The Effect of 3-Dimensional Simulation on Neurosurgical Skill Acquisition and Surgical Performance: A Review of the Literature.
OBJECTIVE
In recent years, 3-dimensional (3D) simulation of neurosurgical procedures has become increasingly popular as an addition to training programmes. However, there remains little objective evidence of its effectiveness in improving live surgical skill. This review analysed the current literature in 3D neurosurgical simulation, highlighting remaining gaps in the evidence base for improvement in surgical performance and suggests useful future research directions.


METHODS
An electronic search of the databases was conducted to identify studies investigating 3D virtual reality (VR) simulation for various types of neurosurgery. Eligible studies were those that used a combination of metrics to measure neurosurgical skill acquisition on a simulation trainer. Studies were excluded if they did not measure skill acquisition against a set of metrics or if they assessed skills that were not used in neurosurgical practice. This was not a systematic review however, the data extracted was tabulated to allow comparison between studies RESULTS: This study revealed that the average overall quality of the included studies was moderate. Only one study assessed outcomes in live surgery, while most other studies assessed outcomes on a simulator using a variety of metrics.


CONCLUSIONS
It is concluded that in its current state, the evidence for 3D simulation suggests it as a useful supplement to training programmes but more evidence is needed of improvement in surgical performance to warrant large-scale investment in this technology.
School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge CB2 0SP, United Kingdom.
Anna D
AD
Clark
Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Damiano G
DG
Barone
Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Nicholas
N
Candy
Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Mathew
M
Guilfoyle
Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Karol
K
Budohoski
Faculty of Education, University of Cambridge, Hills Road, Cambridge, CB2 8PQ, United Kingdom.
Riikka
R
Hofmann
School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge CB2 0SP, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Thomas
T
Santarius
Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
Ramez
R
Kirollos
Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom. Electronic address: rikin.trivedi@addenbrookes.nhs.uk.
Rikin A
RA
Trivedi
D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D006801:Humans; D021621:Imaging, Three-Dimensional; D019635:Neurosurgical Procedures / Q000193:education*; D000066908:Simulation Training / Q000379:methods*; D013647:Task Performance and Analysis; D006113:United Kingdom
3-dimensional; Practice-Based Learning and Improvement; neurosurgical; simulators; training