• Giselle Coelho, Eberval Gadelha Figueiredo, Nícollas Nunes Rabelo, Rodrigues de Souza Matheus M Internal Medicine, University of the State of Mato Grosso, Cáceres, Mato Grosso, Brazil., Caroline Ferreira Fagundes, Manoel Jacobsen Teixeira, and Nelci Zanon.
• Pediatric Neurosurgery-Department of Neurosurgery, Santa Marcelina Hospital, São Paulo, Brazil; Department of Neurosurgery, University of Sao Paulo, São Paulo, Brazil; Neurosurgical Department, EDUCSIM Institute, São Paulo, Brazil.
• World Neurosurg. 2020 Jul 1; 139: e189-e202.

ObjectiveNeurosurgical training requires several years of supervised procedures and represents a long and challenging process. The development of surgical simulation platforms is essential to reducing the risk of potentially intraoperative severe errors arising from inexperience. To present and perform a phase I validation process of a mixed reality simulation (realistic and virtual simulators combined) for neuroendoscopic surgical training.MethodsTridimensional videos were developed by the 3DS Max program. Physical simulators were made with a synthetic thermoretractile and thermosensible rubber, which, when combined with different polymers, produces >30 different textures that simulate consistencies and mechanical resistance of human tissues. Questionnaires regarding the role of virtual and realistic simulators were applied to experienced neurosurgeons to assess the applicability of the mixed-reality simulation for neuroendoscopic surgical training.ResultsThe model was considered as a potential tool for training new residents in neuroendoscopic surgery. It was also adequate for practical application with inexperienced surgeons. According to the overall score, 83% of the surgeons believed that the realistic physical simulator presents distortions when compared with the real anatomic structure, afterwards the model improved 66% tridimensional reconstruction and 66% reported that the virtual simulator allowed a multiangular perspective ability.ConclusionsThis model provides a highly effective way of working with 3-dimensional data and significantly enhances the learning of surgical anatomy and operative strategies. The combination of virtual and realistic tools may safely improve and abbreviate the surgical learning curve.Copyright © 2020 Elsevier Inc. All rights reserved.

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