By Nicoletta Lanese
A new anatomy lab in the basement of the Grant Building gives Stanford neurosurgery trainees a convenient place to hone their skills.
“Our anatomy labs have all been coordinated at outside facilities, and for people on call, they can’t just go 30 minutes away to do a lab,” said neurosurgery resident Linda Wei Xu, MD. “It’ll be great to have our own lab for day-to-day use.” The off-campus labs focused on theoretical cases. With their own lab on the Stanford campus, residents will be able to practice for specific cases, Xu said.
The lab complements the Neurosurgical Simulation and Virtual Reality Center, which opened in 2016 and allows trainees to explore three-dimensional, digital renditions of brain structures. The new anatomy lab acts as a bridge between the simulation center and operating room.
“In the simulation lab, the residents can put on the goggles, interact with the patient anatomy and learn about the case they’re about to do the next day,” said Harminder Singh, MD, clinical associate professor of neurosurgery. “Then in the anatomy lab, they do the dissection on real cadaver heads and practice the surgery techniques.”
Anand Veeravagu, MD, assistant professor of neurosurgery, said, “It’s to give them an opportunity to feel safe, to train outside of the OR, and not feel they ever need to do anything for the first time in the operating room.”
Gary Steinberg, MD, PhD, professor and chair of neurosurgery, spearheaded the creation of the simulation and anatomy labs with the help of Singh, Veeravagu and Michel Kliot, MD, clinical professor of neurosurgery. The simulation lab has already become integral to resident education and clinical practice.
“It’s really a versatile system that translates from patient engagement and intraoperative navigation all the way through to resident and fellow education,” said biomedical engineer Malie Collins, the virtual reality program coordinator. Since the simulation lab opened, Collins has constructed over 500 virtual-reality models of complex neurosurgical cases, including aneurysms, tumors and spine deformities. The software, called Surgical Theater, transforms two-dimensional patient data sets, like angiograms, MRIs and CT scans, into 3-D virtual environments.
The lab seems plucked from a video gamer’s wildest dreams. Cushy chairs face ultra-high-definition monitors. By donning virtual-reality goggles and using handheld controllers, residents can navigate through an actual patient’s neuroanatomy, manipulating it — rotating structures, removing obstructing tissues — as they explore.
The operating system can also travel beyond the simulation lab, wheeled on to operating rooms and clinics. Surgeons can use the system to plan operations and guide their instruments during surgery, like a 3-D GPS system. In the clinic, patients are able to visualize their conditions in a new, totally customized way.
Abhinav leads a training session for
residents in the new neurosurgical
anatomy laboratory. Paul Sakuma
“Even patients that know everything about their disease still benefit, because I guarantee they haven’t flown inside their spine or their brain,” Collins said.
The virtual-reality system headset is a powerful visualization tool for surgeons and patients alike, but it cannot offer residents hands-on training. That’s where the anatomy lab comes in.
“The room looks a little less impressive than the simulation center, but it’s where all the dirty work gets done,” Veeravagu said.
The lab is equipped with shiny new tools, including high-speed drills, high-tech navigation systems and dissection instruments. “We are trying to recreate the OR environment in the cadaver lab so residents can have that same experience,” Singh said. A new microscope commands particular presence in the corner of the room. Standing taller than a man, it allows residents to project 3-D models directly onto their cadavers.
The lab’s donated equipment, worth more than $1.5 million, took about 18 months to procure, and now the lab is ready to go. Residents have unlimited access to the lab to study anatomy, practice surgical procedures and plan operations. The lab will also host workshops demonstrating rare procedures and new techniques. Beyond benefiting residents, these workshops could be instructive to Stanford surgeons and draw practitioners from outside Stanford.
The anatomy lab was christened with one such workshop back in June. Residents gathered around the dissection stations to learn a new technique for treating carpal tunnel syndrome. The minimally invasive procedure uses high-powered ultrasound and requires an incision only the size of a pinprick. In the coming months, the lab will host workshops in minimally invasive spine and skull surgeries.
Though the lab is open for business, it is only a prototype. The Grant Building is scheduled for demolition in the next few years, and the neurosurgical anatomy and simulation labs will be relocated to a more permanent location.
The Department of Neurosurgery hopes to build the next dissection lab from the ground up. “Our current space is not made for a cadaver dissection lab — we basically converted it for lack of space,” Singh said. “The room has to be built in a certain way so you can explore the lab’s full capability.”
Ideally, the future lab would have space for three additional stations, so six dissections could take place at once. The tables would be built into the walls and the room shielded for X-rays. The walls would be lined with freezers for long-term cadaver storage and LCD screens for endoscopic procedures, in which surgeons use instruments to look inside the body. The department also hopes to add to its microscope collection.
In the meantime, neurosurgery trainees are excited to take advantage of the current lab.
“The cadavers provide an education for the entire range of trainees we have, even medical students,” Veeravagu said. “Just getting to specific parts of the brain is very challenging and requires repetitive exercise, and that’s what the cadavers allow folks to do.”
“The real benefit is that, when you have a case come up, you now have a resource where you have a chance to practice before you do it,” Xu said.
Trainees’ work in the simulation center promises to make their time in the anatomy lab even more fruitful. Residents will visualize their case inside a 3-D model, perfect their procedural approach on a cadaver and bring that proficiency to the operating room, Veeravagu said.
“It’s a seamless way to build confidence and training in what they’re doing,” he said.
Medtronic, Stryker, Haag-Streit USA and Mizuho donated equipment to the lab.