Development and prospective validation of a porcine simulation model for training in unilateral biportal endoscopic spine surgery.

OBJECTIVE

Unilateral biportal endoscopic spine surgery (UBE) offers several advantages over traditional techniques but is associated with a steep learning curve and limited access to structured training. Simulation-based education may facilitate skill acquisition, however, validated training platforms for UBE remain limited. This study aimed to develop and validate a porcine simulation model for UBE lumbar decompression and evaluate its educational impact using established simulation validity frameworks.

METHODS

A prospective educational study was conducted at the University of Ottawa between October 2025 and April 2026. Thirty-six participants with varying levels of surgical experience completed a structured curriculum consisting of baseline assessment, instructional training, and posttraining evaluation. Performance was assessed using a 7-point Likert-based global rating scale and task completion time across 3 standardized tasks. Face, content, and construct validity were evaluated through participant questionnaires and performance comparisons. Pre- and posttraining performance was analyzed using paired statistical tests. Univariate and multivariate linear regression analyses were performed to identify predictors of baseline performance.

RESULTS

Twenty-seven participants completed both pre- and posttraining assessments; 35 participants contributed baseline data for construct validity analysis. The simulator demonstrated high face and content validity, with median Likert scores of 6-7. Construct validity was supported by significantly higher baseline performance among advanced participants compared with novices across all tasks (task 1 combined total score, p = 0.003; task 2, p = 0.007; task 3, p < 0.001). Following training, significant improvements were observed across all tasks and performance domains (all p < 0.001). Task completion times also decreased significantly across all tasks (all p < 0.001). Regression analysis identified surgical experience as a key predictor of baseline performance.

CONCLUSIONS

The porcine UBE simulation model represents a cost-effective training platform with established face, content, and construct validity and produces measurable short-term improvements in simulator performance after a single structured session. This model provides a practical approach to support structured training in UBE spine surgery. Predictive validity, long-term skill retention, and whether simulation-acquired skills shorten the operative learning curve remain hypotheses for future study.