title: Assessing bimanual performance in brain tumor resection with NeuroTouch, a virtual reality simulator.
abstract: BACKGROUND
  Validated procedures to objectively measure neurosurgical bimanual psychomotor skills are unavailable. The NeuroTouch simulator provides metrics to determine bimanual performance, but validation is essential before implementation of this platform into neurosurgical training, assessment, and curriculum development.
  
  
  OBJECTIVE
  To develop, evaluate, and validate neurosurgical bimanual performance metrics for resection of simulated brain tumors with NeuroTouch.
  
  
  METHODS
  Bimanual resection of 8 simulated brain tumors with differing color, stiffness, and border complexity was evaluated. Metrics assessed included blood loss, tumor percentage resected, total simulated normal brain volume removed, total tip path lengths, maximum and sum of forces used by instruments, efficiency index, ultrasonic aspirator path length index, coordination index, and ultrasonic aspirator bimanual forces ratio. Six neurosurgeons and 12 residents (6 senior and 6 junior) were evaluated.
  
  
  RESULTS
  Increasing tumor complexity impaired resident bimanual performance significantly more than neurosurgeons. Operating on black vs glioma-colored tumors resulted in significantly higher blood loss and lower tumor percentage, whereas altering tactile cues from hard to soft decreased resident tumor resection. Regardless of tumor complexity, significant differences were found between neurosurgeons, senior residents, and junior residents in efficiency index and ultrasonic aspirator path length index. Ultrasonic aspirator bimanual force ratio outlined significant differences between senior and junior residents, whereas coordination index demonstrated significant differences between junior residents and neurosurgeons.
  
  
  CONCLUSIONS
  The NeuroTouch platform incorporating the simulated scenarios and metrics used differentiates novice from expert neurosurgical performance, demonstrating NeuroTouch face, content, and construct validity and the possibility of developing brain tumor resection proficiency performance benchmarks.
authors.affiliation: *Neurosurgical Simulation Research Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; ‡Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; §Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; ¶Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia; ‖Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran.
authors.forename: Fahad E
authors.initials: FE
authors.lastname: Alotaibi
authors.forename: Gmaan A
authors.initials: GA
authors.lastname: AlZhrani
authors.forename: Muhammad A S
authors.initials: MA
authors.lastname: Mullah
authors.forename: Abdulrahman J
authors.initials: AJ
authors.lastname: Sabbagh
authors.forename: Hamed
authors.initials: H
authors.lastname: Azarnoush
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkler-Schwartz
authors.forename: Rolando F
authors.initials: RF
authors.lastname: Del Maestro
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D009493:Neurosurgery / Q000193:education*; D014584:User-Computer Interface