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Biomimetic 3-Dimensional−Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction
Journal Pre-proof Biomimetic 3D-Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction William Clifton, MD, Aaron Damon, BS, Rachel Stein, DO, Mark Pichelmann, MD, Eric Nottmeier, MD PII:
S1878-8750(19)33166-3
DOI:
https://doi.org/10.1016/j.wneu.2019.12.134
Reference:
WNEU 13981
To appear in:
World Neurosurgery
Received Date: 15 October 2019 Revised Date:
20 December 2019
Accepted Date: 21 December 2019
Please cite this article as: Clifton W, Damon A, Stein R, Pichelmann M, Nottmeier E, Biomimetic 3DPrinted Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction, World Neurosurgery (2020), doi: https://doi.org/10.1016/j.wneu.2019.12.134. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Elsevier Inc. All rights reserved.
Title: Biomimetic 3D-Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction Authors: William Clifton, MD1; Aaron Damon, BS2; Rachel Stein, DO1; Mark Pichelmann, MD3; Eric Nottmeier, MD1 Affiliations: 1 Department of Neurological Surgery, Mayo Clinic Florida; Jacksonville, FL 2 Department of Education, Mayo Clinic Florida 3 Department of Neurosurgery, Mayo Clinic Health Systems; Eau Claire, WI Corresponding Author’s name and complete mailing address: William Clifton, MD Mayo Clinic Department of Neurosurgery 4500 San Pablo Road Jacksonville, FL, 32224 Email: [email protected] Phone: (904)-953-7452 Fax: (904)-953-7233 Running title: 3D printed posterior cervical simulator Keywords: 3D print; soft tissue; material science; thermoplastic polymers; anatomy; medical education; simulation Conflict of Interest Disclosures: The author reports that there are no conflicts of interest to disclose.
Abstract: Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs1. Currently, there is not a standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been utilized to demonstrate surgical technique as well as assess resident skill, but often presents a significant financial and facility burden2-4. Three-dimensional (3D) printing is an alternative to cadaveric tissue in providing high quality representation of surgical anatomy, however this technology has significant limitations in replicating conductive soft tissue structures for the use of cauterization devices and haptic learning for proper tissue manipulation5-7. Our team has combined novel synthesis methods of conductive thermoplastic polymerization and 3D printed cervical spine models to produce a layered biomimetic simulation that provides cost-effective and anatomically accurate education for neurosurgical trainees. This is accomplished through virtual modeling, and layered simulator construction methods by placing the individual polymer layers according to anatomical location of the simulated in-vivo structures. The consistency of the thermoplastics can be tailored according to the desired soft tissue structures (skin, fat, fascia, muscle) according to the degree of polymerization. This cost-effective simulation was designed to represent the material and biomechanical properties of the cervical spine cortico-cancellous interface as well as individual soft tissue components with specific anatomic details of muscle tendinous and ligamentous insertion. These features allow for representative start-to-finish surgical simulation that have not yet been made widely available to neurosurgical training programs.
Video 1. Cost effective biomimetic 3D printed simulator with anatomically constructed features for surgical training and assessment of cervical spine exposure, radiographic assessment, laminectomy, and instrumentation.
1. 2. 3.
4. 5.
Jakola AS, Skoglund T. Surgical experience of neurosurgical residents in Europe: an alarming trend. Acta neurochirurgica. 2019;161(5):841-842. Kovacs G, Levitan R, Sandeski R. Clinical Cadavers as a Simulation Resource for Procedural Learning. AEM Educ Train. 2018;2(3):239-247. Krajewski A, Filippa D, Staff I, Singh R, Kirton OC. Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions. JAMA Surg. 2013;148(8):727-732. Grow B SJ. The Body Trade. Thompson Reuters. Reuters Investigates Web site. Published 2017. Accessed 10/24/2017, 2017. Weiss MY, Melnyk R, Mix D, Ghazi A, Vates GE, Stone JJ. Design and Validation of a Cervical Laminectomy Simulator using 3D Printing and Hydrogel Phantoms. Operative neurosurgery (Hagerstown, Md). 2019.
6.
7.
Garas M, Vaccarezza M, Newland G, McVay-Doornbusch K, Hasani J. 3D-Printed specimens as a valuable tool in anatomy education: A pilot study. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. 2018;219:57-64. Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. Journal of anatomy. 2019;234(4):419-437.
