Abstract
Object
Existing training methods for neuroendoscopic surgery have mainly
emphasized the acquisition of anatomical knowledge and procedures for operating
an endoscope and instruments. For laparoscopic surgery, various training systems
have been developed to teach handling of an endoscope as well as the
manipulation of instruments for speedy and precise endoscopic performance using
both hands. In endoscopic endonasal surgery (EES), especially using a binostril
approach to the skull base and intradural lesions, the learning of more
meticulous manipulation of instruments is mandatory, and it may be necessary to
develop another type of training method for acquiring psychomotor skills for
EES. Authors of the present study developed an inexpensive, portable personal
trainer using a webcam and objectively evaluated its utility.
Methods
Twenty-five neurosurgeons volunteered for this study and were
divided into 2 groups, a novice group (19 neurosurgeons) and an experienced
group (6 neurosurgeons). Before and after the exercises of set tasks with a
webcam box trainer, the basic endoscopic skills of each participant were
objectively assessed using the virtual reality simulator (LapSim) while
executing 2 virtual tasks: grasping and instrument navigation. Scores for the
following 11 performance variables were recorded: instrument time, instrument
misses, instrument path length, and instrument angular path (all of which were
measured in both hands), as well as tissue damage, max damage, and finally
overall score. Instrument time was indicated as movement speed; instrument path
length and instrument angular path as movement efficiency; and instrument
misses, tissue damage, and max damage as movement precision.
Results
In the novice group, movement speed and efficiency were
significantly improved after the training. In the experienced group, significant
improvement was not shown in the majority of virtual tasks. Before the training,
significantly greater movement speed and efficiency were demonstrated in the
experienced group, but no difference in movement precision was shown between the
2 groups. After the training, no significant differences were shown between the
2 groups in the majority of the virtual tasks. Analysis revealed that the webcam
trainer improved the basic skills of the novices, increasing movement speed and
efficiency without sacrificing movement precision.
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