Preoperative preparation for otologic surgery

Abstract

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. However, as technology has progressed over the years, researchers have envisioned new clinical applications for simulators extending to pre-operative surgical planning and case rehearsal. The purpose of this article is to review the current state of the art in TBS and to highlight recent advancements in the field. Due to space limitations, we will limit our discussion to computer-based virtual reality (VR) simulators. Recent findings A review of the recent literature on TBS revealed very limited application of VR simulators for pre-operative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using VR 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 VR simulators with emphasis on pre-operative 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 VR simulation for pre-operative preparation.

A review of simulation applications in temporal bone surgery

“…There is no replacement for actual surgical experience, but high‐fidelity temporal bone models such as those produced with 3D printing and computer simulation have emerged as promising tools in otolaryngologic surgery . Currently, VR simulators have been most widely used in surgical training as a supplement to cadaveric temporal bones.…”

“…Issues in fidelity have still not been adequately resolved for simulations other than cadaveric temporal bone to be widely used in clinical training . The realism of VR simulators is still suboptimal despite advances in haptic feedback, and existing haptic simulations are unable to realistically reproduce the vibration and contact forces experienced during surgery .…”

“…The realism of VR simulators is still suboptimal despite advances in haptic feedback, and existing haptic simulations are unable to realistically reproduce the vibration and contact forces experienced during surgery . Additionally, VR simulations lack soft tissue and blood in dissection and cannot replicate the auditory feedback present during surgery . However, simulations developed for surgical rehearsal may have different fidelity requirements than those developed for surgical training .…”

“…As an alternative to cadaveric temporal bones and 3D printed models, multiple VR simulators exist for temporal bone surgery and have been previously described in the literature . Studies show that trainees exposed to VR simulation demonstrate an increase in surgical confidence throughout all levels of training and that VR training positively correlates with cadaveric dissection performance .…”

Otologic Skills Training

“…Although not directly thought of in relation to initial skills training, pre-operative planning/practice is a type of “just in time” training and a review of otologic simulation platforms for pre-surgical planning was recently published 77 . The authors found that there are several computer-based simulation platforms that have shown at least some form of feasibility to use in pre-surgical planning and practice.…”