A high-fidelity physical simulator as a feasible assessment tool for evaluating percutaneous transforaminal endoscopic discectomy skills

Background Percutaneous transforaminal endoscopic discectomy (PTED) is an increasingly popular technique for treating symptomatic lumbar disc herniation (LDH) worldwide. However, performing PTED demands a high level of surgical proficiency, which can only be achieved through structured and extensive training. Current training methods remain inadequate for equipping novice surgeons. Methods By integrating medical image reconstruction, computer-aided design (CAD), programming, and three-dimensional (3D) printing, a high-fidelity physical simulator with interactive features was developed. An exploratory cross-sectional study involving 19 neurosurgeons and trainees was conducted to examine the preliminary feasibility of the simulator for assessing PTED portal-placement performance. Participants were categorized into three subgroups based on their prior PTED experience. Each participant then performed the simulated portal placement procedure on the simulator. Performance was evaluated using a task-specific checklist, a global rating scale (GRS), and key objective metrics. Participant feedback on the training experience and the simulator itself was collected via a participant feedback survey. Results Significant between-group differences were observed in task-specific checklist scores [ F (2,16) = 32.05, P < 0.001, η² = 0.800, 95% confidence interval (CI) 0.628–0.892], GRS scores [ F (2,16) = 18.30, P < 0.001, η² = 0.696, 95% CI 0.412–0.841], procedural duration [ F (2,16) = 8.131, P = 0.004, η² = 0.504, 95% CI 0.150–0.726], and fluoroscopy count [ F (2,16) = 5.162, P = 0.019, η² = 0.392, 95% CI 0.026–0.633]. Kruskal–Wallis sensitivity analyses supported the checklist and GRS findings. Alarm activation counts did not differ significantly among groups ( H = 2.46, P = 0.293). Clinical experience was positively associated with checklist and GRS scores in exploratory Spearman analyses. Conclusion This study presents a novel approach to developing a high-fidelity physical simulator for PTED training. The simulator distinguished participants across prior PTED experience levels in this exploratory cohort, providing preliminary evidence of its feasibility for assessing portal-placement performance. Favorable participant feedback also suggests its potential application in PTED training.