Ioannou Ioanna, Zhou Yun, Wijewickrema Sudanthi, Piromchai Patorn, Copson Bridget, Kennedy Gregor, O'Leary Stephen
*Department of Surgery (Otolaryngology), University of Melbourne, East Melbourne, Victoria, Australia †Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ‡Centre for the Study of Higher Education, University of Melbourne, Parkville, Victoria, Australia.
Otol Neurotol. 2017 Jul;38(6):e85-e91. doi: 10.1097/MAO.0000000000001398.
To investigate the use of automated metrics from a virtual reality (VR) temporal bone surgery simulator to determine how the performance of experts and trainees differs when performing a complex otological procedure (mastoidectomy with posterior tympanotomy and cochleostomy).
Cohort study.
Using the University of Melbourne VR temporal bone surgery simulator, seven ENT consultants and seven ENT residents performed two trials of the surgical approach to cochlear implantation on a virtual temporal bone. Simulator recordings were used to calculate a range of automated metrics for each stage of the procedure, capturing efficiency, technique characteristics, drilled bone regions, and damage to vital anatomical structures.
Results confirm that experts drilled more efficiently than residents. Experts generally used larger burrs and applied higher forces, resulting in faster material removal. However, they exercised more caution when drilling close to anatomical structures. Residents opened the temporal bone more widely, but neglected important steps in obtaining a clear view toward the round window, such as thinning the external ear canal wall and skeletonizing the medial aspect of the facial nerve. Residents used higher magnification and reoriented the temporal bone more often than experts.
VR simulation provides metrics that allow the objective analysis of surgical technique, and identification of differences between the performance of surgical residents and their senior colleagues. The performance of residents could be improved with more guidance regarding how much force they should apply, what burr size they should use, how they should orient the bone, and for cochlear implant surgery guidance regarding anatomical regions requiring particular attention, to visualize the round window.
研究利用虚拟现实（VR）颞骨手术模拟器的自动测量指标，以确定专家和学员在进行复杂耳科手术（乳突切除伴后鼓室切开术和蜗窗造瘘术）时的表现差异。
队列研究。
使用墨尔本大学的VR颞骨手术模拟器，7名耳鼻喉科顾问医生和7名耳鼻喉科住院医生在虚拟颞骨上进行了两次人工耳蜗植入手术入路的试验。利用模拟器记录来计算手术各阶段的一系列自动测量指标，包括效率、技术特征、钻孔骨区域以及对重要解剖结构的损伤。
结果证实专家的钻孔效率高于住院医生。专家通常使用更大的钻头并施加更高的力量，从而实现更快的骨质去除。然而，他们在靠近解剖结构钻孔时更加谨慎。住院医生更广泛地打开颞骨，但在清晰观察圆窗的重要步骤上有所疏忽，比如削薄外耳道壁以及对面神经内侧进行骨骼化处理。住院医生比专家使用更高的放大倍数，并且更频繁地重新调整颞骨方向。
VR模拟提供了能够客观分析手术技术的测量指标，并能识别手术住院医生与其上级同事表现之间的差异。通过更多关于应施加多大力量、应使用何种钻头尺寸、应如何调整骨骼方向的指导，以及针对人工耳蜗植入手术中需要特别关注的解剖区域以可视化圆窗的指导，可以提高住院医生的表现。
