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Azher S, Mills A, He J, Hyjazie T, Tokuno J, Quaiattini A, Harley JM. Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review. Surg Innov 2024; 31:331-341. [PMID: 38486132 PMCID: PMC11047018 DOI: 10.1177/15533506241238263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Virtual simulations (VSs) enhance clinical competencies and skills. However, a previous systematic review of 9 RCT studies highlighted a paucity of literature on the effects of haptic feedback in surgical VSs. An updated systematic and scoping review was conducted to encompass more studies and a broader range of study methodologies. METHODS A systematic literature search was conducted on July 31, 2023, in MEDLINE, Embase, and Cochrane. English language studies comparing haptic vs non-haptic conditions and using VSs were included. Studies were evaluated and reported using PRISMA-ScR guidelines. RESULTS Out of 2782 initial studies, 51 were included in the review. Most studies used RCT (21) or crossover (23) methodologies with medical residents, students, and attending physicians. Most used post-intervention metrics, while some used pre- and post-intervention metrics. Overall, 34 performance results from studies favored haptics, 3 favored non-haptics, and the rest showed mixed or equal results. CONCLUSION This updated review highlights the diverse application of haptic technology in surgical VSs. Haptics generally enhances performance, complements traditional teaching methods, and offers personalized learning with adequate simulator validation. However, a sparsity of orienting to the simulator, pre-/post-study designs, and small sample sizes poses concerns with the validity of the results. We underscore the urgent need for standardized protocols, large-scale studies, and nuanced understanding of haptic feedback integration. We also accentuate the significance of simulator validation, personalized learning potential, and the need for researcher, educator, and manufacturer collaboration. This review is a guidepost for navigating the complexities and advancements in haptic-enhanced surgical VSs.
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Affiliation(s)
- Sayed Azher
- Department of Surgery, McGill University, Montreal, QC, Canada
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Aralia Mills
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jinzhi He
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Taliah Hyjazie
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junko Tokuno
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andrea Quaiattini
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Jason M. Harley
- Department of Surgery, McGill University, Montreal, QC, Canada
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Brumpt E, Bertin E, Tatu L, Louvrier A. 3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review. BMC MEDICAL EDUCATION 2023; 23:783. [PMID: 37864193 PMCID: PMC10589929 DOI: 10.1186/s12909-023-04744-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Three-dimensional-printed anatomical models (3DPAMs) appear to be a relevant tool due to their educational value and their feasibility. The objectives of this review were to describe and analyse the methods utilised for creating 3DPAMs used in teaching human anatomy and for evaluating its pedagogical contribution. METHODS An electronic search was conducted on PubMed using the following terms: education, school, learning, teaching, learn, teach, educational, three-dimensional, 3D, 3-dimensional, printing, printed, print, anatomy, anatomical, anatomically, and anatomic. Data retrieved included study characteristics, model design, morphological evaluation, educational performance, advantages, and disadvantages. RESULTS Of the 68 articles selected, the cephalic region was the most studied (33 articles); 51 articles mentioned bone printing. In 47 articles, the 3DPAM was designed from CT scans. Five printing processes were listed. Plastic and its derivatives were used in 48 studies. The cost per design ranged from 1.25 USD to 2800 USD. Thirty-seven studies compared 3DPAM to a reference model. Thirty-three articles investigated educational performance. The main advantages were visual and haptic qualities, effectiveness for teaching, reproducibility, customizability and manipulability, time savings, integration of functional anatomy, better mental rotation ability, knowledge retention, and educator/student satisfaction. The main disadvantages were related to the design: consistency, lack of detail or transparency, overly bright colours, long printing time, and high cost. CONCLUSION This systematic review demonstrates that 3DPAMs are feasible at a low cost and effective for teaching anatomy. More realistic models require access to more expensive 3D printing technologies and substantially longer design time, which would greatly increase the overall cost. Choosing an appropriate image acquisition modality is key. From a pedagogical viewpoint, 3DPAMs are effective tools for teaching anatomy, positively impacting the learning outcomes and satisfaction level. The pedagogical effectiveness of 3DPAMs seems to be best when they reproduce complex anatomical areas, and they are used by students early in their medical studies.
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Affiliation(s)
- Eléonore Brumpt
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France.
- Radiologie, CHU de Besançon, Besançon, 25000, France.
- Laboratoire Nano Médecine, Imagerie, Thérapeutique, EA 4662, University of Franche-Comté, 16 Route de Gray, Besançon, F-25000, France.
