Laboratory Training Model Research Articles

Transopercular Insular Approach, Overcoming the Training Curve Using a Cadaveric Simulation Model: 2-Dimensional Operative Video.

Transopercular approach to the insula is indicated for resection of insular low-grade gliomas, particularly for Yasargil's 3B, 5A, and 5B types. Nevertheless, the infrequent location and its challenging approach make it difficult to master the surgery. Consequently, a realistic laboratory training model might help to acquire key surgical skills. In this video, we describe a cadaveric-based model simulating the resection of a temporo-insular low-grade glioma. Kingler's fixation technique was used to fix the cadaver head before injecting red and blue colorants for a realistic vascular appearance. Hemisphere was frozen for white matter tract dissection. Tractography and intraoperative eloquent areas were extrapolated from a glioma patient by using a neuronavigation system. Then, a fronto-temporal craniotomy was performed through a question mark incision, exposing from inferior temporal gyrus up to middle frontal gyrus. After cortical anatomic landmark identification, eloquent areas were extrapolated creating a simulated functional cortical map. Then, transopercular noneloquent frontal and temporal corticectomies were performed, followed by subpial resection. Detailed identification of Sylvian vessels and insular cortex was demonstrated. Anatomic resection limits were exposed, and implicated white matter bundles, uncinate and fronto-occipital fascicles, were identified running through the temporal isthmus. Finally, a temporo-mesial resection was performed. In summary, this model provides a simple, cost-effective, and very realistic simulation of a transopercular approach to the insula, allowing the development of surgical skills needed to treat insular tumors in a safe environment. Besides, the integration of simulated navigation has proven useful in better understanding the complex white matter anatomy involved. Cadaver donation, subject or relatives, includes full consent for publication of the images. For the purpose of this video, no ethics committee approval was needed. Images correspond to a cadaver head donation. Cadaver donation, subject or relatives, includes full consent for any scientific purposes involving the corpse. The consent includes image or video recording. Regarding the intraoperative surgical video and tractography, the patient gave written consent for scientific divulgation prior to surgery.

Development and validation of a porcine organ model for training in essential laparoscopic surgical skills.

ObjectivesTo develop a wet laboratory training model for learning core laparoscopic surgical skills and evaluating learners’ competency level outside the operating room.MethodsParticipants completed three tasks (task 1: tissue dissection around the aorta; task 2: tissue dissection and division of the renal artery; task 3: renal parenchymal closure). Each performance was video recorded and subsequently evaluated by two experts, according to the Global Operative Assessment of Laparoscopic Skills and task‐specific metrics that we developed (Assessment Sheet of Laparoscopic Skills in Wet Lab score). Mean scores were used for analyses. The subjective mental workload was also assessed (NASA Task Load Index).ResultsThe 54 participants included 32 urologists, eight young trainees and 14 medical students. A total of 13 participants were categorized as experts (≥50 laparoscopic surgeries), eight as intermediates (10–49) and 33 as novices (0–9). There were significant differences in the Global Operative Assessment of Laparoscopic Skills and Assessment Sheet of Laparoscopic Skills in Wet Lab scores among the three groups in all three tasks. Higher NASA Task Load Index scores were observed in novices, and there were significant differences in tasks 1 (Kruskal–Wallis test, P = 0.0004) and 2 (P = 0.0002), and marginal differences in task 3 (P = 0.0745) among the three groups.ConclusionsOur training model has good construct validity, and differences in the NASA Task Load Index score reflect previous laparoscopic surgical experiences. Our findings show the ability to assess both laparoscopic surgical skills and mental workloads, which could help educators comprehend trainees’ level outside the operating room. Given the decreasing opportunity to carry out pure laparoscopic surgeries because of the dissemination of robotic surgery, especially in urology, our model can offer practical training opportunities.

