Surgeon Behavior in a New Virtual Reality Temporal Bone Simulator Compared to Cadaveric Dissection

Abstract

Objectives: The gold standard for teaching otologic surgery is cadaveric temporal bone (TB) dissection. However, learning may be enhanced by virtual reality (VR) simulation, which improves access and allows reproducibility. The main criticism of VR has been its lack of fidelity. The objectives of this study were to 1) assess the fidelity of a novel VR TB simulator, and 2) compare surgeon behavior to that in cadaveric TB dissection. Methods: A new 3D high-fidelity force-feedback VR simulator was developed for otologic procedures. Using prospective paired comparisons conducted in June 2012, 6 surgeons each performed a mastoidectomy, facial recess dissection, and a cochleostomy on a human cadaveric TB and in the VR simulator. Drill movements were then compared between cadaveric and VR trials. Results: Stroke number ( P = 0.69), speed ( P = 0.08), and rate ( P = 0.74) did not differ significantly between VR and cadaveric environments for all 3 stages. Compared to cadaveric dissection, subjects in the VR simulator spent less time completing each stage (236s vs. 698s; P = 0.01); spent a greater percentage of time drilling (69.5% vs. 30.4%; P = 0.002); and used a larger percentage of long strokes (39.8% vs. 6.9%; P < 0.001). Conclusions: Drill stroke characteristics among surgeons in the VR simulator were similar to those in the cadaveric dissection. This suggests that real-life drilling behavior was replicated in VR and that it may be a useful adjunct to traditional TB dissection.