- Anatomy Department, UFR Santé, 19 Rue Ambroise Paré, CS 71806, Besançon, F25030, France.
| | - Eugénie Bertin
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Chirurgie Maxillo-Faciale, Stomatologie Et Odontologie Hospitalière, CHU de Besançon, Besançon, 25000, France
| | - Laurent Tatu
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Neurologie, CHU de Besançon, Besançon, 25000, France
- Laboratoire de Neurosciences Intégratives Et Cliniques, University Franche-Comté, EA 481, Besançon, F-25000, France
| | - Aurélien Louvrier
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Chirurgie Maxillo-Faciale, Stomatologie Et Odontologie Hospitalière, CHU de Besançon, Besançon, 25000, France
- Plateforme I3DM (Impression 3D Médicale), CHU Besançon, Besançon, 25000, France
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Khan SA, Mirza FA. Commentary: Associating Surgeon Feedback With Material Physical Properties in the Development Process of a Resective Epilepsy Surgery Simulator. Oper Neurosurg (Hagerstown) 2023; 24:e135-e136. [PMID: 36637325 DOI: 10.1227/ons.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Subhan A Khan
- Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, Kentucky, USA
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Thiong'o GM, Mayer H, Looi T, Kulkarni AV, Drake JM. Associating Surgeon Feedback With Material Physical Properties in the Development Process of a Resective Epilepsy Surgery Simulator. Oper Neurosurg (Hagerstown) 2022; 22:244-248. [PMID: 35147596 DOI: 10.1227/ons.0000000000000113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hands-on neurosurgical simulations, specifically techniques involving white matter disconnection, are underdeveloped owing to the paucity of low indentation materials that can adequately mimic brain dissection. OBJECTIVE To describe the discovery phase of developing a resective epilepsy surgery simulator by quantifying the physical properties of 6 materials and correlating the scores with surgeon feedback data. METHODS Six materials, silicone, TissueMatrix, gel support, Synaptive hydrogel, dry SUP706, and moist SUP706 of equal dimension, were evaluated for hardness by measuring their resistance to indentation. Temporal lobe prototypes, 1 for each material, were dissected by 2 neurosurgeons and ordinal ranking assigned. Two null hypotheses were tested: one is that no differences in the indentation properties of the 6 materials analyzed would be elicited and the other is that there would be no correlation between indentation and surgeon feedback scores. Statistical comparison of the means of the different materials was performed using one-way analysis of variance. Surgeon feedback data and indentation score associations were analyzed using the Kendall rank correlation coefficient. RESULTS A statistically significant effect (P value <.0001; α 0.05) was measured. Gel support and Synaptive hydrogel had the lowest indentation scores and similar physical properties. Moist support material scored lower than dry support (P = .0067). A strong positive correlation (Kendall tau = 0.9333, P < .0001) was ascertained between the surgeon feedback ranking and indentation scores. CONCLUSION Reasonable material options for developing a resective epilepsy surgery are proposed and ranked in this article. Early involvement of surgeons is useful in the discovery phase of simulator invention.
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Affiliation(s)
- Grace M Thiong'o
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Canada.,Center for Image-Guided Innovation and Therapeutic Intervention (CIGITI) Lab, Toronto, Canada
| | - Haley Mayer
- Center for Image-Guided Innovation and Therapeutic Intervention (CIGITI) Lab, Toronto, Canada
| | - Thomas Looi
- Center for Image-Guided Innovation and Therapeutic Intervention (CIGITI) Lab, Toronto, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Canada.,Center for Image-Guided Innovation and Therapeutic Intervention (CIGITI) Lab, Toronto, Canada
| | - James M Drake
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Canada.,Center for Image-Guided Innovation and Therapeutic Intervention (CIGITI) Lab, Toronto, Canada
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Hochman JB, Pisa J, Singh S, Gousseau M, Unger B. Comparison of Summative Temporal Bone Dissection Scales Demonstrate Equivalence. Int Arch Otorhinolaryngol 2022; 26:e556-e560. [PMID: 36405459 PMCID: PMC9668416 DOI: 10.1055/s-0041-1740162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction
Temporal bone surgery is a unique and complicated surgical skill that requires extensive training. There is an educational requirement to maximize trainee experience and provide effective feedback.
Objective
We evaluate three temporal bone dissection scales for efficacy, reliability, and accuracy in identifying resident skill during temporal bone surgery.
