Hostname: page-component-848d4c4894-r5zm4 Total loading time: 0 Render date: 2024-06-14T20:16:27.634Z Has data issue: false hasContentIssue false

Virtual temporal bone simulators and their use in surgical training: a narrative review

Published online by Cambridge University Press:  17 November 2023

Lauren Bolton*
Affiliation:
ENT Offices, York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York UK
Kenneth Young
Affiliation:
ENT, Castle Hill Hospital, Hull University Teaching Hospital, Hull, UK
Jaydip Ray
Affiliation:
ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Gaurav Chawdhary
Affiliation:
ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
*
Corresponding author: Lauren Bolton; Email: lauren.bolton@doctors.org.uk

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.

Type
Review Article
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Lauren Bolton takes responsibility for the integrity of the content of the paper

References

Kashikar, TS, Kerwin, TF, Moberly, AC, Wiet, GJ. A review of simulation applications in temporal bone surgery. Laryngoscope Investig Otolaryngol 2019;4:420–4CrossRefGoogle ScholarPubMed
Pettigrew Temporal Bones. In: https://www.temporal-bone.com/ [23 October 2022]Google Scholar
Ball, J, Shelton, F, Bola, S, George, M. The UK otolaryngology trainees’ lived experience during the COVID-19 pandemic. ENT and Audiology News 2022;2022:unpg. [ent-mar22-onex-trainee-matters-final-page.pdf].Google Scholar
Intercollegiate Surgical Curriculum Programme: Otolaryngology Curriculum. In: https://www.iscp.ac.uk/iscp/curriculum/otolaryngology-curriculum/1-introduction/ [20 September 2022]Google Scholar
Voxel-Man: Visual and Haptic Simulation. In: https://www.voxel-man.com/ [20 May 2022]Google Scholar
Wijewickrema, S, Piromchai, P, Zhou, Y, Ioannou, I, Bailey, J, Kennedy, G et al. Developing effective automated feedback in temporal bone surgery simulation. Otolaryngol Head Neck Surg 2015;152:1082–8CrossRefGoogle ScholarPubMed
CardinalSim: Simulation of Complex Procedures. In: https://med.stanford.edu/content/sm/cardinalsim.html.html [12 April 2022]Google Scholar
Compton, EC, Agrawal, SK, Ladak, HM, Chan, S, Hoy, M, Nakoneshny, SC et al. Assessment of a virtual reality temporal bone surgical simulator: a national face and content validity study. J Otolaryngol Head Neck Surg 2020;49:17CrossRefGoogle ScholarPubMed
de Lotbiniere-Bassett, M, Volpato Batista, A, Lai, C, El Chemaly, T, Dort, J, Blevins, N, et al. The user experience design of a novel microscope within SurgiSim, a virtual reality surgical simulator. Int J Comput Assist Radiol Surg 2023;18:8593CrossRefGoogle ScholarPubMed
Wiet, GJ, Stredney, D, Kerwin, T, Hittle, B, Fernandez, SA, Abdel-Rasoul, M, et al. Virtual temporal bone dissection system: OSU virtual temporal bone system: development and testing. Laryngoscope 2012;122(Suppl 1):S1–12CrossRefGoogle ScholarPubMed
Wiet, GJ, Bryan, J, Dodson, E, Sessanna, D, Stredney, D, Schmalbrock, P et al. Virtual temporal bone dissection simulation. Stud Health Technol Inform 2000;70:378–84Google ScholarPubMed
The Visible Ear Simulator: Advanced Virtual Reality Temporal Bone Surgical Simulator. In: http://visibleearsimulator.com [12 April 2022]Google Scholar
