technology – Neurosurgery Blog

Operative Neurosurgery 10:57–65, 2014

Reductions in working hours affect training opportunities for surgeons. Surgical simulation is increasingly proposed to help bridge the resultant training gap. For simulation training to translate effectively into the operating theater, acquisition of technical proficiency must be objectively assessed. Evaluating “economy of movement” is one way to achieve this.

OBJECTIVE: We sought to validate a practical and economical method of assessing economy of movement during a simulated task. We hypothesized that accelerometers, found in smartphones, provide quantitative, objective feedback when attached to a neurosurgeon’s wrists.

METHODS: Subjects (n = 25) included consultants, senior registrars, junior registrars, junior doctors, and medical students. Total resultant acceleration (TRA), average resultant acceleration, and movements with acceleration .0.6g (suprathreshold acceleration events) were recorded while subjects performed a simulated dural closure task.

RESULTS: Students recorded an average TRA 97.0 6 31.2 ms22 higher than senior registrars (P = .03) and 103 6 31.2 ms22 higher than consultants (P = .02). Similarly, junior doctors accrued an average TRA 181 6 31.2 ms22 higher than senior registrars (P , .001) and 187 6 31.2 ms22 higher than consultants (P , .001). Significant correlations were observed between surgical outcome (as measured by quality of dural closure) and both TRA (r = .44, P , .001) and number of suprathreshold acceleration events (r = .33, P, .001). TRA (219 6 66.6 ms22; P = .01) and number of suprathreshold acceleration events (127 6 42.5; P = .02) dropped between the first and fourth trials for junior doctors, suggesting procedural learning. TRA was 45.4 6 17.1 ms22 higher in the dominant hand for students (P = .04) and 57.2 6 17.1 ms22 for junior doctors (P = .005), contrasting with even TRA distribution between hands (acquired ambidexterity) in senior groups.

CONCLUSION: Data from smartphone-based accelerometers show construct validity as an adjunct for assessing technical performance during simulation training.

J Neurosurg 118:521–529, 2013

It has been over a decade since the introduction of the da Vinci Surgical System into surgery. Since then, technology has been advancing at an exponential rate, and newer surgical robots are becoming increasingly sophisticated, which could greatly impact the performance of surgery. NeuroArm is one such robotic system.

Methods. Clinical integration of neuroArm, an MR-compatible image-guided robot, into surgical procedure has been developed over a prospective series of 35 cases with varying pathology.

Results. Only 1 adverse event was encountered in the first 35 neuroArm cases, with no patient injury. The adverse event was uncontrolled motion of the left neuroArm manipulator, which was corrected through a rigorous safety review procedure. Surgeons used a graded approach to introducing neuroArm into surgery, with routine dissection of the tumor-brain interface occurring over the last 15 cases. The use of neuroArm for routine dissection shows that robotic technology can be successfully integrated into microsurgery. Karnofsky performance status scores were significantly improved postoperatively and at 12-week follow-up.

Conclusions. Surgical robots have the potential to improve surgical precision and accuracy through motion scaling and tremor filters, although human surgeons currently possess superior speed and dexterity. Additionally, neuroArm’s workstation has positive implications for technology management and surgical education. NeuroArm is a step toward a future in which a variety of machines are merged with medicine.

Tag: technology

Validating the Use of Smartphone-Based Accelerometers for Performance Assessment in a Simulated Neurosurgical Task

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Merging machines with microsurgery: clinical experience with neuroArm

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