Methods
Residents of various skill levels performed a mastoidectomy with posterior tympanotomy on identic 3D-printed temporal bone models. Four blinded otologic surgeons evaluated each specimen at two separate intervals using three separate dissection scales: the Welling Scale (WS), the Iowa Temporal Bone Assessment Tool (ITBAT), and the CanadaWest Scale (CWS). Scores from each scale were compared in their ability to accurately separate residents by skill level, inter- and intrarater reliability, and efficiency in application.
Results
Nineteen residents from 9 postgraduate programs participated. Assessment was clustered into junior (postgraduate year or PGY 1, 2), intermediate (PGY 3) and senior resident (PGY 4, 5) cohorts. Analysis of variance (ANOVA) found significant differences between cohort performance (
p
< 0.05) for all 3 scales considering the PGY level and the subjective account of temporal bone surgical experience. The inter-rater reliability was consistent across each scale. The intrarater reliability was comparable between the CWS (0.711) and the WS (0.713), but not the ITBAT (0.289). Time (in seconds) to complete scoring for each scale was also comparable between the CWS (42.7 ± 16.8), the WS (76.6 ± 14.5), and the ITBAT (105.6 ± 38.9).
Conclusion
All three scales demonstrated construct validity and consistency in performance, and consideration should be given to judicious use in training.
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Affiliation(s)
- Jordan B. Hochman
- Division of Neurotologic Surgery, Department of Otolaryngology Head and Neck Surgery, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Justyn Pisa
- Department of Otolaryngology Head and Neck Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Shubhi Singh
- Department of Otolaryngology Head and Neck Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Michael Gousseau
- Department of General Otolaryngology, Dr. Michael Gousseau Medical Corporation, Portage La Prairie, Manitoba, Canada
| | - Bert Unger
- Division of Neurotologic Surgery, Department of Otolaryngology Head and Neck Surgery, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
- Laboratory for Surgical Modeling, Simulation and Robotics, University of Manitoba, Manitoba, Canada
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Hochman JB, Pisa J, Kazmerik K, Unger B. Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone. Ann Otol Rhinol Laryngol 2021; 131:1224-1230. [PMID: 34872376 PMCID: PMC9452853 DOI: 10.1177/00034894211059310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns. METHODS Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length. RESULTS T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01). CONCLUSIONS Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.
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Affiliation(s)
- Jordan B Hochman
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justyn Pisa
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Health Sciences Centre, Winnipeg, MB, Canada
| | - Katrice Kazmerik
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, Pure Lifestyle, Winnipeg, MB, Canada
| | - Bertram Unger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Education, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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7
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Thiong'o GM, Looi T, Drake JM. Application of 3D Printing Support Material for Neurosurgical Simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4169-4173. [PMID: 34892143 DOI: 10.1109/embc46164.2021.9631100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Brain dissection, an intricate neurosurgical skill, is central to life-saving procedures such as intrinsic brain tumor excision and resective epilepsy surgery. The aims of this manuscript are to outline the selection process of a suitable material for the development of a dissectible brain simulator and to present the use of support material, SUP 706, manufactured by Stratasys Ltd. as a non-waste alternative for sustainably engineering solutions for surgical education. A feasibility study was conducted through qualitative function deployment (QFD) followed by a material selection process. End-user requirements and manufacturing product characteristics were incorporated into the workflow. Three materials, silicone, TissueMatrix™ and support material each formed the primary component of the first two prototypes. Expert feedback, manufacturing cost, safety profiling, functional fidelity and post-processing time data were collected and analyzed. The unique break-away feature of moist support material was found to be more suitable than using silicone or TissueMatrix™ for demonstrating brain dissection techniques. In addition, support material displayed higher functional fidelity by mimicking surgical tissues such as pia mater, gray and white matter, and blood vessels. The cost of the support material prototype was 39% less that of TissueMatrix™ and roughly the same as the silicone model. It took twice as long to post-process the support material prototype than it did the TissueMatrix™ design. Support material lost its ideal dissection properties and began to disintegrate after 30 - 45 minutes. In conclusion 3D printer support material is a low-cost material for a dissectible brain simulator.Clinical Relevance- The use of support material as the primary material in developing a dissectible brain simulator is a promising way of advancing neurosurgical education.