Sorensen, MS, Mosegaard, J, Trier, P. The Visible Ear Simulator: a public PC application for GPU-accelerated haptic 3D simulation of ear surgery based on the visible ear data. Otol Neurotol 2009;30:484–7CrossRefGoogle ScholarPubMed
Sieber, DM, Andersen, SAW, Sørensen, MS, Mikkelsen, PT. OpenEar image data enables case variation in high fidelity virtual reality ear surgery. Otol Neurotol 2021;42:1245–52CrossRefGoogle ScholarPubMed
Van Nortwick, SS, Lendvay, TS, Jensen, AR, Wright, AS, Horvath, KD, Kim, S. Methodologies for establishing validity in surgical simulation studies. Surgery 2010;147:622–30CrossRefGoogle ScholarPubMed
Khemani, S, Arora, A, Singh, A, Tolley, N, Darzi, A. Objective skills assessment and construct validation of a virtual reality temporal bone simulator. Otol Neurotol 2012;33:1225–31CrossRefGoogle ScholarPubMed
Varoquier, M, Hoffmann, CP, Perrenot, C, Tran, N, Parietti-Winkler, C. Construct, face, and content validation on Voxel-Man® simulator for otologic surgical training. Int J Otolaryngol 2017;2017:2707690CrossRefGoogle ScholarPubMed
Arora, A, Khemani, S, Tolley, N, Singh, A, Budge, J, Varela, DADV et al. Face and content validation of a virtual reality temporal bone simulator. Otolaryngol Head Neck Surg 2012;146:497503CrossRefGoogle ScholarPubMed
Linke, R, Leichtle, A, Sheikh, F, Schmidt, C, Frenzel, H, Graefe, H et al. Assessment of skills using a virtual reality temporal bone surgery simulator. Acta Otorhinolaryngol Ital 2013;33:273–81Google ScholarPubMed
Zhao, YC, Kennedy, G, Hall, R, O'Leary, S. Differentiating levels of surgical experience on a virtual reality temporal bone simulator. Otolaryngol Head Neck Surg 2010;143(Suppl 3):S30–5CrossRefGoogle ScholarPubMed
Zirkle, M, Roberson, DW, Leuwer, R, Dubrowski, A. Using a virtual reality temporal bone simulator to assess otolaryngology trainees. Laryngoscope 2007;117:258–63CrossRefGoogle ScholarPubMed
Sewell, C, Morris, D, Blevins, NH, Agrawal, S, Dutta, S, Barbagli, F et al. Validating metrics for a mastoidectomy simulator. Stud Health Technol Inform 2007;125:421–6Google ScholarPubMed
O'Leary, SJ, Hutchins, MA, Stevenson, DR, Gunn, C, Krumpholz, A, Kennedy, G et al. Validation of a networked virtual reality simulation of temporal bone surgery. Laryngoscope 2008;118:1040–6CrossRefGoogle ScholarPubMed
Ioannou, I, Zhou, Y, Wijewickrema, S, Piromchai, P, Copson, B, Kennedy, G et al. Comparison of experts and residents performing a complex procedure in a temporal bone surgery simulator. Otol Neurotol 2017;38:e8591CrossRefGoogle Scholar
Wiet, GJ, Stredney, D, Sessanna, D, Bryan, JA, Welling, DB, Schmalbrock, P. Virtual temporal bone dissection: an interactive surgical simulator. Otolaryngol Head Neck Surg 2002;127:7983CrossRefGoogle ScholarPubMed
Kerwin, T, Stredney, D, Wiet, G, Shen, HW. Virtual mastoidectomy performance evaluation through multi-volume analysis. Int J Comput Assist Radiol Surg 2013;8:5161CrossRefGoogle ScholarPubMed
Andersen, SAW, Varadarajan, VV, Moberly, AC, Hittle, B, Powell, KA, Wiet, GJ. Patient-specific virtual temporal bone simulation based on clinical cone-beam computed tomography. Laryngoscope 2021;131:1855–62CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Sørensen, MS. Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance. Laryngoscope 2019;129:2170–7CrossRefGoogle ScholarPubMed
Fang, TY, Wang, PC, Liu, CH, Su, MC, Yeh, SC. Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training. Comput Methods Programs Biomed 2014;113:674–81CrossRefGoogle ScholarPubMed
