Project title

Overcoming the surgical learning curve with highly realistic physical simulators – a study in endoscopic lumbar spine surgery




There are learning curves associated with every surgical procedure. This has profound implications for surgical training and patient safety. Surgeons are slower in the earliest cases of a newly learned operation, and patients that comprise those earliest cases inevitably face greater risks. Traditionally, these risks are managed by the master-apprentice model of training, while also managing the delicate balance between maintaining patient safety and the training needs of trainees.

Endoscopic “keyhole” spine surgery is a relatively new technique, with very few surgeons having the requisite experience. Most surgeons who incorporate endoscopic spinal surgery into their practice rarely have the benefit of long traditional master-apprentice model of training. The keyhole approach to spinal surgery comes with several advantages over the much more familiar “open” surgery approach. Our unpublished review shows that it takes around 50 cases to plateau in terms of operating speed, with most of the improvement happens in the very earliest cases – with around 20 cases required for 80% improvement in operating speed. It takes even longer for the risk of complications to substantially reduce, with 50 cases resulting in 80% reduction in surgical complications.


Fully qualified spinal surgeons, with no or minimal experience in endoscopic spinal surgery, will perform ten procedures on the simulators, the RealSpine Advanced MISS system. The real-life performance of participating surgeons will be monitored and compared against an established learning curve and the data set to find out if using advanced simulation systems might give a “head start” in overcoming the learning curve, increase the rate of learning, or improve patient safety and service delivery.


This project will investigate the extent to which realistic physical surgical simulation training, using endoscopic lumbar spinal surgery as an exemplar, can improve real-world surgical performance and outcomes.