Critical Anatomy-Preserving and Terrain-Augmenting Navigation (CAPTAiN): Application to Laminectomy Surgical Education

Abstract

Surgical training remains a crucial milestone in modern medicine, with procedures such as laminectomy exemplifying the high risks involved. Laminectomy drilling requires precise manual control to mill bony tissue while preserving spinal segment integrity and avoiding breaches in the dura–the protective membrane surrounding the spinal cord. Despite unintended dural tears occurring in up to 11.3% of cases, no assistive tools are currently utilized to reduce this risk. Variability in patient anatomy further complicates learning for novice surgeons. This study introduces CAPTAiN, a critical anatomy-preserving and terrain-augmenting navigation system that provides layered, color-coded voxel guidance to enhance anatomical awareness during spinal drilling. CAPTAiN was evaluated against a standard non-navigated approach through 110 virtual laminectomies performed by 11 orthopedic residents and medical students. CAPTAiN significantly improved surgical completion rates of target anatomy (87.99% vs. 74.42%) and reduced cognitive load across multiple NASA-TLX domains. It also minimized performance gaps across experience levels, enabling novices to perform on par with advanced trainees. These findings highlight CAPTAiN’s potential to optimize surgical execution and support skill development across experience levels. Beyond laminectomy, it demonstrates potential for broader applications across various surgical and drilling procedures, including those in neurosurgery, otolaryngology, and other medical fields.