Zhu Junhao, Yang Jin, Tang Chao, Cong Zixiang, Cai Xiangming, Ma Chiyuan
School of Medicine, Nanjing Medical University, 104 Hanzhong Road, Nanjing, 210002, China.
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
Childs Nerv Syst. 2020 Apr;36(4):743-748. doi: 10.1007/s00381-019-04421-8. Epub 2019 Nov 12.
Simulation-based training has been considered as the most promising curriculum for neurosurgical education to finally improve surgical skills with the greatest efficiency and safety. However, most of the simulators including physical models and virtual reality systems are relatively expensive, which limits their promotion. In this study, the authors tried to develop a realistic, low-cost, and reusable simulator for endoscopic third ventriculostomy (ETV) and evaluate its validity.
A 3D-printed rigid skull with the ventricular system originated from a de-identified patient with obstructive hydrocephalus was constructed. The third ventricular floor was designed as a replaceable module. Thirty-nine neurosurgeons tested the simulator and a rating system was established to assess their performance. All participants filled out questionnaires to evaluate the simulator after training. Five neurosurgical students were recruited to finish the whole training for ten times in order to explore the learning curve of ETV.
We found that (1) the more experienced surgeons performed obviously better than the rather inexperienced surgeons which verified that our model could reflect the ability of the trainees; (2) as the training progressed, the scores of the post-graduates increased and the fifth training average score was obviously higher than their first training average score. The feedback questionnaires showed the average scores for value of the simulator as a training tool and global rating were 3.15 and 3.54 (on a 4-point scale).
Our model was practical for ETV training. The results of our program showed that our model could precisely reflect the operators' ability to perform ETV and could make it more efficient to master basic skills.
基于模拟的培训被认为是神经外科教育中最具前景的课程，有望以最高的效率和安全性最终提高手术技能。然而，包括物理模型和虚拟现实系统在内的大多数模拟器相对昂贵，这限制了它们的推广。在本研究中，作者试图开发一种用于内镜下第三脑室造瘘术（ETV）的逼真、低成本且可重复使用的模拟器，并评估其有效性。
构建了一个源自一名身份不明的梗阻性脑积水患者的带有脑室系统的3D打印硬质颅骨。第三脑室底部被设计为一个可替换模块。39名神经外科医生测试了该模拟器，并建立了一个评分系统来评估他们的表现。所有参与者在训练后填写问卷以评估该模拟器。招募了5名神经外科学生完成10次完整训练，以探索ETV的学习曲线。
我们发现：（1）经验更丰富的外科医生表现明显优于经验较少的外科医生，这证实了我们的模型能够反映受训者的能力；（2）随着训练的进行，研究生的分数有所提高，第五次训练的平均分数明显高于第一次训练的平均分数。反馈问卷显示，该模拟器作为训练工具的价值和整体评分的平均分数分别为3.15和3.54（满分4分）。
我们的模型对于ETV训练是实用的。我们项目的结果表明，我们的模型能够准确反映操作者进行ETV的能力，并能使掌握基本技能的效率更高。
