Surgical Performance Analysis in a Simulated Virtual Reality Anterior Cervical Discectomy and Fusion Task

Abstract

Introduction: Multiple studies have demonstrated the effectiveness of virtual reality (VR) simulators in surgical skills training and assessment. Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures and requires trainees to master a broad spectrum of surgical techniques. The Sim-ortho VR simulator provides a validated anterior cervical discectomy and fusion (ACDF) simulated task. This validated tool can be used in the evaluation and assessment of surgical skill. Objective This thesis aims to analyze the three-dimensional data recorded by the Sim-Ortho VR simulator platform during the discectomy component of the ACDF task. We aim to use the generated data to develop novel metrics to assess the performance of participants with different levels of expertise. Hypothesis We hypothesize that the results of this analysis would establish a methodology to develop novel metrics that can identify performance variability between different groups of expertise and provide new insights into surgical expertise. Methods We recruited participants with different levels of expertise to perform a standardized ACDF simulation task. The three-dimensional structural data were generated from the simulator and recorded after each step. We collected and analyzed different data including volumes of each 5 structure at different stages of the procedure and rate of removal of the disc. Statistical significance was set as p < 0.05. Results Twenty-seven participants were included and divided into three groups based on their surgical expertise: medical student, resident, and post-resident groups. Medical students took longer to perform the discectomy compared to the other groups and left almost three times of disc residual as the resident and post-resident groups (p = 0.068). During the annulotomy component, the post-resident group removed 47.4% more disc than the resident and 102% more than the medical student group (p = 0.03). No statistically significant differences between groups were found during the second stage of the discectomy regarding disc residual and rate of removal. The post-resident group spent 19.1% of their surgical time actively working on areas adjacent to the dura, compared to 13.7% and 5.1% in the resident and medical student groups, respectively (p = 0.017). Conclusion Expert performance is associated with higher efficiency compared to resident and medical student groups. The amount removed and rate of removal represent other features of expertise during the annulotomy stage of the discectomy. These differences expose some of the features of experts’ performance that can be further studied and taught to junior trainees.