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Bolton L, Young K, Ray J, Chawdhary G. Virtual temporal bone simulators and their use in surgical training: a narrative review. J Laryngol Otol 2024; 138:356-360. [PMID: 37973532 DOI: 10.1017/s0022215123002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Temporal bone dissection is a difficult skill to acquire, and the challenge has recently been further compounded by a reduction in conventional surgical training opportunities during the coronavirus disease 2019 pandemic. Consequently, there has been renewed interest in ear simulation as an adjunct to surgical training for trainees. We review the state-of-the-art virtual temporal bone simulators for surgical training. MATERIALS AND METHODS A narrative review of the current literature was performed following a Medline search using a pre-determined search strategy. RESULTS AND ANALYSIS Sixty-one studies were included. There are five validated temporal bone simulators: Voxel-Man, CardinalSim, Ohio State University Simulator, Melbourne University's Virtual Reality Surgical Simulation and Visible Ear Simulator. The merits of each have been reviewed, alongside their role in surgical training. CONCLUSION Temporal bone simulators have been demonstrated to be useful adjuncts to conventional surgical training methods and are likely to play an increasing role in the future.
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Affiliation(s)
- Lauren Bolton
- ENT Offices, York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York UK
| | - Kenneth Young
- ENT, Castle Hill Hospital, Hull University Teaching Hospital, Hull, UK
| | - Jaydip Ray
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gaurav Chawdhary
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Concheri S, Brotto D, Ariano M, Daloiso A, Di Pasquale Fiasca VM, Sorrentino F, Coppadoro B, Trevisi P, Zanoletti E, Franchella S. Intraoperative Measurement of Insertion Speed in Cochlear Implant Surgery: A Preliminary Experience with Cochlear SmartNav. Audiol Res 2024; 14:227-238. [PMID: 38525682 PMCID: PMC10961689 DOI: 10.3390/audiolres14020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES The objectives were to present the real-time estimated values of cochlear implant (CI) electrode insertion speed (IS) during intraoperative sessions using the Cochlear Nucleus SmartNav System to assess whether this measure affected CI outcomes and to determine whether real-time feedback assists expert surgeons in achieving slow insertion. METHODS The IS was measured in 52 consecutive patients (65 implanted ears) using the CI632 electrode. The IS values were analyzed in relation to procedure repetition over time, NRT ratio, and CI audiological outcomes. RESULTS The average IS was 0.64 mm/s (SD = 0.24); minimum and maximum values were 0.23 and 1.24 mm/s, respectively. The IS significantly decreased with each array insertion by the operator (p = 0.006), and the mean decreased by 24% between the first and last third of procedures; however, this reduction fell within the error range of SmartNav for IS (+/-0.48 mm/s). No correlation was found between IS and the NRT ratio (p = 0.51), pure-tone audiometry (PTA) at CI activation (p = 0.506), and PTA (p = 0.94) or word recognition score (p = 0.231) at last evaluation. CONCLUSIONS The estimated IS reported by SmartNav did not result in a clinically significant reduction in insertion speed or an improvement in CI hearing outcomes. Real-time feedback of IS could potentially be used for training, but its effectiveness requires confirmation through additional studies and more accurate tools. Implementation of IS assessment in clinical practice will enable comparisons between measurement techniques and between manual and robot-assisted insertions. This will help define the optimal IS range to achieve better cochlear implant (CI) outcomes.