The Microneurosurgical Training Model for Intrinsic and Extrinsic Brain Tumor Surgery Using Polyurethane Foam and Fresh Cadaveric Cow Brain: An Experimental Study

ObjectiveTo evaluate the feasibility of an experimentally designed brain tumor model consisting of polyurethane foam and fresh cadaveric cow brain for the surgical training of the technique for tumor ablation.MethodsA laboratory-training model was created for microneurosurgical intervention of intrinsic brain tumor ablation covering microdissection of the brain tissue and opening of the pia mater, dissection and separation of the sulcal and cisternal structures, and dissection and removal of the tumor tissue. The left front parietal lobe was used as the area of interest for this experimental study. One-centimeter cube polyurethane foam was injected 2-cm deep inside the brain tissue using a plastic injection tube. After 5 minutes, the model was ready to use under the operating microscope for dissection, separation, and removal of the tumor tissue. The compatibility of the training model also was evaluated as poor, acceptable, and perfect.ResultsTen stripped fresh cadaveric cow brains were used in this experimental feasibility study. The compatibility of the model was evaluated as poor, acceptable, and perfect in 1, 6, and 3 subjects, respectively.ConclusionsIn intrinsic brain tumor ablation, surgical manipulations of sulcal, cisternal, and fissural dissection must be undertaken while preserving vital neural and vascular structures. We believe that our model holds promise in developing the technical skills of neurosurgeons in training.

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques - a systematic review of the current literature.

Due to its high complexity, neurosurgery consists of a demanding learning curve that requires intense training and a deep knowledge of neuroanatomy. Microsurgical skill development can be achieved through various models of simulation, but as human cadaveric models are not always accessible, cadaveric animal models can provide a reliable environment in which to enhance the acquisition of surgical dexterity. The aim of this review was to analyse the current role of animal brains in laboratory training and to assess their correspondence to the procedures performed in humans. A Pubmed literature search was performed to identify all the articles concerning training cranial and spinal techniques on large animal heads. The search terms were 'training model', and 'neurosurgery' in association with 'animal', 'sheep', 'cow', and 'swine'. The exclusion criteria were articles that were on human brains, experimental fundamental research, or on virtual simulators. The search retrieved 119 articles, of which 25 were relevant to the purpose of this review. Owing to their similar neuroanatomy, bovine, porcine and ovine models prove to be reliable structures in simulating neurosurgical procedures. On bovine skulls, an interhemispheric transcalosal and retrosigmoid approach along with different approaches to the Circle of Willis can be recreated. Ovine model procedures have varied from lumbar discectomies on sheep spines to craniosynostosis surgery, whereas in ex vivo swine models, cadaveric dissections of lateral sulcus, median and posterior fossa have been achieved. Laboratory training models enhance surgical advancements by familiarising trainee surgeons with certain neuroanatomical structures and promoting greater surgical dexterity. The accessibility of animal brains allows trainee surgeons to exercise techniques outside the operating theatre, thus optimising outcomes in human surgical procedures.

Using of the Chicken Wing's Bone in the Microneusurgical Training Model for Microdrilling.

Background and Objective:Repetitive practicing of microneurosurgical techniques in experimental laboratory using real surgical instruments on training models is extremely important before starting the real surgical interventions. The modeling of the surgical steps with creating of suitable laboratory models is also another important issue in the successfully gaining of microneurosurgical practice.Materials and Methods:In this experimental study, it was created a laboratory training model for microneurosurgical drilling of cranial bones including the close location with the neural and vascular structures. All steps of this study were performed under the operating microscope. Twenty-five fresh chicken wings obtained from supermarket were used for this study. The difficulty and suitability of the model was evaluated in terms of the usability in the training of microneruosurgical microdrilling. Difficulty of the procedure was divided as three degree (very easy, easy, and difficult). The objective criterion for the evaluation of the difficulty of the procedure was the protection of the neurovascular and muscular structures during the procedure.Results:The suitability of the procedure was also evaluated within three groups as bad, good, and perfect. In four (16%) chicken wing's bone, the difficulty of the microdirilling was evaluated as difficult. Fifteen (60%) of the chicken wing's bones were microsurgically drilled with easy procedure. The remaining six (24%) of the wing's bone microdrilling was evaluated as very easy procedure. The suitability of the model was evaluated as bad in three (12%) of the chicken wing's bone. The suitability was found as good in 16 (64%) of the bones. In the remaining three (24%) of the chicken wing's bone microdrilling, the suitability of the model was evaluated as perfect.Conclusion:Microsurgical drilling of the chicken wing's bone without any vascular and muscular injury is accepted as the indication of the successfully surgical microdrilling process. Consolidation of the surgical practice in a laboratory setting, grasping and using of microsurgical instruments, can be repeated in several times in this model. We believe that this model will contribute to the practical training of microneurosurgery.

