They say practice makes perfect – but for surgeons that’s easier said than done.
Now trainee neurosurgeons in Sheffield have been given a unique chance to learn techniques and get a head start on their operating skills at the first Yorkshire brain school.
Tucked away on the top floor of the Royal Hallamshire Hospital, a group of young medics make incisions in the latest cutting edge simulation tool.
Rowena – Realistic Operative Workstation for Educating Neurosurgical Apprentices –was created by Nottingham neurosurgeon Richard Ashpole using his daughter’s head as a model and includes a moulded plastic base, internal skull anatomy and a realistic plastic brain.
“It has been exceptionally useful,” said trainee Arif Zafar, as he demonstrates how to drill a neat craniotomy flap in the skull, while plastic chaff flies out across a workbench.”
The 28-year-old, of Broomhill, added: “It’s particularly good for trainees because it allows you to try things and make mistakes, which you wouldn’t be able to or want to do on a patient.
“For someone like me who is still training it gives you that independence. You can try to recreate what you have been shown in classes.
“I have been in theatre before and performed some of these techniques but it’s fascinating to be given a free hand.
“Sheffield really is leading the way in neuroscience, compared to other trusts it is one of the best in the country.”
There are limited options available in training neurosurgeons, who specialise in operations on the skull, spinal cord, brain and peripheral nerves.
Using cadavers donated to medical science is now more difficult because of restrictions in the Human Tissue Act, as well as expensive.
Neurosurgeons learn the ropes through eight years of rigorous, specialised training after qualifying as a doctor and heavily supervised sessions in theatre with senior consultants.
In the school, the trainees were shown how to carry out emergency surgery on trauma patients who may have been involved in car crashes, by opening Rowena’s skull to relieve pressure.
Another exercise looked at the correct way to expose the brain to remove a benign acoustic neuroma brain tumour on the hearing nerve.
Tools rarely used in modern neuroscience – such as a Gigli saw and brace – but which might be relied on in a power cut, can be tried out.
Trainee Hugh Sims-Williams will be using very similar instruments when volunteering in Uganda this summer.
Ola Rominiyi, 26, who is moving to Sheffield shortly to take up a new post, said: “The brain school has been wonderful, it gives you an opportunity to do things that otherwise you would be doing for the first time on a real person.
“It’s great to build up your confidence. I have done a little bit of simulation in the past but it was nowhere near as flexible as this.
“There is a huge learning curve in neurosurgery, and once you are competent it is reasonable to start to do parts of operations under supervision but this gives you the chance to practise over and over again.
“It can be daunting in theatre. I think most of the time you just feel privileged to be able to help someone.
“That’s why I wanted to go into neurosurgery. There are a lot of conditions people have through no fault of their own and we have the opportunity to help people in very difficult situations.”
The brain school, which has just run for the first time, aims to promote neurosurgical training, improve patient safety and Sheffield’s standing as a leading training unit.
It was set up by pioneering adult and paediatric neurosurgeon Saurabh Sinha and funded by the Neurocare charity.
He demonstrated endoscopic ventricilostomy, a technique used to treat the potentially fatal ‘water on the brain’.
An endoscope is placed into Rowena’s head through a burr hole and into the ventricle, while a balloon is also introduced into the floor of the third ventricle – a cavity – until a ‘pop’ is felt, and the excess cerebrospinal fluid is relieved.
All of this is done using real CT scan images and high-tech screens which pinpoint the location of the ventricle and tools.
Mr Sinha, also deputy programme director for neurosurgery and known for saving the lives of two young boys by performing their surgeries simultaneously at Sheffield Children’s Hospital, said: “It’s like your sat-nav for surgery.
“I have been operating for years and I think I would have loved to have had something like the brain school to start my training.
“It doesn’t have the pressure of theatre, there’s a different adrenaline there.
“But I think these are brilliant and they give us an opportunity that we’ve never had before.”