Department of Otolaryngology, University of Melbourne, East Melbourne, University of Melbourne, Parkville, Victoria, Australia.
Laryngoscope. 2014 Sep;124(9):2144-50. doi: 10.1002/lary.24708. Epub 2014 Jun 3.
OBJECTIVES/HYPOTHESIS: We compare the behavior of expert surgeons operating on the "gold standard" of simulation-the cadaveric temporal bone-against a high-fidelity virtual reality (VR) simulation. We aim to determine whether expert behavior changes within the virtual environment and to understand how the fidelity of simulation affects users' behavior.
Five expert otologists performed cortical mastoidectomy and cochleostomy on a human cadaveric temporal bone and a VR temporal bone simulator. Hand movement and video recordings were used to derive a range of measures, to facilitate an analysis of surgical technique, and to compare expert behavior between the cadaveric and simulator environments.
Drilling time was similar across the two environments. Some measures such as total time and burr change count differed predictably due to the ease of switching burrs within the simulator. Surgical strokes were generally longer in distance and duration in VR, but these measures changed proportionally to cadaveric measures across the stages of the procedure. Stroke shape metrics differed, which was attributed to the modeling of burr behavior within the simulator. This will be corrected in future versions.
Slight differences in drill interaction between a virtual environment and the real world can have measurable effects on surgical technique, particularly in terms of stroke length, duration, and curvature. It is important to understand these effects when designing and implementing surgical training programs based on VR simulation--and when improving the fidelity of VR simulators to facilitate use of a similar technique in both real and simulated situations.
目的/假设：我们比较了专家外科医生在“金标准”模拟——尸体颞骨上的操作行为与高保真虚拟现实（VR）模拟之间的行为。我们旨在确定在虚拟环境中专家行为是否会发生变化，并了解模拟的逼真度如何影响用户的行为。
五名专家耳科医生在人体尸体颞骨和 VR 颞骨模拟器上进行了皮质乳突切除术和耳蜗切开术。手部运动和视频记录用于得出一系列测量值，以促进手术技术分析，并比较尸体和模拟器环境中的专家行为。
在两种环境下，钻孔时间相似。由于在模拟器中更容易更换钻头，因此某些措施（如总时间和钻头更换次数）会有所不同。在 VR 中，手术冲程通常在距离和持续时间上都更长，但这些测量值在手术过程的各个阶段会与尸体测量值成比例地变化。冲程形状指标有所不同，这归因于模拟器中钻头行为的建模。这将在未来的版本中得到纠正。
虚拟环境与现实世界之间钻头交互的微小差异会对手术技术产生可测量的影响，特别是在冲程长度、持续时间和曲率方面。在基于 VR 模拟设计和实施手术培训计划时，以及在提高 VR 模拟器的逼真度以促进在真实和模拟情况下使用类似技术时，了解这些影响非常重要。