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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9
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Segaran N, Saini G, Mayer JL, Naidu S, Patel I, Alzubaidi S, Oklu R. Application of 3D Printing in Preoperative Planning. J Clin Med 2021; 10:jcm10050917. [PMID: 33652844 PMCID: PMC7956651 DOI: 10.3390/jcm10050917] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Preoperative planning is critical for success in the surgical suite. Current techniques for surgical planning are limited; clinicians often rely on prior experience and medical imaging to guide the decision-making process. Furthermore, two-dimensional (2D) presentations of anatomical structures may not accurately portray their three-dimensional (3D) complexity, often leaving physicians ill-equipped for the procedure. Although 3D postprocessed images are an improvement on traditional 2D image sets, they are often inadequate for surgical simulation. Medical 3D printing is a rapidly expanding field and could provide an innovative solution to current constraints of preoperative planning. As 3D printing becomes more prevalent in medical settings, it is important that clinicians develop an understanding of the technologies, as well as its uses. Here, we review the fundamentals of 3D printing and key aspects of its workflow. The many applications of 3D printing for preoperative planning are discussed, along with their challenges.
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Affiliation(s)
- Nicole Segaran
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Gia Saini
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Joseph L. Mayer
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
| | - Sailen Naidu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Indravadan Patel
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Sadeer Alzubaidi
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Rahmi Oklu
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
- Correspondence: ; Tel.: +1-480-342-5664
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10
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Chien WW, da Cruz MJ, Francis HW. Validation of a 3D-printed human temporal bone model for otology surgical skill training. World J Otorhinolaryngol Head Neck Surg 2021; 7:88-93. [PMID: 33997717 PMCID: PMC8103535 DOI: 10.1016/j.wjorl.2020.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
Hypothesis Three-dimensional (3D) printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery. Background Cadaveric temporal bone dissection is an integral part of otology surgical training. Unfortunately, availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist. In this study, we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery. Methods Seventeen otolaryngology trainees participated in the study. They were asked to complete a series of otologic procedures using 3D-printed temporal bones. A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones. Results Participants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones. They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures. Overall, participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees. Conclusion 3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.
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Affiliation(s)
- Wade W Chien
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Melville J da Cruz
- Department of Otolaryngology, Westmead Hospital, Sydney, Australia.,Department of Surgery, University of Sydney, Sydney, Australia
| | - Howard W Francis
- Department of Otolaryngology-Head & Neck Surgery, Duke University School of Medicine, Durham, NC, USA
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11
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Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med 2020; 6:30. [PMID: 33079298 PMCID: PMC7574578 DOI: 10.1186/s41205-020-00082-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
AIM This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. MATERIALS AND METHODS A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author's purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. RESULTS Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. CONCLUSION Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
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Affiliation(s)
- Matteo Meglioli
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Adrien Naveau
- Department of Prosthodontics, Dental Science Faculty, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Dental and Periodontal Rehabilitation Unit, Saint Andre Hospital, Bordeaux University Hospital, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France
| | - Guido Maria Macaluso
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.,IMEM-CNR, Parco Area delle Scienze 37/A, 43124, Parma, Italy
| | - Sylvain Catros
- Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Department of Oral Surgery, UFR d'Odontologie, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Service de Chirurgie Orale, CHU de Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.
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12
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Abstract
: Patient safety demands enhancements in training. Graduated cadaveric bone exposure is fundamental to otologic training. Printed bone models (PBM) provide a low-cost, anatomically consistent adjunct to cadaveric materials in trainee skill acquisition.The purpose of this study is to determine if resident training level can be distinguished on the basis of performance employing a printed temporal bone model, graded by a previous validated scale. METHODS Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1-7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale. RESULTS ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores.Subjective experience judged printed bone to be similar to cadaveric in drill-bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed. CONCLUSION Subjectively, printed bone compared favorably to cadaveric.The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.
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McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW, Moon N, Cooke M, Mowry SE. Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. Ann Otol Rhinol Laryngol 2020; 129:1168-1173. [DOI: 10.1177/0003489420918273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
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Affiliation(s)
- Alexandra McMillan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Simone E. Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Elias George Kikano
- Department of Diagnostic Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anisha Garg
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria W. Huang
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas Moon
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Malcolm Cooke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland OH, USA
| | - Sarah E. Mowry
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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14
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.
Recent Findings
Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.
Summary
A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.
