Abstract
BackgroundMinimally invasive endoscopic techniques in spine surgery continue to gain in popularity. Unfortunately, there is a long learning period for novice endoscope users to acquire basic skills, and complex training simulators are frequently cost-prohibitive. This paper describes the development and validation of a low-cost endoscopic spine training simulator.MethodologyA low-cost endoscopic spine training model was created utilizing a budget of less than 65 USD. Afterward, a training curriculum consisting of five tasks was designed to mimic standard techniques frequently utilized in endoscopic spine surgery. This curriculum was tested on a cohort of surgical trainees. The initial time to completion as well as errors made during the tasks and repeat trials were recorded. A composite score was generated to quantify the overall scores which included both time and errors in each task.ResultsIn total, 11 students and surgical residents completed the curriculum. The first attempt required an average of 622 seconds for the completion of the curriculum compared to 283 seconds in the second trial (p < 0.001; SD = 36.75). In regards to trials in which errors were counted, fewer errors occurred during the second attempt (2.55 vs. 1.53); however, this difference was not statistically significant (p > 0.05). In regards to the composite score, the composite score of the intern group demonstrated an average improvement of 0.345 compared to an average improvement of 0.47 in the resident group.ConclusionsOur study demonstrates the feasibility of a low-cost endoscopic spine trainer as well as its efficacy in improving basic endoscopic skills in trainees.
Highlights
Endoscopic spine surgery (ESS) is an increasingly popular approach for spine decompression and discectomy
The first attempt required an average of 622 seconds for the completion of the curriculum compared to 283 seconds in the second trial (p < 0.001; SD = 36.75)
In regards to trials in which errors were counted, fewer errors occurred during the second attempt (2.55 vs. 1.53); this difference was not statistically significant (p > 0.05)
Summary
Endoscopic spine surgery (ESS) is an increasingly popular approach for spine decompression and discectomy. It was initially described and popularized by Parvis Kambin and refined by both Mayer and Brock in 1993 and later by Foley and Smith in 1997 [1,2]. Lee et al evaluated the first 51 cases of percutaneous endoscopic lumbar discectomy at their institution demonstrating a significantly decreased operative time following the first 17 cases [3]. A larger systematic review conducted of all minimally invasive spine techniques in 2014 demonstrated that the learning curve, as defined by longer procedures times and higher complication rates, typically was overcome after 20 to 30 consecutive cases [4]. Invasive endoscopic techniques in spine surgery continue to gain in popularity. This paper describes the development and validation of a lowcost endoscopic spine training simulator
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