Using walnut shell in the microdrilling training model

Aims: The modeling of the surgical steps with creating a suitable laboratory models is critically important issue in the successful gaining of microneurosurgical practice. In this experimental study, a laboratory-training model was created for microneurosurgical drilling of delicate and thin cranial base bones using walnut shell in the repetitive repeating of experimental microsurgical training technique. Materials and Methods: All steps of this study were performed under the operating microscope. Twenty-five walnut shells were used for this experimental feasibility study. The difficulty and suitability of the model were evaluated in terms of the usability in the training of microneurosurgical microdrilling. Difficulty of the procedure was divided into three degrees (very easy, easy, and difficult). The objective criterion for the evaluation of the difficulty of the procedure was the protection of the interior organic material during the procedure. The suitability of the procedure was also evaluated within three groups, bad, good, and perfect. Results: In three (12%) walnut shells, the microdrilling was evaluated as difficult. The microdrilling procedures of the twelve (48%) walnut shells were evaluated as easy procedure. Microdrilling procedure of the remaining ten (40%) of the walnut shells was evaluated as very easy. The suitability of the model was evaluated as bad in two (8%) of the walnut shells. The suitability was found as good in 17 (68%) of the walnut shells. In microdrilling of the remaining six (24%) of the walnut shells, the suitability of the model was evaluated as perfect. Conclusion: Microsurgical drilling of the walnut shells without any interior organic injury is accepted as the indication of the successful surgical microdrilling process. Consolidation of the surgical practice in a laboratory setting, grasping, and using of microsurgical instruments can be repeated several times in this model. We believe that this model will contribute to the practical training of microneurosurgery.

Navigation-Guided Endoscopic Intraventricular Injectable Tumor Model: Cadaveric Tumor Resection Model for Neurosurgical Training

Intraventricular tumors present difficult challenges to the neurosurgeon. Neurosurgeons have begun to explore the possibilities of using the endoscope in the radical resection of solid intraventricular lesions. There is a steep learning curve when dealing with such lesions with an endoscope. The aim of this study was to create a laboratory training model for neuroendoscopic surgery of intraventricular lesions guided by the navigation system. We believe this technique is more reliable than the traditional approach using contrast injection with C-arm x-ray guidance. Five formalin-fixated, latex-injected cadaveric heads were used. The arterial system was injected with red latex through the common carotid arteries, and the venous system was injected with blue latex through the internal jugular veins at the C6 vertebral level. The contrast-enhancing tumor polymer, Stratathane resin ST-504-derived polymer (SRSDP), was injected into the lateral ventricle via Frazier's point under direct endoscopic visualization and real-time neuronavigation guidance. When navigation was used for trajectory planning, the peel-away sheath was registered using a frameless navigational system (BrainLAB, Feldkirchen, Germany). A questionnaire was distributed to all participants in an endoscopic cadaveric course in which the models were used to evaluate the endoscopic tumor model. Neurosurgeons participating in the course performed an endoscopic approach to resect the intraventricular tumor model through an ipsilateral frontal burr hole. The properties of the SRSDP mixture could be manipulated through varying concentrations of the materials used, in order to reach the desired consistency of a nodular solid lesion and possibility for piecemeal resection. The tumor model allowed participants to compare between normal and pathologic endoscopic anatomy in the same cadaveric head. This injectable tumor model with the combination of neuroendoscopy and navigation can improve the accuracy of the endoscopic approach and minimize the risk of cadaveric brain specimen damage that in return augments the feeling of lifelike conditions. Using this endoscopic injectable tumor model technique can assist neurosurgeons' preparation for the challenges associated with an endoscopic piecemeal resection of a solid lesion in the lateral or third ventricle.