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15
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Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. J Anat 2019; 234:419-437. [PMID: 30710355 DOI: 10.1111/joa.12934] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional (3D) printing, or additive manufacturing, is now a widely used tool in pre-operative planning, surgical teaching and simulator training. However, 3D printing technology that produces models with accurate haptic feedback, biomechanics and visuals for the training surgeon is not currently available. Challenges and opportunities in creating such surgical models will be discussed in this review paper. Surgery requires proper tissue handling as well as knowledge of relevant anatomy. To prepare doctors properly, training models need to take into account the biomechanical properties of the anatomical structures that will be manipulated in any given operation. This review summarises and evaluates the current biomechanical literature as it relates to human tissues and correlates the impact of this knowledge on developing high fidelity 3D printed surgical training models. We conclude that, currently, a printer technology has not yet been developed which can replicate many of the critical qualities of human tissue. Advances in 3D printing technology will be required to allow the printing of multi-material products to achieve the mechanical properties required.
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Affiliation(s)
- Ratheesraj Ratinam
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Michelle Quayle
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - John Crock
- Department of Surgery, Monash University, Clayton, Vic., Australia
| | - Michelle Lazarus
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Quentin Fogg
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Vic., Australia
| | - Paul McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
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Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M. New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:286-303. [PMID: 30197421 PMCID: PMC6146580 DOI: 10.14639/0392-100x-1984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022]
Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.
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Affiliation(s)
- P. Canzi
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - M. Magnetto
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - S. Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - P. Morbini
- Department of Pathology, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | - S. Mauramati
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - F. Aprile
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - I. Avato
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
- PhD in Experimental Medicine, University of Pavia, Italy
| | - F. Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - M. Benazzo
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
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17
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Pisa J, Gousseau M, Mowat S, Westerberg B, Unger B, Hochman JB. Simplified Summative Temporal Bone Dissection Scale Demonstrates Equivalence to Existing Measures. Ann Otol Rhinol Laryngol 2017; 127:51-58. [DOI: 10.1177/0003489417745090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Justyn Pisa
- Surgical Hearing Implant Program, Department of Otolaryngology-Head and Neck Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Michael Gousseau
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Stephanie Mowat
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul’s Hospital, Division Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Bert Unger
- Laboratory for Surgical Modeling, Simulation and Robotics; Biomedical Engineering Program; Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jordan B. Hochman
- Neurotologic Surgery, Department of Otolaryngology Head and Neck Surgery, Faculty of Health Sciences, University of Manitoba, Canada
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18
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Unger B, Sepehri N, Rampersad V, Pisa J, Michael Gousseau, Hochman JB. Elements of virtual temporal bone surgery: Manipulandum format may be more important to surgeons than haptic device force capabilities. Laryngoscope Investig Otolaryngol 2017; 2:358-362. [PMID: 29299508 PMCID: PMC5743167 DOI: 10.1002/lio2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/08/2022] Open
Abstract
Background Temporal bone simulations are critiqued for poor drill‐bone interaction. This project appraises the import of increasing haptic device and manipulandum fidelity on the perceived realism of drilling a virtual temporal bone. Virtual surgical contact forces rely on haptic device fidelity and are transmitted through a manipulandum. With identical software, both device hardware and manipulandum may each contribute to realism. We compare the three degrees of freedom (DOF), 3N Geomagic Touch (3D Systems, SC) to a 6DOF, 5.5N HD2 (Quanser, ON) with the both standard (“HD2–Standard”) and in‐house customized otic drill manipulandum (“HD2–Modified”). Methods Six otologic surgeons performed three virtual mastoidectomy surgeries on a temporal bone surgical simulator. The HD2 manipulandum was modified for attached otic drill with gravity compensation and requisite mechanical modifications. Surgeons, in random order, performed the dissection with the different hardware platforms. Results Two‐tailed t‐tests demonstrate that for the acoustic properties of each simulation, the HD2–Modified manipulandum was favored (p ≤ 0.0004). For overall similarity of bone, both HD2–Standard (p ≤ 0.05) HD2–Modified (p ≤ 0.03)) were favored over the Geomagic; however they were not appreciably different when directly compared to each other. There was no preference for increasing haptic device fidelity in virtual drill bone interaction. In forced rank, users favored the HD2–Modified in osseus, vibrational and overall realism, as well as being preferred for education and preoperative rehearsal (p ≤ 0.0164). Conclusion Increasing manipulandum realism was favored. However surprisingly, there was no preference for increased device fidelity, illustrating incremental stiffness had nominal impact. There may be a ceiling to drill bone interaction in virtual haptic simulation. Level of Evidence 2b.