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Affiliation(s)
- Stefano Concheri
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Davide Brotto
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Marzia Ariano
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Antonio Daloiso
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | | | - Flavia Sorrentino
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Beatrice Coppadoro
- Pediatric Hematology Oncology Unit, Department of Woman’s and Child’s Health, Azienda Ospedale-Università di Padova, 35122 Padua, Italy
| | - Patrizia Trevisi
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Sebastiano Franchella
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
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Zagury-Orly I, Solinski MA, Nguyen LH, Young M, Drozdowski V, Bain PA, Gantwerker EA. What is the Current State of Extended Reality Use in Otolaryngology Training? A Scoping Review. Laryngoscope 2023; 133:227-234. [PMID: 35548939 DOI: 10.1002/lary.30174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To map current literature on the educational use of extended reality (XR) in Otolaryngology-Head and Neck Surgery (OHNS) to inform teaching and research. STUDY DESIGN Scoping Review. METHODS A scoping review was conducted, identifying literature through MEDLINE, Ovid Embase, and Web of Science databases. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. Studies were included if they involved OHNS trainees or medical students who used XR for an educational purpose in OHNS. XR was defined as: fully-immersive virtual reality (VR) using head-mounted displays (HMDs), non-immersive and semi-immersive VR, augmented reality (AR), or mixed reality (MR). Data on device use were extracted, and educational outcomes were analyzed according to Kirkpatrick's evaluation framework. RESULTS Of the 1,434 unique abstracts identified, 40 articles were included. All articles reported on VR; none discussed AR or MR. Twenty-nine articles were categorized as semi-immersive, none used occlusive HMDs therefore, none met modern definitions of immersive VR. Most studies (29 of 40) targeted temporal bone surgery. Using the Kirkpatrick four-level evaluation model, all studies were limited to level-1 (learner reaction) or level-2 (knowledge or skill performance). CONCLUSIONS Current educational applications of XR in OHNS are limited to VR, do not fully immerse participants and do not assess higher-level learning outcomes. The educational OHNS community would benefit from a shared definition for VR technology, assessment of skills transfer (level-3 and higher), and deliberate testing of AR, MR, and procedures beyond temporal bone surgery. Laryngoscope, 133:227-234, 2023.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mark A Solinski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lily Hp Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Meredith Young
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veronica Drozdowski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Li J, Wu Y, Zhuo J, Wang Z. Modeling and simulation of cochlear perimodiolar electrode based on composite spring-mass model. Comput Methods Biomech Biomed Engin 2021; 25:290-297. [PMID: 34263671 DOI: 10.1080/10255842.2021.1950145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper proposes, a method for the physical modeling of the perimodiolar electrode, particularly for the process of recovering its preset shape with the guide wire drawn out, based on the composite spring-mass model by employing the virtual-volumetric spring inspired from the traditional spring-mass model. Simulation experiments of modeling and virtual insertion of perimodiolar electrode were carried out. The results indicated that the mean and standard deviation of the difference between the local deformation angles of the simulated and measured sets of mass points, (1, 2, 3), (2, 3, 4), …, (13, 14, 15), were 6.34° and 5.98°, respectively. Additionally, the physical model of the perimodiolar electrode can reflect the overall morphological changes of the real perimodiolar electrode.
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Affiliation(s)
- Jianjun Li
- College of Mechanical and Electrical Engineering, China Jiliang University, Hangzhou, China
| | - Yue Wu
- College of Mechanical and Electrical Engineering, China Jiliang University, Hangzhou, China
| | - Jianye Zhuo
- College of Mechanical and Electrical Engineering, China Jiliang University, Hangzhou, China
| | - Zuo Wang
- College of Artificial Intelligence and Innovation, Ma'anshan University, Ma'anshan, China
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Frendø M, Frithioff A, Konge L, Sørensen MS, Andersen SAW. Cochlear implant surgery: Learning curve in virtual reality simulation training and transfer of skills to a 3D-printed temporal bone - A prospective trial. Cochlear Implants Int 2021; 22:330-337. [PMID: 34151753 DOI: 10.1080/14670100.2021.1940629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Mastering Cochlear Implant (CI) surgery requires repeated practice, preferably initiated in a safe - i.e. simulated - environment. Mastoidectomy Virtual Reality (VR) simulation-based training (SBT) is effective, but SBT of CI surgery largely uninvestigated. The learning curve is imperative for understanding surgical skills acquisition and developing competency-based training. Here, we explore learning curves in VR SBT of CI surgery and transfer of skills to a 3D-printed model. METHODS Prospective, single-arm trial. Twenty-four novice medical students completed a pre-training CI inserting test on a commercially available pre-drilled 3D-printed temporal bone. A training program of 18 VR simulation CI procedures was completed in the Visual Ear Simulator over four sessions. Finally, a post-training test similar to the pre-training test was completed. Two blinded experts rated performances using the validated Cochlear Implant Surgery Assessment Tool (CISAT). Performance scores were analyzed using linear mixed models. RESULTS Learning curves were highly individual with primary performance improvement initially, and small but steady improvements throughout the 18 procedures. CI VR simulation performance improved 33% (p < 0.001). Insertion performance on a 3D-printed temporal bone improved 21% (p < 0.001), demonstrating skills transfer. DISCUSSION VR SBT of CI surgery improves novices' performance. It is useful for introducing the procedure and acquiring basic skills. CI surgery training should pivot on objective performance assessment for reaching pre-defined competency before cadaver - or real-life surgery. Simulation-based training provides a structured and safe learning environment for initial training. CONCLUSION CI surgery skills improve from VR SBT, which can be used to learn the fundamentals of CI surgery.
