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“Imagine you are a young neurosurgery resident: you have studied for years, spent hundreds of hours, and watched others operate in the room. Then, one day, it’s your turn. This is how Francesco DiMeco, Director of the Department of Neurosurgery at the Carlo Besta National Neurological Institute in Milan, explains how the idea of the ASTRO-NETS project was born, which aims to train neurosurgeons with an innovative approach and training inspired by astronauts and pilots.
Neurosurgeons as astronauts and pilots
Let’s imagine a doctor, about 30 years old, with a scalpel in his hand and a patient in front of him, who is not always sedated because he may have to operate on alert and cooperating patients in order to be able to monitor and protect their neurological functions ( It is called Awake Surgery. The decisions are his, he has to move his hands in this very sensitive area which is the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves). They have a responsibility towards the patient and their relatives, and the risk of undesirable consequences is always high in areas that are as complex as they are crucial.
The level of stress, tension, anxiety and even fear is very high. “After all, not much different than someone piloting a plane full of passengers or setting off on a mission in space,” says DiMeco, director of the Besta School of Specialization in Neurosurgery and professor at the University of Milan. . Training and preparation are essential. Not only to learn the technique, but also to gain confidence and know how to deal with the many possible unexpected events. This is why ASTRO-NETS was born. It uses methods and insights from astronaut training to improve and innovate the training of neurosurgeons, with a particular focus on developing soft skills and managing complex, high-risk situations.”
Basic preparation
To illustrate the similarities, Paolo Nespoli, former Italian astronaut, engineer and soldier, spoke at the project’s presentation in Milan. Born in 1957, Nespoli performed his first launch in 2007, the last landing in 2017, three missions in space for a total of 313 days, 2 hours and 36 minutes in orbit. In 2021, he underwent successful surgery for cerebral lymphoma.
“During the various phases of space missions, including launch, I was never afraid because I was aware of both the preparation of the other team members who were with me on the spacecraft or in the ground support centers, as well as my own personal level and professional preparation – he said –. As a patient, I fearlessly placed myself in the hands of Besta’s experienced neurosurgeons and had full confidence in their preparation and ability to work. For this reason, I consider it essential that young neurosurgeons complete this course in order to obtain the necessary personal and professional preparation.” Part of the training in neurosurgery takes place on a cadaver, with various limitations, starting with the fact that Often there is no real illness and the operation is obviously not as complex as in reality. Psychological pressure included.
The new project: the simulation platform
“An important step forward was taken with the NeuroSim Center, a state-of-the-art neurosurgical simulation center founded 10 years ago that allowed us to exploit all the innovations of virtual and augmented reality with very expensive machines,” continues diMeco. And then with HUVANT, a start-up from the University of Milan founded in 2023, which allows the creation of a new class of surgical simulation platforms based on the use of printed organ models obtained through 3D manufacturing technologies and materials of innovative polymers with the mechanical and functional properties of biological ones “Completely simulate tissue”.
Trainees therefore have a good chance of acquiring the technical skills essential to their profession, but the “behavioral aspects” still need to be refined: relationships with patients, coping with critical situations (in the operating room and outside), fear and stress. And this is where the ASTRO-NETS project comes into play, the result of the collaboration between DiMeco and Alessandro Perin, neurosurgeon at Besta and scientific director of the NeuroSim Center; Simone De Biase, President of the Healche Foundation, funds and promotes the project and is committed to the development of research in the fight against brain tumors; Simone Pozzi and Vanessa Arrigoni, respectively CEO and Lead Consultant of Deep Blue, a human factors and security company with experience in the aerospace industry.
Limit mistakes, like when flying
“The link between the training of astronauts and that of neurosurgeons lies in the application of advanced and innovative training techniques and approaches and is based on some key elements – emphasizes Perin –: high-risk environments, training based on immersive experiences to develop key competencies.” such as teamwork, communication, problem solving, decision making and stress management in a hostile environment, simulators and advanced technologies, non-technical skills training and adapting to unexpected situations. On this trip, Paolo Nespoli was a valuable source of discussion and experience. We want to understand whether neurosurgeons can also benefit from “comprehensive” training, as is already the case for astronauts and airplane pilots. It is no longer acceptable to train physicians, including neurosurgeons, through training that is also trial and error. When we board a plane, we don’t ask ourselves who the pilot is, what he looks like, whether he is qualified or not; We trust, without doubts or fears. We want this to happen tomorrow also for patients who need to resolve a health problem and undergo surgery in complete safety.”
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