Design and Validation of an Open-Source, Partial Task Trainer for Endonasal Neuro-Endoscopic Skills Development: Indian Experience

• Published in: World neurosurgery Vol. 86; pp. 259 - 269
• Main Authors: Singh, Ramandeep, Baby, Britty, Damodaran, Natesan, Srivastav, Vinkle, Suri, Ashish, Banerjee, Subhashis, Kumar, Subodh, Kalra, Prem, Prasad, Sanjiva, Paul, Kolin, Anand, Sneh, Kumar, Sanjeev, Dhiman, Varun, Ben-Israel, David, Kapoor, Kulwant Singh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Adolescent; Adult; Clinical Competence; Computer Simulation; Educational Measurement; Endonasal; Endoscopy - education; Female; Humans; India; Internship and Residency; Male; Manikins; Middle Aged; Nasal Cavity - surgery; Neuro-endoscopy; Neuroendoscopy - education; Neurosurgery; Neurosurgery - education; Open source; Partial task trainer; Physical simulator; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Reproducibility of Results; Self-Assessment; Simulation; Skills training; Skull base; Skull Base - surgery; Surgeons; Tomography, X-Ray Computed; Young Adult; India; Physical simulator; Simulation; Skull base; Skills training; Neuro-endo-trainer; Neuro-endoscopy; Partial task trainer; Open source; NET; Endonasal
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.09.045

Background Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. Objective The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery. Methods We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score. Results Group E had lower task completion times and greater skills assessment scale scores than both Group N and R ( P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002). Conclusions The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy.