title: Design and Validation of an Open-Source, Partial Task Trainer for Endonasal Neuro-Endoscopic Skills Development: Indian Experience.
abstract: BACKGROUND
  Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity.
  
  
  OBJECTIVE
  The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery.
  
  
  METHODS
  We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score.
  
  
  RESULTS
  Group E had lower task completion times and greater skills assessment scale scores than both Group N and R (P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002).
  
  
  CONCLUSIONS
  The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy.
authors.affiliation: Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Britty
authors.initials: B
authors.lastname: Baby
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Natesan
authors.initials: N
authors.lastname: Damodaran
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vinkle
authors.initials: V
authors.lastname: Srivastav
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: surineuro@gmail.com.
authors.forename: Ashish
authors.initials: A
authors.lastname: Suri
authors.affiliation: Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
authors.forename: Subhashis
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
authors.forename: Prem
authors.initials: P
authors.lastname: Kalra
authors.affiliation: Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
authors.forename: Sanjiva
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
authors.forename: Kolin
authors.initials: K
authors.lastname: Paul
authors.affiliation: Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.
authors.forename: Sneh
authors.initials: S
authors.lastname: Anand
authors.affiliation: Central Scientific Instruments Organization (CSIR-CSIO) Sector 30-C, Chandigarh, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Central Scientific Instruments Organization (CSIR-CSIO) Sector 30-C, Chandigarh, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Dhiman
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: David
authors.initials: D
authors.lastname: Ben-Israel
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kulwant Singh
authors.initials: KS
authors.lastname: Kapoor
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004521:Educational Measurement; D004724:Endoscopy / Q000193:education*; D005260:Female; D006801:Humans; D007194:India; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D044583:Neuroendoscopy / Q000193:education*; D009493:Neurosurgery / Q000193:education*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D015203:Reproducibility of Results; D012647:Self-Assessment; D019291:Skull Base / Q000601:surgery; D066231:Surgeons; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Endonasal; Neuro-endoscopy; Open source; Partial task trainer; Physical simulator; Simulation; Skills training; Skull base