title: Virtual reality case-specific rehearsal in temporal bone surgery: a preliminary evaluation.
abstract: OBJECTIVE
  1. To investigate the feasibility of performing case-specific surgical rehearsal using a virtual reality temporal bone simulator. 2. To identify potential clinical applications in temporal bone surgery.
  
  
  METHODS
  Prospective assessment study.
  
  
  METHODS
  St Mary's Hospital, Imperial College NHS Trust, London UK.
  
  
  METHODS
  Sixteen participants consisting of a trainer and trainee group.
  
  
  METHODS
  Twenty-four cadaver temporal bones were CT-scanned and uploaded onto the Voxelman simulator. Sixteen participants performed a 90-min temporal bone dissection on the generic simulation model followed by 3 dissection tasks on the case simulation and cadaver models. Case rehearsal was assessed for feasibility. Clinical applications and usefulness were evaluated using a 5-point Likert-type scale.
  
  
  RESULTS
  The upload process required a semi-automated system. Average time for upload was 20 min. Suboptimal reconstruction occurred in 21% of cases arising when the mastoid process and ossicular chain were not captured (n = 2) or when artefact was generated (n = 3). Case rehearsal rated highly (Likert score >4) for confidence (75%), facilitating planning (75%) and training (94%). Potential clinical applications for case rehearsal include ossicular chain surgery, cochlear implantation and congenital anomalies. Case rehearsal of cholesteatoma surgery is not possible on the current platform due to suboptimal soft tissue representation.
  
  
  CONCLUSIONS
  The process of uploading CT data onto a virtual reality temporal bone simulator to perform surgical rehearsal is feasible using a semi-automated system. Further clinical evaluation is warranted to assess the benefit of performing patient-specific surgical rehearsal in selected procedures.
authors: Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK. Electronic address: asitarora@doctors.org.uk.
authors: Asit
authors: A
authors: Arora
authors: Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
authors: Chloe
authors: C
authors: Swords
authors: Department of ENT, Surrey and Sussex NHS Trust, Redhill RH1 5RH, UK.
authors: Sam
authors: S
authors: Khemani
authors: Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
authors: Zaid
authors: Z
authors: Awad
authors: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, W2 1NY, UK.
authors: Ara
authors: A
authors: Darzi
authors: Department of Otolaryngology, Northwick Park Hospital, London HA1 3UJ, UK.
authors: Arvind
authors: A
authors: Singh
authors: Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
authors: Neil
authors: N
authors: Tolley
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D006801:Humans; D008131:London; D013506:Otologic Surgical Procedures / Q000193:education* / Q000379:methods; D013701:Temporal Bone / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface
keywords: Otology; Surgical rehearsal; Training; Virtual reality simulation