Piromchai, P, Avery, A, Laopaiboon, M, Kennedy, G, O'Leary, S. Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat. Cochrane Database Syst Rev 2015;(9):CD010198Google ScholarPubMed
Lui, JT, Hoy, MY. Evaluating the effect of virtual reality temporal bone simulation on mastoidectomy performance: a meta-analysis. Otolaryngol Head Neck Surg 2017;156:1018–24CrossRefGoogle ScholarPubMed
Nash, R, Sykes, R, Majithia, A, Arora, A, Singh, A, Khemani, S. Objective assessment of learning curves for the Voxel-Man TempoSurg temporal bone surgery computer simulator. J Laryngol Otol 2012;126:663–9CrossRefGoogle ScholarPubMed
Francis, HW, Malik, MU, Diaz Voss Varela, DA, Barffour, MA, Chien, WW, Carey, JP et al. Technical skills improve after practice on virtual-reality temporal bone simulator. Laryngoscope 2012;122:1385–91CrossRefGoogle ScholarPubMed
Al-Noury, K. Virtual reality simulation in ear microsurgery: a pilot study. Indian J Otolaryngol Head Neck Surg 2012;64:162–6CrossRefGoogle ScholarPubMed
Reddy-Kolanu, G, Alderson, D. Evaluating the effectiveness of the Voxel-Man TempoSurg virtual reality simulator in facilitating learning mastoid surgery. Ann R Coll Surg Engl 2011;93:205–8CrossRefGoogle ScholarPubMed
Arora, A, Hall, A, Kotecha, J, Burgess, C, Khemani, S, Darzi, A et al. Virtual reality simulation training in temporal bone surgery. Clin Otolaryngol 2015;40:153–9CrossRefGoogle ScholarPubMed
Ahmed, A, Ahmad, M, Stewart, CM, Francis, HW, Bhatti, NI. Effect of distractions on operative performance and ability to multitask—a case for deliberate practice. Laryngoscope 2015;125:837–41CrossRefGoogle ScholarPubMed
Arora, A, Swords, C, Khemani, S, Awad, Z, Darzi, A, Singh, A et al. Virtual reality case-specific rehearsal in temporal bone surgery: a preliminary evaluation. Int J Surg 2014;12:141–5CrossRefGoogle ScholarPubMed
Zhao, YC, Kennedy, G, Yukawa, K, Pyman, B, O'Leary, S. Improving temporal bone dissection using self-directed virtual reality simulation: results of a randomized blinded control trial. Otolaryngol Head Neck Surg 2011;144:357–64CrossRefGoogle ScholarPubMed
Zhao, YC, Kennedy, G, Yukawa, K, Pyman, B, O'Leary, S. Can virtual reality simulator be used as a training aid to improve cadaver temporal bone dissection? Results of a randomized blinded control trial. Laryngoscope 2011;121:831–7CrossRefGoogle ScholarPubMed
Wijewickrema, S, Zhou, Y, Ioannou, I, Copson, B, Piromchai, P, Yu, C et al. Presentation of automated procedural guidance in surgical simulation: results of two randomised controlled trials. J Laryngol Otol 2018;132:257–63CrossRefGoogle ScholarPubMed
Gawęcki, W, Węgrzyniak, M, Mickiewicz, P, Gawłowska, MB, Talar, M, Wierzbicka, M. The impact of virtual reality training on the quality of real antromastoidectomy performance. J Clin Med 2020;9:3197CrossRefGoogle ScholarPubMed
Talks, BJ, Lamtara, J, Wijewickrema, S, Gerard, JM, Mitchell-Innes, AM, O'Leary, S. The Melbourne Mastoidectomy Scale: validation of an end-product dissection scale for cortical mastoidectomy. Clin Otolaryngol. 2020;45:746–53CrossRefGoogle ScholarPubMed
Copson, B, Wijewickrema, S, Zhou, Y, Piromchai, P, Briggs, R, Bailey, J et al. Supporting skill acquisition in cochlear implant surgery through virtual reality simulation. Cochlear Implants Int 2017;18:8996CrossRefGoogle ScholarPubMed
