Arikatla Sreekanth, Ravikumar Sadhana, White Raymond, Nguyen Tung, Paniagua Beatriz
Medical Computing, Kitware Inc, 101 E Weaver St g4, Carrboro, NC, 27510, USA.
School of Dentistry, University of North Carolina at Chapel Hill, Street, Chapel Hill, NC, 27599, USA.
Int J Comput Assist Radiol Surg. 2025 Mar;20(3):535-543. doi: 10.1007/s11548-024-03297-7. Epub 2024 Dec 11.
The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills.
We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback.
Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel.
The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures.
口腔颌面外科界正在积极努力开发新的手术培训方法，以应对工作时间限制，缩小培训标准差异，提高学习效率，同时将患者风险降至最低。基于模拟的学习是其他培训模式中采用的一项技术，有潜力增强外科医生的知识和心理运动技能。
我们基于Kitware的开源可视化和交互式模拟库开发了一个完全沉浸式、高保真的虚拟模拟训练系统：交互式医学模拟工具包（iMSTK）和可视化工具包（VTK）。该系统允许外科医生使用笔式握持摆动锯训练双侧矢状劈开截骨术（BSSO）中的关键截骨步骤，在虚拟环境中使用3D Systems Geomagic Touch触觉设备进行控制。模拟器包含一个基于熟练度的进阶评估系统，以评估切割的正确性并提供用户反馈。
三名专家临床医生和两名高级住院医师测试了我们的试验模拟器，以评估所开发的系统与实际手术表现相比如何。面部和内容验证研究的结果在模拟图像质量方面显示出有希望的结果，并且他们从设备获得的力反馈响应与他们预期的感觉相符。
所开发的训练器有潜力降低涉及截骨术的口腔颌面外科手术后不良手术结果的发生率。观察临床医生并讨论一些困难帮助我们确定了关键的改进领域。未来的工作将集中于对BSSO手术场景进行进一步的临床评估，并将训练器扩展到包括其他颅面截骨手术。
