Hi-Fidelity VR/3D Models Can Aid in Temporal Bone Surgery Practice

by Amy E. Hamaker •

What are the various temporal bone simulation platforms, and what are their best uses?

BOTTOM LINE
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.

Background: Temporal bone simulation platforms of sufficient fidelity to match the anatomy and pathology can mitigate learning curves and potentially
improve preoperative understanding of complex anatomy and rare pathology. Currently, cadaveric temporal bone is the gold standard, and the two most commonly used simulation platforms are three-dimensional (3D) printed models and virtual reality (VR) simulation platforms.

Study design: Literature search of studies that reported the use of simulation in temporal bone surgery through August 2018.

Setting: PubMed database.

Synopsis: Surgical Training: Cadaveric temporal bones have the highest fidelity, but there are limitations in the number of bones available, the need for a specialized laboratory, an inherent infection risk, and one-time use. 3D printed models can provide a standardized, reproducible simulation, but they may not allow for accurate bone property replication while also being anatomically accurate, do not allow for bleeding simulation during dissection, and require a specialized laboratory. VR simulation’s repeated, self-directed practice can expedite skills acquisition. However, existing haptic simulations cannot realistically reproduce vibration and contact forces experienced during surgery. Surgical Skills Assessment: There is currently no standardized assessment format for VR. Most assessment processes are not fully automated and still require expert input, extending the time it takes to provide trainee feedback. Presurgical Planning and Rehearsal: Experienced surgeons found VR simulation more helpful with difficult tasks than simple ones, and there was a strong positive correlation between operative utility ratings and cadaveric dissection scores among advanced surgical tasks. The virtual environment also provides an undo/redo function that allows experimentation with different approaches on patient-specific anatomy and pathology.

Citation: Kashikar TS, Kerwin TF, Moberly AC, Wiet GJ. A review of simulation applications in temporal bone surgery. Laryngoscope Inv Otol. Published June 7, 2019.