High Simulation Training System for Spinal Full-Endoscopic Surgery, Based on the Combination of VR/AR and Magneto-Optical Navigation Technology

Abstract

Objective: Spinal full-endoscopic surgery is a challenging technique with a steep learning curve, limited by inadequate training models and the shortcomings of cadaver-based training. To address this, we propose a high-simulation training system using VR/AR and magneto-optical navigation technology to enhance skill development and reduce the learning curve.

Methods: A new simulation training system for spinal full-endoscopic surgery was established, which was conducted by using the data of Chinese Digital Human with medical image parameters for the three-dimensional (3D) reconstruction, as well as integrating the technical advantages of VR/AR, 3D printing, and magneto-optical navigation technology.

Results: Based on the original dataset of Chinese digital humans and clinical medical imaging processing, the data model was obtained and then the 3D printing engineering model was created. The simulation perspective filming technology, joint process shaping and cutting technology, and tube placement technology have been constructed, based on the combination of VR/AR under optical navigation. Based on electromagnetic tracking, a microscopic anatomical simulation using preorder optical navigation has been designed. Finally, a physical simulation model based on the clinical reality of flocculent behavior was constructed. As a simulator for spinal endoscopic surgery training, it was tested during an advanced endoscopic training course. Moreover, 17 out of 20 novices (85%) met the surgical standards by the end of the final simulation training session.

Conclusion: We present a high simulation training system based on the combination of VR/AR and magneto-optical navigation for spinal full-endoscopic surgery. The model may be used by surgeons starting with spinal endoscopy and should be considered a comparable and sufficiently realistic tool to train key operation steps to reduce the learning curve.

Keywords

optical magnetic navigation / simulation training system / spinal endoscopic surgery / spine / VR/AR

References

[1] A. T. Yeung and P. M. Tsou, “Posterolateral Endoscopic Excision for Lumbar Disc Herniation: Surgical Technique, Outcome, and Complications in 307 Consecutive Cases,” Spine 27 (2002): 722-731, https://doi.org/10.1097/00007632-200204010-00009.

[2] T. Hoogland, M. Schubert, B. Miklitz, and A. Ramirez, “Transforaminal Posterolateral Endoscopic Discectomy With or Without the Combination of a Low-Dose Chymopapain: A Prospective Randomized Study in 280 Consecutive Cases,” Spine 31 (2006): E890-E897, https://doi.org/10.1097/01.brs.0000245955.22358.3a.

[3] Y. Ahn, “Endoscopic Spine Discectomy: Indications and Outcomes,” International Orthopaedics 43 (2019): 909-916, https://doi.org/10.1007/s00264-018-04283-w.

[4] J. S. Lee, H. S. Kim, Y. H. Pee, J. S. Jang, and I. T. Jang, “Comparison of Percutaneous Endoscopic Lumbar Diskectomy and Open Lumbar Microdiskectomy for Recurrent Lumbar Disk Herniation,” Journal of Neurological Surgery. Part A, Central European Neurosurgery 79 (2018): 447-452, https://doi.org/10.1055/s-0037-1608870.

[5] X. Zhang, J. Du, and A. T. J. Yeung, “Development of Percutaneous Endoscopic Lumbar Discectomy (PELD) Technology in China,” Journal of Spine 6 (2017): 1-3, https://doi.org/10.4172/2165-7939.1000376.

[6] H. T. Hsu, S. J. Chang, S. S. Yang, and C. L. Chai, “Learning Curve of Full-Endoscopic Lumbar Discectomy,” European Spine Journal 22 (2013): 727-733, https://doi.org/10.1007/s00586-012-2540-4.

[7] M. Alostaz, P. Derman, P. Lipson, et al., “Attitudes Regarding Barriers to Entry and the Learning Curve Associated With Endoscopic Decompression-Only Surgery: An International Survey,” Spine Journal (2024): 1-3, https://doi.org/10.1016/j.spinee.2024.11.009.

[8] R. Fukushi, A. Teramoto, M. Yoshimoto, et al., “How Much Experience is Required to Acquire the Skills to Independently Perform Spine Surgery? What Milestones are Needed for Successful Surgery?,” Advances in Medical Education and Practice 14 (2023): 657-667, https://doi.org/10.2147/amep.S411047.

[9] N. E. Seymour, A. G. Gallagher, S. A. Roman, et al., “Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study,” Annals of Surgery 236 (2002): 458-463, https://doi.org/10.1097/00000658-200210000-00008.

[10] W. E. Lorensen and H. E. Cline, Marching Cubes: A High Resolution 3D Surface Construction Algorithm (ACM SIGGRAPH Computer Graphics, 1987), 163-169.

[11] D. Y. Lee and S. H. Lee, “Learning Curve for Percutaneous Endoscopic Lumbar Discectomy,” Neurologia Medico-Chirurgica 48 (2008): 383-388, https://doi.org/10.2176/nmc.48.383.

[12] G. Choi, S. H. Lee, K. Deshpande, and H. Choi, “Working Channel Endoscope in Lumbar Spine Surgery,” Journal of Neurosurgical Sciences 58 (2014): 77-85.

[13] G. Fan, X. Gu, Y. Liu, et al., “Lower Learning Difficulty and Fluoroscopy Reduction of Transforaminal Percutaneous Endoscopic Lumbar Discectomy With an Accurate Preoperative Location Method,” Pain Physician 19 (2016): E1123-e1134.

RIGHTS & PERMISSIONS

2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.