Learning brain aneurysm microsurgical skills in a human placenta model: Predictive validity

Marcelo Magaldi Ribeiro De Oliveira, Carlos Eduardo Ferrarez, Taise Mosso Ramos, Jose Augusto Malheiros, Arthur Nicolato, Carla Jorge Machado, Mauro Tostes Ferreira, Fellype Borges De Oliveira, Cecília Félix Penido Mendes De Sousa, Pollyana Helena Vieira Costa, Sebastiao Gusmao, Giuseppe Lanzino, Rolando Del Maestro

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE: Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS: Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS: All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fis-sure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS: The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and dome, and bipolar coagulation of surrounding microvessels. When performing surgery for an unruptured MCA aneurysm, residents who had trained in the human placenta model performed better than residents trained with other simulation scenarios/models. In this age of reduced exposure to aneurysm surgery and restrictions on resident working hours, the placenta model is a valid simulation for microneurosurgery with striking similarities with real surgery.

Original languageEnglish (US)
Pages (from-to)846-852
Number of pages7
JournalJournal of Neurosurgery
Volume128
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Intracranial Aneurysm
Placenta
Learning
Cadaver
Aneurysm
Microvessels
Head
Neck Dissection
Dissection
Aptitude
Brain Neoplasms
Reproduction
Blood Vessels
Rupture
Anatomy
Cohort Studies
Neck

Keywords

  • Brain aneurysm
  • Cerebrovascular surgery
  • Human placenta
  • Neurosurgical simulation
  • Predictive validity
  • Surgical technique
  • Sylvian fissure
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Ribeiro De Oliveira, M. M., Ferrarez, C. E., Ramos, T. M., Malheiros, J. A., Nicolato, A., Machado, C. J., ... Del Maestro, R. (2018). Learning brain aneurysm microsurgical skills in a human placenta model: Predictive validity. Journal of Neurosurgery, 128(3), 846-852. https://doi.org/10.3171/2016.10.JNS162083

Learning brain aneurysm microsurgical skills in a human placenta model : Predictive validity. / Ribeiro De Oliveira, Marcelo Magaldi; Ferrarez, Carlos Eduardo; Ramos, Taise Mosso; Malheiros, Jose Augusto; Nicolato, Arthur; Machado, Carla Jorge; Ferreira, Mauro Tostes; De Oliveira, Fellype Borges; Mendes De Sousa, Cecília Félix Penido; Costa, Pollyana Helena Vieira; Gusmao, Sebastiao; Lanzino, Giuseppe; Del Maestro, Rolando.

In: Journal of Neurosurgery, Vol. 128, No. 3, 01.03.2018, p. 846-852.

Research output: Contribution to journalArticle

Ribeiro De Oliveira, MM, Ferrarez, CE, Ramos, TM, Malheiros, JA, Nicolato, A, Machado, CJ, Ferreira, MT, De Oliveira, FB, Mendes De Sousa, CFP, Costa, PHV, Gusmao, S, Lanzino, G & Del Maestro, R 2018, 'Learning brain aneurysm microsurgical skills in a human placenta model: Predictive validity', Journal of Neurosurgery, vol. 128, no. 3, pp. 846-852. https://doi.org/10.3171/2016.10.JNS162083
Ribeiro De Oliveira MM, Ferrarez CE, Ramos TM, Malheiros JA, Nicolato A, Machado CJ et al. Learning brain aneurysm microsurgical skills in a human placenta model: Predictive validity. Journal of Neurosurgery. 2018 Mar 1;128(3):846-852. https://doi.org/10.3171/2016.10.JNS162083
Ribeiro De Oliveira, Marcelo Magaldi ; Ferrarez, Carlos Eduardo ; Ramos, Taise Mosso ; Malheiros, Jose Augusto ; Nicolato, Arthur ; Machado, Carla Jorge ; Ferreira, Mauro Tostes ; De Oliveira, Fellype Borges ; Mendes De Sousa, Cecília Félix Penido ; Costa, Pollyana Helena Vieira ; Gusmao, Sebastiao ; Lanzino, Giuseppe ; Del Maestro, Rolando. / Learning brain aneurysm microsurgical skills in a human placenta model : Predictive validity. In: Journal of Neurosurgery. 2018 ; Vol. 128, No. 3. pp. 846-852.
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abstract = "OBJECTIVE: Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a {"}live{"} human brain cadaveric model. METHODS: Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS: All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fis-sure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS: The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and dome, and bipolar coagulation of surrounding microvessels. When performing surgery for an unruptured MCA aneurysm, residents who had trained in the human placenta model performed better than residents trained with other simulation scenarios/models. In this age of reduced exposure to aneurysm surgery and restrictions on resident working hours, the placenta model is a valid simulation for microneurosurgery with striking similarities with real surgery.",
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T1 - Learning brain aneurysm microsurgical skills in a human placenta model

T2 - Predictive validity

AU - Ribeiro De Oliveira, Marcelo Magaldi

AU - Ferrarez, Carlos Eduardo

AU - Ramos, Taise Mosso

AU - Malheiros, Jose Augusto

AU - Nicolato, Arthur

AU - Machado, Carla Jorge

AU - Ferreira, Mauro Tostes

AU - De Oliveira, Fellype Borges

AU - Mendes De Sousa, Cecília Félix Penido

AU - Costa, Pollyana Helena Vieira

AU - Gusmao, Sebastiao

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N2 - OBJECTIVE: Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS: Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS: All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fis-sure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS: The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and dome, and bipolar coagulation of surrounding microvessels. When performing surgery for an unruptured MCA aneurysm, residents who had trained in the human placenta model performed better than residents trained with other simulation scenarios/models. In this age of reduced exposure to aneurysm surgery and restrictions on resident working hours, the placenta model is a valid simulation for microneurosurgery with striking similarities with real surgery.

AB - OBJECTIVE: Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS: Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS: All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fis-sure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS: The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and dome, and bipolar coagulation of surrounding microvessels. When performing surgery for an unruptured MCA aneurysm, residents who had trained in the human placenta model performed better than residents trained with other simulation scenarios/models. In this age of reduced exposure to aneurysm surgery and restrictions on resident working hours, the placenta model is a valid simulation for microneurosurgery with striking similarities with real surgery.

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KW - Cerebrovascular surgery

KW - Human placenta

KW - Neurosurgical simulation

KW - Predictive validity

KW - Surgical technique

KW - Sylvian fissure

KW - Vascular disorders

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