Locketz, GD, Lui, JT, Chan, S, Salisbury, K, Dort, JC, Youngblood, P et al. Anatomy-specific virtual reality simulation in temporal bone dissection: perceived utility and impact on surgeon confidence. Otolaryngol Head Neck Surg 2017;156:1142–9CrossRefGoogle ScholarPubMed
Andersen, SAW, Cayé-Thomasen, P, Sørensen, MS. Mastoidectomy performance assessment of virtual simulation training using final-product analysis. Laryngoscope 2015;125:431–5CrossRefGoogle ScholarPubMed
Andersen, SAW, Konge, L, Cayé-Thomasen, P, Sørensen, MS. Learning curves of virtual mastoidectomy in distributed and massed practice. JAMA Otolaryngol Head Neck Surg 2015;141:913–18Google ScholarPubMed
Frithioff, A, Frendø, M, von Buchwald, JH, Trier Mikkelsen, P, Sørensen, MS, Andersen, SAW. Automated summative feedback improves performance and retention in simulation training of mastoidectomy: a randomised controlled trial. J Laryngol Otol 2022;136:2936CrossRefGoogle ScholarPubMed
Andersen, SAW, Foghsgaard, S, Konge, L, Cayé-Thomasen, P, Sørensen, MS. The effect of self-directed virtual reality simulation on dissection training performance in mastoidectomy. Laryngoscope 2016;126:1883–8CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Konge, L, Cayé-Thomasen, P, Sørensen, MS. Cognitive load in mastoidectomy skills training: virtual reality simulation and traditional dissection compared. J Surg Educ 2016;73:4550CrossRefGoogle ScholarPubMed
Andersen, SAW, Foghsgaard, S, Cayé-Thomasen, P, Sørensen, MS. The effect of a distributed virtual reality simulation training program on dissection mastoidectomy performance. Otol Neurotol 2018;39:1277–84CrossRefGoogle ScholarPubMed
Frendø, M, Thingaard, E, Konge, L, Sørensen, MS, Andersen, SAW. Decentralized virtual reality mastoidectomy simulation training: a prospective, mixed-methods study. Eur Arch Otorhinolaryngol 2019;276:2783–9CrossRefGoogle ScholarPubMed
Frendø, M, Konge, L, Cayé-Thomasen, P, Sørensen, MS, Andersen, SAW. Decentralized virtual reality training of mastoidectomy improves cadaver dissection performance: a prospective, controlled cohort study. Otol Neurotol 2020;41:476–81CrossRefGoogle ScholarPubMed
Andersen, SAW, Frendø, M, Guldager, M, Sørensen, MS. Understanding the effects of structured self-assessment in directed, self-regulated simulation-based training of mastoidectomy: a mixed methods study. J Otol 2020;15:117–23CrossRefGoogle ScholarPubMed
Arnesen, KA, Frithioff, A, Sørensen, MS, Andersen, SAW, Frendø, M. Mastoidectomy training: is anatomical variation needed? A randomized, controlled trial on performance and skills transfer from virtual reality to a three-dimensional printed model. Otol Neurotol 2022;43:900–7CrossRefGoogle ScholarPubMed
Frithioff, A, Frendø, M, Mikkelsen, PT, Sørensen, MS, Andersen, SAW. Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial. Eur Arch Otorhinolaryngol 2020;277:1335–41CrossRefGoogle ScholarPubMed
Frendø, M, Frithioff, A, Konge, L, Cayé-Thomasen, P, Sørensen, MS, Andersen, SAW. Cochlear implant surgery: virtual reality simulation training and transfer of skills to cadaver dissection—a randomized, controlled trial. J Int Adv Otol 2022;18:219–24CrossRefGoogle ScholarPubMed