Intraventricular injectable tumor model for neuroendoscopic surgery: Laboratory Study

Abstract Intraventricular tumors present difficult challenges to the neurosurgeon. Neurosurgeons have begun to explore the possibilities of the endoscope in the complete resection of solid intraventricular tumors. The learning curve is considered steep when dealing with such lesions endoscopically. The aim of this study was to develop a laboratory training model for pathological intraventricular neuroendoscopic surgery. Thirty formalin-fixated, latex-injected cadaveric heads were used. The contrast-enhancing tumor polymer, Stratathane resin ST-504 derived polymer (SRSDP), was injected into the lateral ventricle via Frazer’s point under direct endoscopic visualization and real-time fluoroscopic guidance. Neurosurgeon participants at a ventricular endoscopic course then performed an endoscopic approach to the intraventricular tumor model lesion via an ipsilateral frontal burr hole. The properties of the SRSDP mixture could be manipulated through varying concentrations of source materials in order to achieve a desired consistency and allow for piecemeal resection. Tumor could be injected into the lateral and third ventricles. The tumor model allowed participants to compare both normal and pathological endoscopic anatomy in the one specimen. Our novel injectable tumor model can assist neurosurgeons preparing themselves for the challenges associated with a piecemeal resection of a solid lesion in the lateral or third ventricle.

Microsurgical training model for residents to approach to the orbit and the optic nerve in fresh cadaveric sheep cranium.

Background:Neurosurgery and ophthalmology residents need many years to improve microsurgical skills. Laboratory training models are very important for developing surgical skills before clinical application of microsurgery. A simple simulation model is needed for residents to learn how to handle microsurgical instruments and to perform safe dissection of intracranial or intraorbital nerves, vessels, and other structures.Materials and Methods:The simulation material consists of a one-year-old fresh cadaveric sheep cranium. Two parts (Part 1 and Part 2) were designed to approach structures of the orbit. Part 1 consisted of a 2-step approach to dissect intraorbital structures, and Part 2 consisted of a 3-step approach to dissect the optic nerve intracranially.Results:The model simulates standard microsurgical techniques using a variety of approaches to structures in and around the orbit and the optic nerve.Conclusions:This laboratory training model enables trainees to gain experience with an operating microscope, microsurgical instruments and orbital structures.

The impact of social cognition training on recovery from psychosis

Social cognition training is an emerging intervention, which aims to ameliorate impairment in social interaction and improve functional outcomes in persons with a psychosis. This article reviews the research conducted on the impact of this intervention published in English language journals over the past 2 years. Social cognition training comprises three types of programs; targeted, broad-based, and comprehensive - targeted programs being the most effective. Programs largely focus on the domains of facial affect, or emotion recognition (FAR), Theory of Mind (ToM), and attributional bias. There is some evidence that ToM is amenable to change, but not FAR and attributional bias. Interventions designed to ameliorate impairment in social functioning largely involve a skills training laboratory model underpinned by social learning theory. The evidence for the effectiveness of current social cognition training strategies to improve functional outcome for persons with psychosis in general and schizophrenia in particular remains equivocal. Clearly, further work is required beyond the laboratory training model and future research may well benefit from the inclusion of longitudinal naturalistic studies.

