title: Virtual reality: a new paranasal sinus surgery simulator.
abstract: OBJECTIVE
  Virtual surgical training systems are of growing value. Current prototypes for endonasal sinus surgery simulation are very expensive or lack running stability. No reliable system is available to a notable number of users yet. The purpose of this work was to develop a dependable simulator running on standard PC hardware including a detailed anatomic model, realistic tools and handling, stereoscopic view, and force feedback.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  A three-dimensional voxel model was created based on a high-resolution computed tomography study of a human skull, from which the bony structures were segmented. The mucosa and organs at risk were added manually. The model may be manipulated with virtual surgical tools controlled with a low-cost haptic device, which is also used to adjust microscopic or endoscopic views. Visualization, haptic rendering, and tissue removal are represented with subvoxel resolution.
  
  
  RESULTS
  The handling of the model is convincing. The haptic device provides a realistic feeling regarding the interaction between tool tip and anatomy. Three-dimensional orientation and the look and feel of virtual surgical interventions get close to reality.
  
  
  CONCLUSIONS
  The newly developed system is a stable, fully operational simulator for sinus surgery based on standard PC hardware. Besides the limitations of a low-cost haptic device, the presented system is highly realistic regarding anatomy, visualization, manipulation, and the appearance of the tools. It is mainly intended for gaining surgical anatomy knowledge and for training navigation in a complex anatomical environment. Learning effects, including motor skills, have yet to be quantified.
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany. tolsdorff_b@klinik.uni-wuerzburg.de
authors.forename: Boris
authors.initials: B
authors.lastname: Tolsdorff
authors.forename: Andreas
authors.initials: A
authors.lastname: Pommert
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Höhne
authors.forename: Andreas
authors.initials: A
authors.lastname: Petersik
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pflesser
authors.forename: Ulf
authors.initials: U
authors.lastname: Tiede
authors.forename: Rudolf
authors.initials: R
authors.lastname: Leuwer
mesh_terms: D003198:Computer Simulation; D004724:Endoscopy / Q000193:education*; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education*; D010256:Paranasal Sinuses / Q000601:surgery*; D014584:User-Computer Interface