Fartoussi, HA, Sørensen, MS, Andersen, SAW. Learning curves in directed self-regulated virtual reality training of mastoidectomy and the role of repetition and motivation. J Int Adv Otol 2023;19:99104CrossRefGoogle ScholarPubMed
West, N, Konge, L, Cayé-Thomasen, P, Sørensen, MS, Andersen, SAW. Peak and ceiling effects in final-product analysis of mastoidectomy performance. J Laryngol Otol 2015;129:1091–6CrossRefGoogle ScholarPubMed
Andersen, SAW, Konge, L, Mikkelsen, PT, Cayé-Thomasen, P, Sørensen, MS. Mapping the plateau of novices in virtual reality simulation training of mastoidectomy. Laryngoscope 2017;127:907–14CrossRefGoogle ScholarPubMed
Andersen, SAW, Guldager, M, Mikkelsen, PT, Sørensen, MS. The effect of structured self-assessment in virtual reality simulation training of mastoidectomy. Eur Arch Otorhinolaryngol 2019;276:3345–52CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Sørensen, MS. The effect of simulator-integrated tutoring for guidance in virtual reality simulation training. Simul Healthc 2020;15:147–53CrossRefGoogle ScholarPubMed
Andersen, SAW, Frithioff, A, von Buchwald, JH, Sørensen, MS, Frendø, M. Am I doing this right? Structured self-assessment during simulation training of mastoidectomy improves cadaver dissection performance: a prospective educational study. Eur Arch Otorhinolaryngol 2023;280:97103CrossRefGoogle Scholar
Al-Shahrestani, F, Sørensen, MS, Andersen, SAW. Performance metrics in mastoidectomy training: a systematic review. Eur Arch Otorhinolaryngol 2019;276:657–64CrossRefGoogle ScholarPubMed
Favier, V, Ayad, T, Blanc, F, Fakhry, N, Andersen, SAW. Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey. Eur Arch Otorhinolaryngol 2021;278:5043–50CrossRefGoogle ScholarPubMed
Frithioff, A, Sørensen, MS, Andersen, SAW. European status on temporal bone training: a questionnaire study. Eur Arch Otorhinolaryngol 2018;275:357–63CrossRefGoogle ScholarPubMed
Lui, JT, Compton, ED, Ryu, WHA, Hoy, MY. Assessing the role of virtual reality training in Canadian otolaryngology–head & neck residency programs: a national survey of program directors and residents. J Otolaryngol Head Neck Surg 2018;47:61CrossRefGoogle ScholarPubMed
Motaharifar, M, Norouzzadeh, A, Abdi, P, Iranfar, A, Lotfi, F, Moshiri, B et al. Applications of haptic technology, virtual reality, and artificial intelligence in medical training during the COVID-19 pandemic. Front Robot AI 2021;8:612949CrossRefGoogle ScholarPubMed
Sommer, GM, Broschewitz, J, Huppert, S, Sommer, CG, Jahn, N, Jansen-Winkeln, B et al. The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: visual spatial ability as a predictor for improved surgical performance: a randomized trial. Medicine (Baltimore) 2021;100:e27844CrossRefGoogle ScholarPubMed
Feenstra, TM, Tejedor, P, Popa, DE, Francis, N, Schijven, MP. Surgical education in the post-COVID era: an EAES DELPHI-study. Surg Endosc 2023;37:2719–28CrossRefGoogle ScholarPubMed
Supplementary material: File

Bolton et al. supplementary material 1

Bolton et al. supplementary material
Download Bolton et al. supplementary material 1(File)
File 40.3 KB
Supplementary material: File

Bolton et al. supplementary material 2

Bolton et al. supplementary material
Download Bolton et al. supplementary material 2(File)
File 12.7 KB
Supplementary material: File

Bolton et al. supplementary material 3

Bolton et al. supplementary material
Download Bolton et al. supplementary material 3(File)
File 57.1 KB