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Surgical simulation is the future

AI-assisted training will make surgery safer

Technology developed at The Neuro could one day revolutionize how brain surgery is taught around the world.

A team led by Dr. Rolando Del Maestro, The Neuro’s William Feindel Professor Emeritus in Neuro-oncology, is playing a major role in perfecting an advanced neurosurgical simulator.

“There is no way in the next five years that medical students going into neurosurgery are going to operate on humans without first being trained on simulators,” says Dr. Del Maestro, Director of the Neurosurgical Simulation and Artificial Intelligence Learning Centre (NSAILC).

Simulators are used in the aviation industry to train pilots and ensure they maintain their skills over the years. In the United States and Ireland, general surgeons in training are being taught using low-fidelity simulators that do not have all the capabilities of those being developed and assessed in the NSAILC, which include NeuroVR and OSSimTech systems.

The long-term goal is to provide objective data that can be used to measure a trainee’s level of skill and improve their operative performance. Pilots’ competence is regularly assessed on simulators, and practicing surgeons could also undergo competence evaluations in the future.

“The big thing about a simulator is that you can get information that you’d never get simply by watching a person operate,” explains Dr. Del Maestro. “The data can outline all the multiple forces that the individual applied during the complete operation — every single force applied by every instrument during every part of the operation. We call this the surgical force fingerprint.”

Dr. Del Maestro’s team came to an interesting conclusion when it conducted a study of force fingerprints of junior and more experienced neurosurgeons.

“We developed a simulation model for how to conduct virtual reality operations that supports the concept that experts always focus on two major issues associated with operations — safety and efficiency. Residents are still learning these skills.”

Dr. Del Maestro’s team has a patent pending for an artificial intelligence (AI) computer simulation platform focused on safety that prevents participants from continuing if they are using unsafe techniques.

“The system acts like an instructor and can say things like ‘You’re putting too much force on the spinal chord.’ It then provides the student’s individual data and both compares it to the proper performance and shows a video of how to do it properly. Only when the procedure is safely performed can the student proceed to the following stage.”

As a neurosurgeon trained in an era without simulators, Dr. Del Maestro is aware of potential impediments in using AI systems to monitor a surgeon’s performance.

“Pilots were also initially concerned about being assessed by flight simulators. However, simulation-based training and assessment are now the global standard associated with aviation, and this has significantly decreased the number of airplane incidents.”

One can predict that it will be only a matter of time before simulators become a useful component of medical academic curricula.

“Today when someone has finished six years’ neurosurgical training, a box is checked off saying that this individual is technically competent. Right now, we do not have standardized, objective data to support this assessment. Having large amounts of data collected over many years from different universities and surgeons at different stages of their careers will substantially help in assessing competence and, if necessary, in ordering specific retraining.”

NSAILC receives major research funding from the AO Foundation, a non-profit organization based in Zurich, Switzerland that supports research and development into methods to improve the training of surgeons dealing with musculoskeletal and spinal injuries.

“We have to prove that by training on a simulator, a person is better in the operating room,” says Dr. Del Maestro. “We’re doing that trial right now.”

Neurosurgical Simulation and Artificial Intelligence Learning Centre – Staff

Dr. Rolando Del Maestro, Director

Dr. Alexander Winkler-Schwarz, neurosurgery resident and PhD candidate

Nicole Ledwos, MSc candidate in the Integrated Program in Neuroscience, McGill University

Nykan Mirchi, Vincent Bissonnette and Dr. Recai Yilmaz, MSc candidates, Department of Experimental Surgery, McGill University

Dr. Bekir Karlik, Research Scientist, (NSAILC)

The Montreal Neurological Institute & Hospital is a McGill University research and teaching institute; delivering the highest quality of care to patients, as part of the Neuroscience Mission of the McGill University Health Centre. The Neuro is proud to be a Killam Institution, supported by the Killam Trusts.