CORRESPONDENCE
treatment strategy applied in this case, we supply this letter with a new schematic drawing (Figure). Disclosure
this. The gold standard of validation has to be that performance in the actual procedure is enhanced by the simulator. A focus on the educational aspects of the simulator seems as important as the focus on modeling procedural fidelity.
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
Disclosure
Giuseppe Esposito Luca Regli Zurich, Switzerland
Acknowledgment We thank Peter Roth (Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland) for the drawings in the Figure. 1. Esposito G, Durand A, van Doormaal T, Regli L. Selective-targeted extra-intracranial bypass surgery in complex middle cerebral artery aneurysms: correctly identifying the recipient artery using indocyanine green video-angiography. Neurosurgery. 2012;71(suppl Operative 2):ons274-ons284; discussion ons284-ons285. 2. Lawton MT, Hamilton MG, Morcos JJ, Spetzler RF. Revascularization and aneurysm surgery: current techniques, indications, and outcome. Neurosurgery. 1996;38(1):83-94. 3. van Doormaal TP, van der Zwan A, Verweij BH, Regli L, Tulleken CA. Giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis bypass. Neurosurgery. 2010;66(3):439-447; discussion 447. 4. Carvalho FG, Godoy BL, Reis M, et al. Frameless stereotactic navigation for intraoperative localization of infectious intracranial aneurysm. Arq Neuropsiquiatr. 2009;67(3B):911-913. 10.1227/NEU.0000000000000280
Simulating Ventriculostomy To the Editor: We were pleased to see the article by Schirmer et al1 because it represents an update to our original concept from 20002 with enhanced modernized haptics and fidelity. The authors have updated our original model with an immersive environment and better 3-D representation. It is conceptually similar in terms of the procedural steps modeled, and their assessment of our simulator from 2000. We have updated our simulator to run on the iPad since this article was submitted https://itunes.apple.com/gb/app/vcath/id568887198?mt¼8.3 This is quite a simple App; however, it lacks haptic feedback, but it makes up for it in terms of accessibility and low cost. It has inbuilt evaluation of the procedural steps. We have concentrated on educational content and concepts rather than fidelity of procedural accuracy. Improvements in procedural fidelity are very resource intense and seem, over the years since our original model, to have had limited success. The authors describe and illustrate some of the problems of validation of surgical simulators. We perceive a tendency to demonstrate that the simulator shows improvement in learning the simulator rather than in learning an actual procedure. The authors have rightly used alternative methods of didactic teaching to counter
E458 | VOLUME 74 | NUMBER 4 | APRIL 2014
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Nicholas I. Phillips Leeds, United Kingdom Nigel W. John Gwynedd, Wales 1. Schirmer CM, Elder JB, Roitberg B, Lobel DA. Virtual reality-based simulation training for ventriculostomy: an evidence-based approach. Neurosurgery. 2013;73 (suppl 4):66-73. doi: 10.1227/NEU.0000000000000074. 2. Phillips NI, John NW. Web-based surgical simulation for ventricular catheterization. Neurosurgery. 2000;46(4):933-936; discussion 936-937. 3. Cenydd LA, John NW, Phillips NI, Gray WP. VCath: a tablet-based neurosurgery training tool. Stud Health Technol Inform. 2013;184:20-23. 10.1227/NEU.0000000000000279
In Reply: Simulating Ventriculostomy We would like to thank the authors for their comments in response to our article, “Virtual Reality-Based Simulation Training for Ventriculostomy: An Evidence-Based Approach.”1 We would like to point out that the intent of our article was to demonstrate that neurosurgical resident training in ventriculostomy placement can be enhanced through virtual reality-based simulation training. We chose a commercially available simulator, designed by ImmersiveTouch (Chicago, Illinois),2 to provide ventriculostomy training to neurosurgical residents as part of a larger simulation course. We wish to clarify that none of the authors of our article were involved in the development of the simulator. We are pleased to see that the authors have now developed an iPad application3 to supplement their Web-based surgical ventriculostomy simulator.4 As they describe, there are many components of educating trainees in surgical techniques. Their simulator offers the ability to perform key components of ventriculostomy placement, including selection of an entry point and trajectory of the catheter and selection of depth of catheter placement. Final catheter placement can then be verified by a cutaway image of the brain. Although there is no haptic feedback with this system, and in truth, realistic haptics are a limitation of even the most advanced virtual reality-based simulators at this time, we contend that the most common errors in ventriculostomy placement may be avoided by educating trainees with simulators such as the VCath, described by the authors, and the ImmersiveTouch system, which we used as part of our training course. The technical implementation of a simulator is a necessary component of a successful, validated simulation curriculum. As described in our article, the use of structured instruction and testing is at least equally as important. We were
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
treatment strategy applied in this case, we supply this letter with a new schematic drawing (Figure). Disclosure
this. The gold standard of validation has to be that performance in the actual procedure is enhanced by the simulator. A focus on the educational aspects of the simulator seems as important as the focus on modeling procedural fidelity.
