Improving the metric of surgical freedom in the laboratory based on a novel concept of volume

Authors

Lena Mary Houlihan, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
David Naughton, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Thanapong Loymak, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Jubran H. Jubran, University of Arizona College of Medicine, Tucson, AZ, USA.Follow
Michael G. O'Sullivan, Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland.
Michael T. Lawton, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.Follow
Mark C. Preul, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA - Neuropub@barrowneuro.org.

Document Type

Article

Abstract

BACKGROUND: In laboratory-based neuroanatomical studies, surgical freedom, the most important metric of instrument maneuverability, has been based on Heron's formula. Inaccuracies and limitations hinder this study design's applicability. A new methodology, volume of surgical freedom (VSF), may produce a more realistic qualitative and quantitative representation of a surgical corridor. METHODS: Overall, 297 data set measurements assessing surgical freedom were completed for cadaveric brain neurosurgical approach dissections. Heron's formula and VSF were calculated specifically to different surgical anatomical targets. Quantitative accuracy and the results of an analysis of human error were compared. RESULTS: Heron's formula for irregularly shaped surgical corridors resulted in overestimation of the respective areas (minimum overestimation 31.3%). In 92% (188/204) of data sets reviewed for influence of offset, areas calculated on the basis of measured data points were larger than areas calculated on the basis of the translated best-fit plane points (mean [SD] overestimation of 2.14% [2.62%]). Variability in the probe length attributable to human error was small (mean [SD] calculated probe length 190.26 mm [5.57 mm]). CONCLUSIONS: VSF is an innovative concept that can develop a model of a surgical corridor producing better assessment and prediction of the ability to maneuver and manipulate surgical instruments. VSF corrects for deficits in Heron's method by generating the correct area for an irregular shape using the shoelace formula, adjusting the data points to account for offset, and attempting to correct for human error. VSF produces 3-dimensional models and, therefore, is a preferable standard for assessing surgical freedom.

Publication Date

2-21-2023

Publication Title

Journal of neurosurgical sciences

E-ISSN

1827-1855

PubMed ID

36800812

Digital Object Identifier (DOI)

10.23736/S0390-5616.23.05988-X

Recommended Citation

Houlihan, Lena Mary; Naughton, David; Loymak, Thanapong; Jubran, Jubran H.; O'Sullivan, Michael G.; Lawton, Michael T.; and Preul, Mark C., "Improving the metric of surgical freedom in the laboratory based on a novel concept of volume" (2023). Neurosurgery. 1802.
https://scholar.barrowneuro.org/neurosurgery/1802