Practice on virtual reality system may enhance surgical skills

A task simulator with 3D and tactile feedback can provide neurosurgeons in training with valuable practice in developing essential surgical skills, suggests a study in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Christian J. Luciano, Ph.D., P. Pat Banerjee, Ph.D., both of University of Illinois at Chicago and colleagues designed a study to evaluate the use of a virtual reality system combining visual and haptic (tactile) feedback as a training tool for neurosurgeons. The technology provided trainees with the opportunity to practice a basic but critical neurosurgical skill: placing screws in vertebrae as part of surgery to stabilize the spine.

Practice on Virtual Reality System May Enhance Surgical Skills
The "ImmersiveTouch" virtual reality system provides real-time feedback to surgeons as they perform simulated procedures. The simulation was based on 3D computed tomography reconstructions of an actual patient. The system provides both visual and tactile feedback to make the experience as realistic as possible. For example, the simulated 3D view shifts in response to head movement. When the surgeon operates a virtual drill, the system provides resistance and vibration.

The study included 51 neurosurgery residents and fellows attending a national meeting. After five minutes of training on a practice model, the junior surgeons were tested on their ability to place a screw accurately through a vertebra. This maneuver—called pedicle screw placement—is an essential skill for every neurosurgeon, but one with a substantial learning curve.

The results showed a small reduction in the residents' failure rate: from 16.9 percent during practice sessions to 12.5 percent during the test session. Although below the accepted threshold for statistical significance, the improvement is "notable" and deserving of further study, according to Drs. Luciano, Banerjee and coauthors.

Given the short time allowed for practice, the researchers were surprised to see as much improvement in the test sessions as they did. If trainees were given the opportunity to perform extensive repetitions of the simulated procedure, even greater improvements in accuracy might be expected. The trainees found the 3D simulator faithfully represents the "real life" conditions encountered in screw placement.

The experiment was part of a series of studies using the ImmersiveTouch system to enhance neurosurgical training. The researchers are working to increase the "library of tasks" simulated for use in the virtual reality environment.

Drs. Luciano, Banerjee and colleagues note that the system can be adjusted to a variety of simulation settings, based on the preferences of trainees and teachers. With further development, they believe the ImmersiveTouch simulator will be useful in practicing and testing a wide range of surgical tasks—providing trainees with valuable experience in developing their skills.