title: Smart trepanation system: preclinical analysis of safety, efficiency, and user satisfaction.
abstract: OBJECTIVE
  To reduce the risk of dural tears during craniotomies and the associated complications, we developed the Smart Trepanation System (STS) that provides an image- and sensor-based automatic control of the cutting depth of a manually guided soft tissue preserving saw. This article presents the results of an initial user-centered evaluation.
  
  
  METHODS
  Interactive usability tests with six neurosurgeons were conducted. Resection time and accuracy were recorded in a standardized laboratory setting and compared with a standard craniotome. User satisfaction and subjective workload were assessed using the National Aeronautics and Space Administration Task Load Index scale and a questionnaire regarding intuitiveness, fault tolerance, learnability, and user satisfaction.
  
  
  RESULTS
  The mean resection time after getting used to the STS was 36.4 ± 9.2 second longer than with the conventional craniotome. All task load indexes except for the temporal demand were rated higher when using the STS, but all were rated smaller than 3 and thus classified as only a small extra task load. The questionnaire showed that the system is not only feasible but also accepted by surgeons and that the user interaction seems to be designed as intuitive, fault tolerant, and easy to learn.
  
  
  CONCLUSIONS
  Although the conventional craniotome seems to perform a trepanation faster and with less workload, the advantage of performing a dura-preserving trepanation with significantly smaller cutting gaps outweighs those disadvantages. For validation of those promising in vitro results, further studies have to be conducted in a fresh human cadaver model or in a clinical setting.
authors.affiliation: Department of Neurosurgery, Knappschafts-Krankenhaus Bochum Langendreer, Bochum, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Fontana
authors.affiliation: Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Korff
authors.affiliation: Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Follmann
authors.affiliation: Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Radermacher
authors.affiliation: Department of Neurosurgery, Knappschafts-Krankenhaus Bochum Langendreer, Bochum, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Schmieder
mesh_terms: D003399:Craniotomy / Q000009:adverse effects* / Q000193:education / Q000379:methods; D004388:Dura Mater / Q000293:injuries*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D061646:Operative Time; D011795:Surveys and Questionnaires; D016526:Workload