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Affiliation(s)
- Martin Frendø
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
| | - Andreas Frithioff
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
| | | | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven A W Andersen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
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Liu T, Tai Y, Zhao C, Wei L, Zhang J, Pan J, Shi J. Augmented reality in neurosurgical navigation: a survey. Int J Med Robot 2020; 16:e2160. [PMID: 32890440 DOI: 10.1002/rcs.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Neurosurgery has exceptionally high requirements for minimally invasive and safety. This survey attempts to analyze the practical application of AR in neurosurgical navigation. Also, this survey describes future trends in augmented reality neurosurgical navigation systems. METHODS In this survey, we searched related keywords "augmented reality", "virtual reality", "neurosurgery", "surgical simulation", "brain tumor surgery", "neurovascular surgery", "temporal bone surgery", and "spinal surgery" through Google Scholar, World Neurosurgery, PubMed and Science Direct. We collected 85 articles published over the past five years in areas related to this survey. RESULTS Detailed study has been conducted on the application of AR in neurosurgery and found that AR is constantly improving the overall efficiency of doctor training and treatment, which can help neurosurgeons learn and practice surgical procedures with zero risks. CONCLUSIONS Neurosurgical navigation is essential in neurosurgery. Despite certain technical limitations, it is still a necessary tool for the pursuit of maximum security and minimal intrusiveness. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tao Liu
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Yonghang Tai
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Chengming Zhao
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Lei Wei
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC, Australia
| | - Jun Zhang
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Junsheng Shi
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
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Transfer of Automated Performance Feedback Models to Different Specimens in Virtual Reality Temporal Bone Surgery. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7334188 DOI: 10.1007/978-3-030-52237-7_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Virtual reality has gained popularity as an effective training platform in many fields including surgery. However, it has been shown that the availability of a simulator alone is not sufficient to promote practice. Therefore, simulator-based surgical curricula need to be developed and integrated into existing surgical training programs. As practice variation is an important aspect of a surgical curriculum, surgical simulators should support practice on multiple specimens. Furthermore, to ensure that surgical skills are acquired, and to support self-guided learning, automated feedback on performance needs to be provided during practice. Automated feedback is typically provided by comparing real-time performance with expert models generated from pre-collected data. Since collecting data on multiple specimens for the purpose of developing feedback models is costly and time-consuming, methods of transferring feedback from one specimen to another should be investigated. In this paper, we discuss a simple method of feedback transfer between specimens in virtual reality temporal bone surgery and validate the accuracy and effectiveness of the transfer through a user study.
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Brenner M, Cramer J, Cohen S, Balakrishnan K. Leveraging Quality Improvement and Patient Safety Initiatives to Enhance Value and Patient-Centered Care in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0209-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Providing Automated Real-Time Technical Feedback for Virtual Reality Based Surgical Training: Is the Simpler the Better? LECTURE NOTES IN COMPUTER SCIENCE 2018. [DOI: 10.1007/978-3-319-93843-1_43] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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