeuroTouch进行模拟脑肿瘤切除的神经外科双手操作表现指标。
评估了对8个具有不同颜色、硬度和边界复杂性的模拟脑肿瘤进行双手切除的情况。评估的指标包括失血量、肿瘤切除百分比、切除的模拟正常脑体积总量、总尖端路径长度、器械使用的最大力和力的总和、效率指数、超声吸引器路径长度指数、协调指数以及超声吸引器双手力比。对6名神经外科医生和12名住院医师（6名高年级和6名低年级）进行了评估。
肿瘤复杂性增加对住院医师双手操作表现的损害明显大于神经外科医生。切除黑色肿瘤与胶质瘤色肿瘤相比，失血量显著更高，肿瘤切除百分比更低，而将触觉提示从硬改为软会降低住院医师的肿瘤切除率。无论肿瘤复杂性如何，神经外科医生、高年级住院医师和低年级住院医师在效率指数和超声吸引器路径长度指数方面均存在显著差异。超声吸引器双手力比显示高年级和低年级住院医师之间存在显著差异，而协调指数显示低年级住院医师和神经外科医生之间存在显著差异。
包含所使用的模拟场景和指标的NeuroTouch平台能够区分神经外科新手和专家的表现，证明了NeuroTouch的表面效度、内容效度和结构效度，以及制定脑肿瘤切除熟练程度表现基准的可能性。
