The ASTRO-NETS project starts at Besta in Milan: neurosurgeons trained as astronauts and pilots

Imagine being a young neurosurgery resident: for years you have studied, hundreds of hours, and, in the room, you have watched others operate. Then, one day, it's your turn. Thus Francesco DiMeco, director of the Department of Neurosurgery of the Carlo Besta National Neurological Institute in Milan, explains how the idea of ​​the ASTRO-NETS project which aims to train neurosurgeons with an innovative approach and training inspired by that of astronauts and pilots.

Neurosurgeons as astronauts and pilots

Let's imagine that doctor, around 30 years old, with a scalpel in his hand and a patient in front of him, who is not always sedated because it may happen that he operates on alert and cooperating patients in order to be able to monitor and safeguard their neurological functions (it's called Awake Surgery, English expression meaning awake surgery). The decisions are his, he must move his hands on that very delicate field that is the central nervous system (brain and spinal cord) or peripheral (nerves). His responsibility towards the patient and his family and the risk of unwanted consequences, touching on areas as complex as they are decisive, is always high.

The level of stress, tension, anxiety and even fear is very high. Not very different, after all, from that of someone who flies a plane full of passengers or someone who leaves for a mission in space – says DiMeco, director of the Besta School of Specialization in Neurosurgery and Professor at the University of Milan -. Training, preparation, is fundamental. Not only to learn the technique, but also to gain confidence and know how to manage the many possible unexpected events. ASTRO-NETS was born for this. Leverage methodologies and lessons learned from astronaut training to improve and innovate neurosurgeon training, with a particular focus on developing soft skills and managing complex, high-risk situations.

Fundamental preparation

To testify to the similarities, he spoke at the presentation of the project in Milan Paolo Nespoli, former Italian astronaut, engineer and soldier. Born in 1957, Nespoli carried out 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.

In the various phases of the space missions, including the launch, I never felt fear because I was aware both of the preparation of the other team members who were with me on the spacecraft or in the ground support centers, and of my own level of personal and professional preparation – he said –. As a patient, I fearlessly placed myself in the hands of Besta's expert neurosurgeons, having full confidence in their preparation and professional abilities. For this reason I believe it is essential that young neurosurgeons follow this course in order to acquire the necessary personal and professional preparation. Part of neurosurgery training takes place on a corpse, with various limitations, starting from the fact that there is often no real disease present and that, obviously, operating is not as complex as in reality. Psychological pressure included.

The new project: the simulation platform

An important step forward was made with the NeuroSim Center, a cutting-edge neurosurgical simulation center, started 10 years ago which has allowed us to exploit all the innovations deriving from virtual and augmented reality, with very expensive machinery – continues diMeco -. And then with HUVANT, a start up from the University of Milan, launched 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 innovative polymeric materials capable of fully simulating the mechanical and functional properties of biological tissues.

Thus, trainees have great opportunities to acquire the technical skills essential for their profession, but the behavioral aspects remain to be refined: r

Andrelationships with patients, management of critical situations (in the operating room and outside), anxiety 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 Heal Foundation which finances and promotes the project, committing itself to the development of research in the fight against brain tumors; Simone Pozzi and Vanessa Arrigoni, respectively CEO and Lead Consultant of Deep Bluea company specialized in the field of Human Factors and Security, with experience in the aviation and space sectors.

Limit errors, like in flight

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 – underlines Perin -: high-risk environments, training based on immersive experience to develop key skills such as teamwork, communication, problem solving, decision making and stress management in a hostile environment, simulators and advanced technologies, non-technical skills training and adaptation to unexpected situations. In this journey Paolo Nespoli was a precious source of discussion and experience. We want to understand if neurosurgeons can also benefit from “complete” training, as already happens for astronauts and airline pilots. It is no longer acceptable to train doctors, including neurosurgeons, through an apprenticeship that also proceeds through trial and error. When we board a plane, we don't ask who the pilot is, what he looks like, whether or not he is qualified; we trust, without doubts or fears. We want this to happen tomorrow also for patients who need to solve a health problem and undergo surgery in complete safety.

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