Gesture-controlled interactive three dimensional anatomy: a novel teaching tool in head and neck surgery

Comparison of Summative Temporal Bone Dissection Scales Demonstrate Equivalence

Introduction  Temporal bone surgery is a unique and complicated surgical skill that requires extensive training. There is an educational requirement to maximize trainee experience and provide effective feedback.

Objective  We evaluate three temporal bone dissection scales for efficacy, reliability, and accuracy in identifying resident skill during temporal bone surgery.

Methods  Residents of various skill levels performed a mastoidectomy with posterior tympanotomy on identic 3D-printed temporal bone models. Four blinded otologic surgeons evaluated each specimen at two separate intervals using three separate dissection scales: the Welling Scale (WS), the Iowa Temporal Bone Assessment Tool (ITBAT), and the CanadaWest Scale (CWS). Scores from each scale were compared in their ability to accurately separate residents by skill level, inter- and intrarater reliability, and efficiency in application.

Results  Nineteen residents from 9 postgraduate programs participated. Assessment was clustered into junior (postgraduate year or PGY 1, 2), intermediate (PGY 3) and senior resident (PGY 4, 5) cohorts. Analysis of variance (ANOVA) found significant differences between cohort performance ( p  < 0.05) for all 3 scales considering the PGY level and the subjective account of temporal bone surgical experience. The inter-rater reliability was consistent across each scale. The intrarater reliability was comparable between the CWS (0.711) and the WS (0.713), but not the ITBAT (0.289). Time (in seconds) to complete scoring for each scale was also comparable between the CWS (42.7 ± 16.8), the WS (76.6 ± 14.5), and the ITBAT (105.6 ± 38.9).

Conclusion  All three scales demonstrated construct validity and consistency in performance, and consideration should be given to judicious use in training.

Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review

Background

The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture–based human-computer interaction is currently being explored as a solution in surgical environments.

Objective

The aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS).

Methods

For this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected.

Results

A total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms.

Conclusions

COTS devices applied to hand and instrument gesture–based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up.

Preoperative preparation for otologic surgery: temporal bone simulation

PURPOSE OF REVIEW

The field of temporal bone simulation (TBS) has largely focused on the development and validation of simulators as training and assessment tools. As technology has progressed over the years, researchers have, however, envisioned new clinical applications for simulators extending to preoperative surgical planning and case rehearsal. The purpose of this article was to review the current state of the art in TBS and to highlight recent advancements in the field. Because of space limitations, we will limit our discussion to computer-based virtual reality simulators.

RECENT FINDINGS

A review of the recent literature on TBS revealed very limited application of virtual reality simulators for preoperative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using virtual reality simulation. Further investigation and clinical evaluation are required to validate its use outside of training and skill assessment.

SUMMARY

This article provides an overview of the current use of virtual reality simulators with emphasis on preoperative planning. We evaluate the limitations of the technology, and discuss potential areas of improvement for the future. More studies are necessary to assess the value of virtual reality simulation for preoperative preparation.