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Practice on an Augmented Reality/Haptic Simulator and Library of Virtual Brains Improves Residents’ Ability to Perform a Ventriculostomy

Yudkowsky, Rachel MD, MHPE; Luciano, Cristian PhD; Banerjee, Pat PhD; Schwartz, Alan PhD; Alaraj, Ali MD; Lemole, G. Michael Jr MD; Charbel, Fady MD; Smith, Kelly PhD; Rizzi, Silvio MS; Byrne, Richard MD; Bendok, Bernard MD, FACS; Frim, David MD, PhD

doi: 10.1097/SIH.0b013e3182662c69
Empirical Investigations

Introduction Ventriculostomy is a neurosurgical procedure for providing therapeutic cerebrospinal fluid drainage. Complications may arise during repeated attempts at placing the catheter in the ventricle. We studied the impact of simulation-based practice with a library of virtual brains on neurosurgery residents’ performance in simulated and live surgical ventriculostomies.

Methods Using computed tomographic scans of actual patients, we developed a library of 15 virtual brains for the ImmersiveTouch system, a head- and hand-tracked augmented reality and haptic simulator. The virtual brains represent a range of anatomies including normal, shifted, and compressed ventricles. Neurosurgery residents participated in individual simulator practice on the library of brains including visualizing the 3-dimensional location of the catheter within the brain immediately after each insertion. Performance of participants on novel brains in the simulator and during actual surgery before and after intervention was analyzed using generalized linear mixed models.

Results Simulator cannulation success rates increased after intervention, and live procedure outcomes showed improvement in the rate of successful cannulation on the first pass. However, the incidence of deeper, contralateral (simulator) and third-ventricle (live) placements increased after intervention. Residents reported that simulations were realistic and helpful in improving procedural skills such as aiming the probe, sensing the pressure change when entering the ventricle, and estimating how far the catheter should be advanced within the ventricle.

Conclusions Simulator practice with a library of virtual brains representing a range of anatomies and difficulty levels may improve performance, potentially decreasing complications due to inexpert technique.

From the Departments of Medical Education (R.Y., A.S.), Neurosurgery (A.A., F.C.), and Medicine (K.S.), College of Medicine, and Department of Mechanical and Industrial Engineering (C.L., P.B., S.R.), College of Engineering, University of Illinois at Chicago; Department of Neurosurgery (R.B.), Rush University; Department of Neurological Surgery (B.B.), Northwestern University Feinberg School of Medicine; and Section of Neurosurgery (D.F.), University of Chicago, Chicago, IL; and Division of Neurosurgery (G.M.L.), University of Arizona, Tucson, AZ.

Reprints: Rachel Yudkowsky, MD, MHPE, Department of Medical Education, College of Medicine, University of Illinois at Chicago, 986 CME, 808 S Wood St, MC 591, Chicago, IL 60612 (e-mail:

Supported in part by a grant from the Agency for Healthcare Research and Quality Grant award number 1 R03 HS017361-01.

Opinions expressed are those of the authors and do not reflect the official position of Agency for Healthcare Research and Quality or the US Department of Health and Human Services.

This work is from the Department of Medical Education, College of Medicine, University of Illinois at Chicago.

The University of Illinois has exclusively licensed a technology patent to ImmersiveTouch, Inc.

Drs Banerjee and Charbel own shares in ImmersiveTouch, Inc. Drs Luciano and Alaraj are coinvestigators on a National Institutes of Health Small Business Innovation Research grant awarded to ImmersiveTouch, Inc, providing salary compensation.

© 2013 Society for Simulation in Healthcare