A virtual reality neurosurgery simulator seems poised to provide a cost-effective alternative to conventional surgical training approaches, according to an analysis of two initial training tasks completed on prototypes and published in the September issue of Neurosurgery.

The traditional surgical training process, in which residents assist surgeons with hundreds of procedures, can decrease operating room efficiency by as much as 35 percent, according to Sebastien Delorme, PhD, from National Research Council Canada in Boucherville, and colleagues. Simulators can save training costs and increase efficiency.

Delorme and 50 other experts from National Research Council Canada teamed up with surgeons from 20 teaching hospitals in Canada to develop NeuroTouch, a virtual reality neurosurgery simulator with haptic feedback. The system includes a stereovision system, bimanual haptic tool manipulators and a workstation.

The researchers leveraged MRI scans to construct two training tasks: tumor debulking and tumor cauterization.

“A tumor-debulking task introduces trainees to the use of the aspirator and the ultrasonic aspirator and provides both training and feedback assessment of how to discriminate healthy brain from tumor using touch and visual cues,” wrote Delorme et al. The task is designed to help trainees learn to define normal tissue and simulate complete tumor removal with minimal removal of healthy brain.

The second task, tumor cauterization, introduces bipolar electrocautery, which allows deformation, grasping and cauterization of tissue. The goal is to remove as much tumor as possible while minimizing blood loss.

Delorme and colleagues reviewed 121 comments from 32 surgeons and classified these as praise, criticisms or suggestions for each of the following categories: visual, touch, content and ergonomics. “The most praised category was visual, and the most criticized was touch. Most suggestions concerned ergonomics.”

The researchers identified several areas for future development, including extending the toolset to the Penfield dissector, microscissors, retractors, patties, clips appliers for vascular occlusion, endoscope and endoscopic tools. Other possibilities for future development include developing different levels of training simulation paradigms, such as turning bleeding on or off and enhancing the boundary between tumor and tissue, and addition of new craniotomy-based tasks. Furthermore, the simulator could be extended to patient-specific rehearsal based on the conversion of patient imaging data into simulation models.