A low-cost passive navigation training system for image-guided spinal intervention

World Neurosurgery. dx.doi.org/10.1016/j.wneu.2016.08.006

A low-cost passive navigation training system for image-guided spinal intervention

Lorias Espinoza Daniel, PhD, Vicente González Carranza, MD, Fernando Chico Ponce de León, MD, Fernando Pérez Escamirosa, PhD, Arturo Minor Martinez, PhD

BACKGROUND: Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tri-dimensional mental interpretation of bi-dimensional data. However, inexpensive surgical simulators for spinal surgery are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3D navigation using 2D images without altering or limiting the surgeon’s natural movement.

METHODS: A training system was developed using an anatomical lumbar model and two webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior (AP) views obtained.

RESULTS: The system was tested using a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α  ), average speed (View the MathML source), and acceleration (a) were accurately obtained. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described.

CONCLUSIONS: This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, non-innate skills and allows the novice apprentice to quickly and economically move beyond the basics.

KEYWORDS: training in neurosurgery; spine simulator; metric-based teaching; spine trainer simulator