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Comprehensive healthcare simulation : neurosurgery
Alaraj A., Springer International Publishing, New York, NY, 2018. 350 pp. Type: Book (978-3-319755-82-3)
Date Reviewed: Jun 19 2019

There have been many changes in the ways in which surgeons gain early experience. These include a worldwide reduction in working hours and a migration from hands-on apprenticeship-type training. There have also been changes in patient expectations, particularly with respect to the level of risk that will be tolerated. These changes combined with the increasing use of more precise, less invasive procedures all put pressure on the training of surgeons. They also challenge the traditional ways that surgeons have built their own mental models of the details of the human anatomy. This edited volume, the second of four volumes (to date) in a series on simulation in a key number of medical specialties, focuses on the simulation of neurosurgery to the brain and spinal cord. The editor hopes to improve surgical planning and training related to the most anatomically challenging organs of the body. My perspective is one of a technologist who wishes to support surgeons in their work.

The book divides its treatment of planning and training tools into sections covering the physical, the biological, and virtual reality. These sections are sandwiched between a historical introduction and two short sections on simulation training courses. The latter includes a survey on the use of surgical simulation tools around the world and nonprocedural training, including anesthesia and critical care.

The book seeks to shed light on the tools used both in the past and today, and gives a good overview of commercial tools and tools in development. It also gives insight into potential future methods. It has 24 chapters contributed by almost 70 authors, with more than 20 of these clinicians recognized by Doctor of Medicine (MD) or Bachelor of Medicine, Bachelor of Surgery (MBBS) qualifications in the author list. Many key authors, including the editor, have made multiple contributions. As is usual with this kind of clinically targeted textbook, most chapters are short and to the point. The individual chapters are also downloadable from the publisher’s website. The book has extras online, including videos.

The physical simulation and virtual reality chapters readily engage the technical reader. The biologically focused chapters show the use of animal, placental, cadaver, and very life-like “live cadaver” models. The latter include soft tissue, bleeding, pulsating arteries, pseudoaneurysms, and tumors. They powerfully remind us of the inherent complexity and high-precision demands faced by surgeons when tackling issues related to microanastomosis, aneurysms, and the spinal cord. These complexities also include the range of disease presentations that surgeons may encounter and their wide choice of devices and instruments. Important chapters overview the use of 3D printed models in neurosurgical training and demonstrate the focused use of 3D models for training in endovascular surgery and the microsurgery of anastomosis (joining blood vessels). Anastomosis is a recurring theme that also appears as a chapter in the biological modeling section.

The virtual reality section includes an introduction to haptics and a discussion of the potential use of virtual reality tools for competency assessment. There is also an important sequence of seven practical application chapters (13 through 19). This part closes with a brief chapter on the future of visualization and simulation in neurosurgery, including augmented reality approaches. The application chapters will perhaps be of most interest to those with an engineering and computing background. They quickly communicate the state of the art and challenges in a range of areas. They address minimally invasive neurosurgery simulation; immersive touch simulation; simulation of aneurysm clipping (the surgical isolation of a bulge in a blood vessel with the potential to burst); simulation of neurosurgical anatomy; spine surgery simulation; and simulation of laser ablation for epilepsy treatment. These chapters emphasize that virtual reality techniques have been used in planning since around 2000, and continue to develop through multiple generations of specifically targeted modules. They do, however, hint that there is more to do to enhance their value in training and to deliver them at an affordable price.

I would recommend this book to those who collaborate with neurosurgeons in order to give them better planning and training tools. This book has much to offer for both engineers and computer scientists who have experience working with clinical colleagues and those who have just begun this journey, perhaps as graduate students. It is inevitable that clinical training will continue to change, for example, the increasing use of such tools and more robotic procedures. It is our role as technologists to ensure, by working as part of broadly skilled teams, that these tools are those that our surgical colleagues both require and deserve. This has been emphasized for me by the value that senior surgical colleagues place on the use of realistic simulations for the training of trauma surgeons. Important technological areas to be addressed include physical 3D simulations, the simulation of biological complexity, the haptics of both tissue cutting and deformation, and the rapid multi-modality rendering and visualization of patient data at an individual patient level. Significantly, all of these problems need to be addressed at the extremes of precision required in brain surgery.

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Reviewer:  D. J. Williams Review #: CR146602 (1909-0330)
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