Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel; Department of Biomedical Engineering, The Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Department of Neurosurgery, Northwell Health Lenox Hill Hospital, New York, New York, USA.
World Neurosurg. 2021 Jul;151:155-162. doi: 10.1016/j.wneu.2021.05.013. Epub 2021 May 12.
Attainment of micro-neurosurgical skills is a challenge in teaching hospitals throughout training. Models that mimic the workflow as well as haptics are time-consuming, expensive, and unsuitable to serve as a routine platform. Our objective was to present a model and a set of tasks, based on a hard-boiled egg, microscope, and a Cavitron ultrasonic aspirator (CUSA; Integra Lifesciences Corp., Tullamore, Ireland), which is cheap, easy to setup and can be used for training microsurgery and CUSA skills, required for removal of deep-seated tumors.
The goal was to remove the egg yolk from within a hard-boiled egg, representing an intrinsic brain tumor, surrounded by the egg's white, representing adjacent brain tissue, while preserving it. Assessment was based on the yolk's exposure, completeness of removal, and collateral damage and task completion duration, with repeated trials (n = 4), for validation purposes, for 6 operators with different experience levels.
Improvement in overall score (mean of 47.5 ± 19 in the first trial vs. 80.0 ± 12 in the fourth trial, P < 0.01), and task duration completion (mean initial duration of 21:25 ± 4:52 minutes to 15:30 ± 5:17 minutes, P < 0.01) was observed. Parameters gradually improved on repeated attempts, and experience level of the operators correlated with scores.
The egg model is an easy-to-handle, cheap model that enables the acquisition of basic micro-neurosurgical skills and basic workflow required for removing of intrinsic brain tumors. This study has validated and defined reproducible tasks that can be scored, correlated with performance. This model can be incorporated into a resident's routine and potentially provide an accessible training platform for neurosurgical trainees.
在教学医院的培训过程中，获得微神经外科技能是一项挑战。模仿工作流程和触觉的模型既耗时又昂贵，不适合作为常规平台。我们的目的是提出一种基于煮鸡蛋、显微镜和 Cavitron 超声吸引器（CUSA； Integra Lifesciences Corp.，Tullamore，爱尔兰）的模型和一系列任务，该模型价格便宜，易于设置，可用于培训深部肿瘤切除所需的显微外科和 CUSA 技能。
目标是在煮鸡蛋的白色蛋清中取出蛋黄，代表内在脑肿瘤，同时保留其完整性。评估基于蛋黄的暴露程度、完全去除程度以及附带损伤和任务完成时间，对 6 名不同经验水平的操作人员进行了 4 次重复试验（n=4）验证。
总评分（第一次试验的平均 47.5±19 分，第四次试验的平均 80.0±12 分，P<0.01）和任务完成时间（初始平均持续时间 21:25±4:52 分钟至 15:30±5:17 分钟，P<0.01）均有所提高。参数在重复尝试中逐渐改善，操作人员的经验水平与得分相关。
鸡蛋模型易于操作且价格低廉，可用于获得切除内在脑肿瘤所需的基本显微神经外科技能和基本工作流程。本研究验证并定义了可评分的可重复任务，与表现相关。该模型可以纳入住院医师的常规培训，并为神经外科受训者提供一个可及的培训平台。