Abbreviations List CT – Computed Tomography DICOM – Digital Imaging and Communications in Medicine STL – Standard Tessellation Language
Disclosure Form Dr. William Clifton has no conflicts of interest to disclose Mr. Aaron Damon has no conflicts of interest to disclose Dr. Rachel Stein has no conflicts of interest to disclose Dr. Mark Pichelmann has no conflicts of interest to disclose Dr. Eric Nottmeier has no conflicts of interest to disclose
S1878-8750(19)33166-3
DOI:
https://doi.org/10.1016/j.wneu.2019.12.134
Reference:
WNEU 13981
To appear in:
World Neurosurgery
Received Date: 15 October 2019 Revised Date:
20 December 2019
Accepted Date: 21 December 2019
Please cite this article as: Clifton W, Damon A, Stein R, Pichelmann M, Nottmeier E, Biomimetic 3DPrinted Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction, World Neurosurgery (2020), doi: https://doi.org/10.1016/j.wneu.2019.12.134. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Elsevier Inc. All rights reserved.
Title: Biomimetic 3D-Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction Authors: William Clifton, MD1; Aaron Damon, BS2; Rachel Stein, DO1; Mark Pichelmann, MD3; Eric Nottmeier, MD1 Affiliations: 1 Department of Neurological Surgery, Mayo Clinic Florida; Jacksonville, FL 2 Department of Education, Mayo Clinic Florida 3 Department of Neurosurgery, Mayo Clinic Health Systems; Eau Claire, WI Corresponding Author’s name and complete mailing address: William Clifton, MD Mayo Clinic Department of Neurosurgery 4500 San Pablo Road Jacksonville, FL, 32224 Email: [email protected] Phone: (904)-953-7452 Fax: (904)-953-7233 Running title: 3D printed posterior cervical simulator Keywords: 3D print; soft tissue; material science; thermoplastic polymers; anatomy; medical education; simulation Conflict of Interest Disclosures: The author reports that there are no conflicts of interest to disclose.
Abstract: Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs1. Currently, there is not a standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been utilized to demonstrate surgical technique as well as assess resident skill, but often presents a significant financial and facility burden2-4. Three-dimensional (3D) printing is an alternative to cadaveric tissue in providing high quality representation of surgical anatomy, however this technology has significant limitations in replicating conductive soft tissue structures for the use of cauterization devices and haptic learning for proper tissue manipulation5-7. Our team has combined novel synthesis methods of conductive thermoplastic polymerization and 3D printed cervical spine models to produce a layered biomimetic simulation that provides cost-effective and anatomically accurate education for neurosurgical trainees. This is accomplished through virtual modeling, and layered simulator construction methods by placing the individual polymer layers according to anatomical location of the simulated in-vivo structures. The consistency of the thermoplastics can be tailored according to the desired soft tissue structures (skin, fat, fascia, muscle) according to the degree of polymerization. This cost-effective simulation was designed to represent the material and biomechanical properties of the cervical spine cortico-cancellous interface as well as individual soft tissue components with specific anatomic details of muscle tendinous and ligamentous insertion. These features allow for representative start-to-finish surgical simulation that have not yet been made widely available to neurosurgical training programs.
Video 1. Cost effective biomimetic 3D printed simulator with anatomically constructed features for surgical training and assessment of cervical spine exposure, radiographic assessment, laminectomy, and instrumentation.
1. 2. 3.
4. 5.
Jakola AS, Skoglund T. Surgical experience of neurosurgical residents in Europe: an alarming trend. Acta neurochirurgica. 2019;161(5):841-842. Kovacs G, Levitan R, Sandeski R. Clinical Cadavers as a Simulation Resource for Procedural Learning. AEM Educ Train. 2018;2(3):239-247. Krajewski A, Filippa D, Staff I, Singh R, Kirton OC. Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions. JAMA Surg. 2013;148(8):727-732. Grow B SJ. The Body Trade. Thompson Reuters. Reuters Investigates Web site. Published 2017. Accessed 10/24/2017, 2017. Weiss MY, Melnyk R, Mix D, Ghazi A, Vates GE, Stone JJ. Design and Validation of a Cervical Laminectomy Simulator using 3D Printing and Hydrogel Phantoms. Operative neurosurgery (Hagerstown, Md). 2019.
6.
7.
Garas M, Vaccarezza M, Newland G, McVay-Doornbusch K, Hasani J. 3D-Printed specimens as a valuable tool in anatomy education: A pilot study. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. 2018;219:57-64. Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. Journal of anatomy. 2019;234(4):419-437.
Abbreviations List CT – Computed Tomography DICOM – Digital Imaging and Communications in Medicine STL – Standard Tessellation Language
Disclosure Form Dr. William Clifton has no conflicts of interest to disclose Mr. Aaron Damon has no conflicts of interest to disclose Dr. Rachel Stein has no conflicts of interest to disclose Dr. Mark Pichelmann has no conflicts of interest to disclose Dr. Eric Nottmeier has no conflicts of interest to disclose