Laboratory training in the retrosigmoid approach using cadaveric silicone injected cow brain

Background. A neurosurgical laboratory training model is designed for trainees in microneurosurgery to learn to handle surgical microscopes and microneurosurgical instruments. The silicone injection of a fresh cadaveric cow cranium is an alternative to using a cadaveric human brain for becoming familiar with the cerebellopontine angle (CPA) via the retrosigmoid approach. To report an improved method for training in the CPA via the retrosigmoid approach, using a fresh cadaveric cow cranium injected with silicone. Methods. The material consists of a cadaveric cow brain injected with silicone. Preparation consists of irrigation of the major vessels followed by injection of silicone, coloured either red or blue. Results. A three-step approach was designed to simulate microneurosurgical dissection along with the cerebellopontine angle and to dissect cranial nerves emerging from the brain stem. Conclusion. This laboratory training model is useful in allowing trainees to gain experience with the use of an operating microscope and familiarity with the CPA via the retrosigmoid approach. The aim of this study was to develop a novel model and to adapt it to create a life-like neurosurgical training system.

A Practical Laboratory Study Simulating the Lumbar Microdiscectomy: Training Model in Fresh Cadaveric Sheep Spine

Laboratory training models are essential for developing and refining surgical skills prior to clinical application of spinal surgery. A simple simulation model is needed for young residents to learn how to handle instruments and to perform safe lumbar approaches. Our aim is to present a practical laboratory model using a fresh sheep lumbar spine that allows to simulate lumbar microdiscectomy in humans. The material consists of a fresh cadaveric spine from a 2-year-old sheep. The surgical steps for lumbar microdiscectomy were conducted under the magnification of the operating microscope. The cadaveric sheep spine represents a useful model to train posterior lumbar microdiscectomy.

A practical laboratory study simulating the percutaneous lumbar transforaminal epidural injection: training model in fresh cadaveric sheep spine

Laboratory training models are essential for developing and refining treatment skills before the clinical application of surgical and invasive procedures. A simple simulation model is needed for young trainees to learn how to handle instruments, and to perform safe lumbar transforaminal epidural injections. Our aim is to present a model of a fresh cadaveric sheep lumbar spine that simulates the lumbar transforaminal epidural injection. The material consists of a 2-year-old fresh cadaveric sheep spine. A 4-step approach was designed for lumbar transforaminal epidural injection under C-arm scopy. For the lumbar transforaminal epidural injection, the fluoroscope was adjusted to get a proper oblique view while the material was stabilized in a prone position. The procedure then begin, using the C-arm guidance scopy. The model simulates well the steps of standard lumbar transforaminal epidural injections in the human spine. The cadaveric sheep spine represents a good method for training and it simulates fluoroscopic lumbar transforaminal epidural steroid injection procedures performed in the human spine.

A laboratory training model using fresh sheep spines for pedicular screw fixation

Background. Laboratory training models are essential for developing and refining surgical skills prior to clinical application of spinal surgery. A simple simulation model is needed for young residents to learn how to handle instruments and to perform safe posterior lumbar approaches. Our aim is to present a practical laboratory model using a fresh sheep lumbar spine that simulates the pedicular screw fixation in spine surgery. Methods. The material consists of a fresh cadaveric spine from a 2-year-old sheep. A two-step approach was designed for posterior lumbar approaches including placement of lumbar pedicular screws. Results. The model simulates standard posterior lumbar pedicular screw fixation of the human spine. Conclusions. The cadaveric sheep spine represents a useful method to accustom trainees of neurosurgery and spine surgery residents and simulates posterior lumbar pedicular screw fixation performed in the human spine.

The Effects of Information and Communication Technology Based Approach and Laboratory Training Model of Teaching on Achievement and Retention in Chemistry

The purpose of the present study was to investigate the effectiveness of the Information and Communication Technology (ICT) based approach and the Laboratory Training Model of Teaching (LTM) chemistry. It strived to determine whether the ICT or the LTM would be more effective with respect to the male and female students’ overall as well as component-based achievement in chemistry and their retention of learning. The sample of the study consisted of 120 seventh standard students from two English-medium elementary schools in Mysore city, India. Four homogenous groups were formed randomly for the study and the effects of independent variables were tested under experimental conditions. The Test of Higher Mental Ability in Science (THMAS) was used to determine the homogeneity of the participants. After one month, the delayed posttest for achievement in chemistry was administered to determine the retention level of the students. The statistical techniques used to analyze the data were the independent sample t-test and two-way analysis of variance (ANOVA). The findings indicated that as far as the overall achievement in chemistry, component-based achievement, and retention of knowledge, comprehension, application, and skills are concerned, the ICT-based method of teaching chemistry was more effective than the LTM of teaching. The effects of gender varied according to comparisons.

