Department of Surgery (Otolaryngology), University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria Australia.
Department of Surgery (Otolaryngology), University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria Australia; Department of Otolaryngology, Taunton and Somerset NHS Foundation Trust, Somerset, United Kingdom.
J Int Adv Otol. 2023 Jan;19(1):16-21. doi: 10.5152/iao.2023.22851.
Surgical rehearsal - patient-specific preoperative surgical practice - can be provided by virtual reality simulation. This study investigated the effect of surgical rehearsal on cortical mastoidectomy performance and procedure duration.
University students (n=40) were randomized evenly into a rehearsal and control group. After watching a video tutorial on cortical mastoidectomy, participants completed the procedure on a virtual reality simulator as a pre-test. Participants completed a further 8 cortical mastoidectomies on the virtual reality simulator as training before drilling two 3-dimensional (3D) printed temporal bones. The rehearsal group received 3D printed bones they had previously operated on in virtual reality, while the control group received 2 new bones. Cortical mastoidectomy was assessed by 3 blinded graders using the Melbourne Mastoidectomy Scale.
There was high interrater reliability between the 3 graders (intraclass correlation coefficient, r=0.8533, P < .0001). There was no difference in the mean surgical performance on the two 3D printed bones between the control and rehearsal groups (P=.2791). There was no significant difference in the mean procedure duration between the control and rehearsal groups for both 3D printed bones (P=.8709). However, there was a significant decrease in procedure duration between the first and second 3D printed bones (P < .0001).
In this study, patient-specific virtual reality rehearsal provided no additional advantage to cortical mastoidectomy performance by novice operators compared to generic practice on a virtual reality simulator. Further, virtual reality training did not improve cortical mastoidectomy performance on 3D printed bones, highlighting the impact of anatomical diversity and changing operating modalities on the acquisition of new surgical skills.
手术排练——针对特定患者的术前手术实践——可以通过虚拟现实模拟来实现。本研究旨在探讨手术排练对颞骨皮质切除术操作表现和手术时间的影响。
将 40 名大学生随机均分为排练组和对照组。在观看了关于颞骨皮质切除术的视频教程后，参与者在虚拟现实模拟器上完成了手术作为预测试。在虚拟现实模拟器上完成了另外 8 例颞骨皮质切除术的训练后，参与者钻了两个 3 维（3D）打印的颞骨模型。排练组使用他们之前在虚拟现实中操作过的 3D 打印骨头，而对照组则收到 2 个新的骨头。使用墨尔本颞骨切除术量表由 3 名盲评者评估颞骨皮质切除术。
3 名评分者之间的评分者间信度很高（组内相关系数，r=0.8533，P <.0001）。在两个 3D 打印骨头的手术表现上，对照组和排练组之间的平均差异无统计学意义（P=.2791）。两组在两个 3D 打印骨头的手术时间上无显著差异（P=.8709）。然而，在两个 3D 打印骨头之间，手术时间显著缩短（P <.0001）。
在这项研究中，与在虚拟现实模拟器上进行通用练习相比，针对特定患者的虚拟现实排练并未为新手操作者提供颞骨皮质切除术操作表现的额外优势。此外，虚拟现实训练并未提高 3D 打印骨上的颞骨皮质切除术表现，突出了解剖多样性和操作方式改变对新手术技能获取的影响。
