Periodic Reporting for period 2 - UpSurgeOn Academy (The first hybrid simulation platform for neurosurgery) Periodo di rendicontazione: 2020-10-01 al 2021-12-31 Sintesi del contesto e degli obiettivi generali del progetto UpSurgeOn (www.upsurgeon.com) is an innovative Italian med-tech start-up, based in Assago (Milan), specialized in the development of virtual reality and physical simulation technologies for psychomotor enhancement, for surgical and neurosurgical training in particular. UpSurgeOn counts on the collaboration of a team of over twenty-five people, all with a solid technical-scientific background. Thanks to a Horizon 2020 grant obtained by the European Community in 2019, UpSurgeOn has developed a series of 3D models of anatomical structures with micrometric precision to simulate surgical procedures. The technology integrates virtual reality and simulates physical reality that replicates tissues and surgical scenarios in a hyper-realistic way. As an example, the technology does so by artificially duplicating the human brain with a surgically removable tumor inside the skull box. The uniqueness of UpSurgeOn's platform consists of its integration of physical and virtual anatomical and surgical representations in advanced and innovative psychomotor training sequences. Importantly, UpSurgeOn’s innovation eliminates the need to use human anatomical preparations of cadaveric derivation. The aim is to progress from mere physiological simulation to a pathological one, even up to the realization of patient-specific solutions. UpSurgeOn has already begun to widen the applications from neurosurgery to other surgical specializations. Despite the pandemic, in 2021 UpSurgeOn spread its technologies to more than 70 countries around the world, including 11 emerging countries. To the latter, a training program has been dedicated, conceived and funded by the Italian company, called Global Training Project: a neurosurgical training programme on the use of on-site neurosurgical simulators. UpSurgeOn has participated in training sessions in developing countries with the support of international medical school faculties connected online to the educational events. This project was supported by the WFNS (World Federation of Neurosurgical Societies) and NIHR (National Institute for Health Research). Thanks to the great success of these initiatives, UpSurgeOn, in addition to holding neurosurgical courses in the most prestigious Universities and healthcare Institutions in the world such as the Charité in Berlin or Mass General Hospital, Harvard Medical School, Boston, USA, is developing many high-level collaborations, such as an important validation study of its technologies started in February at Harvard Medical School in Boston, USA. Lavoro eseguito dall’inizio del progetto fino alla fine del periodo coperto dalla relazione e principali risultati finora ottenuti UpSurgeOn has developed the mental (App) and manual (physical products) training tools related to 6 cranial procedures for neurosurgery: Pterional, Temporal, Retrosigmoid, Interhemispheric, Suboccipital and Transsphenoidal approach. For the digital part of the development (mental training), these approaches are included in “Neurosurgery” App while the physical components of UpSurgeOn Academy are composed of 6 different physical devices, integrated in a unique modular solution, the BrainBox.During Period 1, we’ve started to collaborate with leading institutions for demonstration and acceptability and we had the first real-live demonstrations at University of Berlin - Charitè Hospital (Berlin) and Royal London Hospital (London) where we had workshops with students, resident and young neurosurgeons who had the chance to experiment a series of tasks with our prototypes products.At the same time, several dissemination and communication activities have also been implemented to raise awareness of UpSurgeOn Academy products In the second period, the pandemic forced us to review our large-scale testing and dissemination strategy because of the interruption of live scientific events and travelling. Talking about the hands-on courses, we have successfully experimented a new way of disseminating training and testing experience by opting for a “distancing hands-on” training strategy. We started delivering the technology allowing to local faculties to perform cadavers-free neurosurgical courses in their institutions with our online support in the use of the technology and the online participation of international faculties. Actually, this kind of training strategies were part of our mission since the beginning and represented a major driver in the design of our technologies. Talking about dissemination activities during the second period, we organized 35 hands-on training courses and 7 conferences. In all the courses and workshops, we collected survey-based feedbacks (around 250) and recorded interviews (around 25).In terms of Business Model, despite our initial focus on B2C and Institutional B2B, we started working on creating specific collaborations with medical industries. The courses organized around the world and global training have naturally strengthened the interest of industrial B2B. With the pandemic and the drastic interruption of cadaver lab courses, Institutional B2B has strengthened the demand for technologies for remote training or in any case without the use of cadavers. For the same reasons medical industries started asking for alternatives to cadavers for their courses.For those reasons, we reversed our business model strategy by targeting schools directly, and through schools to reach end users, i.e. trainees, all this through collaboration with industries, often major sponsors of courses within institutions. Commercially, in 2021 we carried out more than 35 courses and recorded more than 300 customers in more than 70 countries around the world, 50% of which represented by Universities and Neurosurgery Schools. Progressi oltre lo stato dell’arte e potenziale impatto previsto (incluso l’impatto socioeconomico e le implicazioni sociali più ampie del progetto fino ad ora) State of the art in surgical simulations remains linked either to digital or physical tools with limited impact on the life-like training experience. The idea behind UpSurgeOn to have a low-cost, easy distributable and multi-usable platform which integrates digital and physical tools (through AR) remains unique in the market. The opportunity to have a “cadaver-free lab” available everywhere, not just in Hospitals or expensive medical schools, maintains the social impact plus of the academy and has created an (unforeseen) interest in Muslim countries where the use (even for scientific research or training) of cadaver is prohibited by religion roles (read Shari’a).As mentioned above, our technology has an impact both on developed countries by accelerating training and reducing costs associated with using cadavers and developing countries by replacing cadavers. The results of this dissemination are listed in the previous paragraphs. It is essential to underline the importance of the conceptual evolution of training in surgery. In the last 20 years we have been moving from a traditional approach such as “see one, do one, teach one” to “see one, do many, teach many”, obviously adopting ways of training based on simulation-based resources, as alternative to patients or cadaveric dissection. This is the arise of the concept of psychomotor training based on the repetition of a low-cost exercise. This evolution will lead us to the certification of surgical skills, as seen in other disciplines such as aviation. UpSurgeOn, thanks to its integration between virtual and physical, is taking fundamental steps in this direction. Real-live demonstration AR development First set of 3 BrainBoxes Real-live demonstration Set of 6 BrainBoxes + Aneurysms (pathologic variant of Pterional) AR development