The Effect of Laboratory Training Model of Teaching and Traditional method on Knowledge, Comprehension, Application, Skills-Components of Achievement, Total Achievement and Retention Level in Chemistry

The Effect of Laboratory Training Model of Teaching and Traditional method on Knowledge, Comprehension, Application, Skills-Components of Achievement, Total Achievement and Retention Level in Chemistry

A laboratory training model in fresh cadaveric sheep brain for microneurosurgical dissection of cranial nerves in posterior fossa

A neurosurgical laboratory training model is designed for residents of neurosurgery to handle surgical microscopes and microneurosurgical instruments. The material consists of a one-year-old fresh cadaveric sheep cranium. A four-step approach was designed to simulate microneurosurgical dissection along the posterior fossa cisterns, and to dissect cranial nerves emerging from the brain stem. We conclude that this laboratory training model is useful to allow trainees to gain experience with the general use of an operating microscope, and familiarity with handling cranial nerves.

Microneurosurgical training model in fresh cadaveric cow brain: a laboratory study simulating the approach to the circle of Willis

Backgrounds Residents of neurosurgery need many years to develop microneurosurgical skills, and laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. A simple simulation model is needed for young residents to learn how to handle microneurosurgical instruments, and to perform safe dissection of intracranial vessels and nerves. Methods The material consists of a 2-year-old fresh cadaveric cow cranium. A 4-step approach was designed to dissect the internal carotid artery and its proximal branches, the optic nerve, the optic chiasm, and the pituitary stalk. Results The model simulates standard microneurosurgery using a variety of approaches to vessels and neural structures in and around the circle of Willis of the human brain. Conclusion The cadaveric cow brain, besides being cost-effective, represents a fairly useful method to accustom residents of neurosurgery, especially junior residents, to dissecting intracranial vessels and nerves, and it simulates intracranial microneurosurgical procedures performed in the human brain.

A laboratory training model for interhemispheric-transcallosal approach to the lateral ventricle

Laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. Our aim is to train residents of neurosurgery to be familiar with a basic microneurosurgical technique in access to the lateral ventricle via a transcallosal approach. The training material consists of a 2-year-old fresh cadaveric cow cranium. A four-step approach was designed to simulate microneurosurgical dissection along the falx to visualize cingulated gyri, callosomarginal and pericallosal arteries in order to perform callosotomy and access to the lateral ventricle, and finally to the foramen of Monroe. We conclude that the model perfectly simulates standard microneurosurgical steps in interhemispheric-transcallosal approach to the lateral ventricle and to the area of the foramen of Monroe.

New Alternative to Animal Models for Surgical Training

Laboratory training models are essential for developing and refining surgical skills, especially in microsurgery. A perfect training model is the one that can provide the same situation during surgery, in the same anatomy; the closer to live surgery the model is, the greater the benefit. The lack of an accurate vascular model has sometimes necessitated the use of live models when bleeding, and vascular liquid filling is desired for optional learning. We developed a new model utilising human cadavers that can replace the use of live anaesthetised animals for surgical training. The vessels in a cadaveric specimen were connected to artificial blood reservoirs. The arterial side was connected to a pump to provide pulsating pressure inside the arteries, while the venous side was kept under static pressure that applied to the reservoir. This method provides a condition that simulates live surgery in terms of bleeding, pulsation and liquid filling of the vascular tree. It is an excellent alternative model and can be applied to the whole cadaver or to a particular cadaveric specimen (head, arm, leg) or to an isolated organ. It is distinctive and of a great practical value for training in a wide range of surgical procedures, Utilising this technique could forever eliminate the use of live anaesthetised animals for surgical training. The model and device are patent pending application no. 10/339,053.