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
Disclosure
Giuseppe Esposito Luca Regli Zurich, Switzerland
Acknowledgment We thank Peter Roth (Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland) for the drawings in the Figure. 1. Esposito G, Durand A, van Doormaal T, Regli L. Selective-targeted extra-intracranial bypass surgery in complex middle cerebral artery aneurysms: correctly identifying the recipient artery using indocyanine green video-angiography. Neurosurgery. 2012;71(suppl Operative 2):ons274-ons284; discussion ons284-ons285. 2. Lawton MT, Hamilton MG, Morcos JJ, Spetzler RF. Revascularization and aneurysm surgery: current techniques, indications, and outcome. Neurosurgery. 1996;38(1):83-94. 3. van Doormaal TP, van der Zwan A, Verweij BH, Regli L, Tulleken CA. Giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis bypass. Neurosurgery. 2010;66(3):439-447; discussion 447. 4. Carvalho FG, Godoy BL, Reis M, et al. Frameless stereotactic navigation for intraoperative localization of infectious intracranial aneurysm. Arq Neuropsiquiatr. 2009;67(3B):911-913. 10.1227/NEU.0000000000000280
Simulating Ventriculostomy To the Editor: We were pleased to see the article by Schirmer et al1 because it represents an update to our original concept from 20002 with enhanced modernized haptics and fidelity. The authors have updated our original model with an immersive environment and better 3-D representation. It is conceptually similar in terms of the procedural steps modeled, and their assessment of our simulator from 2000. We have updated our simulator to run on the iPad since this article was submitted https://itunes.apple.com/gb/app/vcath/id568887198?mt¼8.3 This is quite a simple App; however, it lacks haptic feedback, but it makes up for it in terms of accessibility and low cost. It has inbuilt evaluation of the procedural steps. We have concentrated on educational content and concepts rather than fidelity of procedural accuracy. Improvements in procedural fidelity are very resource intense and seem, over the years since our original model, to have had limited success. The authors describe and illustrate some of the problems of validation of surgical simulators. We perceive a tendency to demonstrate that the simulator shows improvement in learning the simulator rather than in learning an actual procedure. The authors have rightly used alternative methods of didactic teaching to counter
E458 | VOLUME 74 | NUMBER 4 | APRIL 2014
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Nicholas I. Phillips Leeds, United Kingdom Nigel W. John Gwynedd, Wales 1. Schirmer CM, Elder JB, Roitberg B, Lobel DA. Virtual reality-based simulation training for ventriculostomy: an evidence-based approach. Neurosurgery. 2013;73 (suppl 4):66-73. doi: 10.1227/NEU.0000000000000074. 2. Phillips NI, John NW. Web-based surgical simulation for ventricular catheterization. Neurosurgery. 2000;46(4):933-936; discussion 936-937. 3. Cenydd LA, John NW, Phillips NI, Gray WP. VCath: a tablet-based neurosurgery training tool. Stud Health Technol Inform. 2013;184:20-23. 10.1227/NEU.0000000000000279
In Reply: Simulating Ventriculostomy We would like to thank the authors for their comments in response to our article, “Virtual Reality-Based Simulation Training for Ventriculostomy: An Evidence-Based Approach.”1 We would like to point out that the intent of our article was to demonstrate that neurosurgical resident training in ventriculostomy placement can be enhanced through virtual reality-based simulation training. We chose a commercially available simulator, designed by ImmersiveTouch (Chicago, Illinois),2 to provide ventriculostomy training to neurosurgical residents as part of a larger simulation course. We wish to clarify that none of the authors of our article were involved in the development of the simulator. We are pleased to see that the authors have now developed an iPad application3 to supplement their Web-based surgical ventriculostomy simulator.4 As they describe, there are many components of educating trainees in surgical techniques. Their simulator offers the ability to perform key components of ventriculostomy placement, including selection of an entry point and trajectory of the catheter and selection of depth of catheter placement. Final catheter placement can then be verified by a cutaway image of the brain. Although there is no haptic feedback with this system, and in truth, realistic haptics are a limitation of even the most advanced virtual reality-based simulators at this time, we contend that the most common errors in ventriculostomy placement may be avoided by educating trainees with simulators such as the VCath, described by the authors, and the ImmersiveTouch system, which we used as part of our training course. The technical implementation of a simulator is a necessary component of a successful, validated simulation curriculum. As described in our article, the use of structured instruction and testing is at least equally as important. We were
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
