A High-Fidelity Neurosurgical Training Platform for Bimanual Procedures: A Feasibility Study

TL;DR

This study develops and evaluates a realistic neurosurgical simulation platform with instrument tracking to objectively assess and improve bimanual surgical skills across different experience levels.

Contribution

Introduces a novel ex-vivo brain simulation platform with integrated instrument tracking for objective assessment of bimanual neurosurgical procedures.

Findings

Tracking system captured instrument motion in 81% of active use periods.

Metrics significantly differentiate expertise levels.

Bimanual coordination metrics show potential for skill assessment.

Abstract

Background. Bimanual psychomotor proficiency is fundamental to neurosurgical procedures, yet it remains difficult for trainees to acquire and for educators to objectively evaluate performance. In this study, we investigate the feasibility of a neurosurgical simulation platform that integrates an anatomically realistic brain model with surgical instrument tracking to support training and objective assessment of bimanual tasks in the context of subpial corticectomy. Methods. We developed and evaluated a neurosurgical simulation platform based on an ex-vivo calf brain model and a multi-camera tracking system capable of simultaneously capturing the motion of surgical instruments in both hands, including collection of real-time instrument trajectories and synchronized video recordings. These enabled extraction of motion-based, time-based, and bimanual coordination metrics. We conducted a case series involving 47 participants across four training levels: medical students, junior residents, senior residents, and neurosurgeons. Results. The tracking system successfully captured instrument motion during 81% of the periods when instruments were actively used throughout the simulation procedure. Several extracted metrics were able to significantly differentiate between levels of surgical expertise. In particular, instrument usage duration and custom-defined bimanual coordination metrics such as instrument tip separation distance and simultaneous usage time, show potential as features to identify participant expertise levels with different instruments. Conclusions. We demonstrated the feasibility of tracking surgical instruments during complex bimanual tasks in an ex-vivo brain simulation platform. The metrics developed provide a foundation for objective performance assessment and highlight the potential of motion analysis to improve neurosurgical training and evaluation.