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Affiliation(s)
- Bertram Unger
- Department of Medical Education University of Manitoba Winnipeg Manitoba Canada
| | - Nariman Sepehri
- Faculty of Engineering University of Manitoba Winnipeg Manitoba Canada
| | - Vivek Rampersad
- Department of Otolaryngology-Head and Neck Surgery University of Manitoba Winnipeg Manitoba Canada
| | - Justyn Pisa
- Department of Otolaryngology-Head and Neck Surgery Health Sciences Centre Winnipeg Manitoba Canada
| | - Michael Gousseau
- Faculty of Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Jordan B Hochman
- Department of Otolaryngology-Head and Neck Surgery University of Manitoba Winnipeg Manitoba Canada
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Muelleman T, Shew M, Muelleman RJ, Villwock M, Sykes KJ, Staecker H, Lin J. Impact of Resident Participation on Operative Time and Outcomes in Otologic Surgery. Otolaryngol Head Neck Surg 2017; 158:151-154. [DOI: 10.1177/0194599817737270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To describe the impact of resident involvement in tympanoplasty on operative time and surgical complication rates. Study Design Case series with chart review. Setting Tertiary medical center. Subjects and Methods Current Procedural Terminology codes were used to identify patients in the 2011-2014 public use files of the American College of Surgeons National Surgical Quality Improvement Program who underwent a tympanoplasty or tympanomastoidectomy. Cases were included if the database indicated whether the operating room was staffed with an attending alone or an attending with residents. Categorical and continuous variables were compared with chi-square, Fisher’s exact, and Mann-Whitney U tests. Generalized linear models with a log-link and gamma distribution were used to examine the factors affecting operative time. Results Overall, 1045 cases met our study criteria (tympanoplasty, n = 797; tympanomastoidectomy, n = 248). Resident involvement increased mean operative time for tympanoplasties by 46% (107 vs 73 minutes, P < .001) and tympanomastoidectomies by 49% (175 vs 117 minutes, P < .001). While controlling for confounding factors, the variable with the largest impact on operative time was resident involvement. There were no significant differences observed in the rate of surgical complications between attending-alone and attending-resident cases. Conclusion Resident involvement in tympanoplasty and tympanomastoidectomy did not affect the surgical complication rate. Resident involvement increased operative time for tympanoplasties and tympanomastoidectomies; however, the specific reasons for the increase are not explained by the available data.
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Affiliation(s)
- Thomas Muelleman
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Matthew Shew
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Robert J. Muelleman
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark Villwock
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Hinrich Staecker
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - James Lin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
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Evaluation of a Low-Fidelity Surgical Simulator for Large Loop Excision of the Transformation Zone (LLETZ). ACTA ACUST UNITED AC 2017; 12:304-307. [DOI: 10.1097/sih.0000000000000242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current Status of Simulation in Otolaryngology: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:203-215. [PMID: 27839694 DOI: 10.1016/j.jsurg.2016.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Otolaryngology is a highly technical and demanding specialty and the requirements for surgical trainees to acquire proficiency remains challenging. Simulation has been purported to be an effective tool in assisting with this. The aim of this systematic review is to identify the available otolaryngology simulators, their status of validation, and evaluation the level of evidence behind each training model and thereby establish a level of recommendation. DESIGN PubMed, ERIC, and Google Scholar databases were searched for articles that described otolaryngology simulators or training models between 1980 and April 2016. Any validation studies for simulators were also retrieved. Titles and abstracts were screened for relevance using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Level of evidence (LoE) and Level of recommendation (LoR) was awarded to each study and model, respectively. RESULTS A total of 70 studies were identified describing 64 simulators. Out of these, at least 54 simulators had 1 validation study. Simulators for the ear and temporal bone surgery were the most common (n = 32), followed by laryngeal and throat (n = 20) and endoscopic sinus surgery (n = 12). Face validity was evaluated by 29 studies, 20 attempted to show construct, 20 assessed content, 20 transfer, and only 2 assessed concurrent validity. Of the validation assessments, 2 were classified as Level 1b, 10 Level 2a, and 48 Level 2b. No simulators received the highest LoR, but 8 simulators received a LoR of 2. CONCLUSIONS Despite the lack of evidence in outcome studies and limited number of high-validity otolaryngology simulators, the role of simulation continues to grow across surgical specialties Hence, it is imperative that the simulators are of high validity and construct for trainees to practice and rehearse surgical skills to develop confidence.
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Affiliation(s)
- Omar Musbahi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Yasser Al Omran
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Christopher James Skilbeck
- Department of ENT and Head and Neck Surgery, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
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22
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Hiraumi H, Sato H, Ito J. Papercraft temporal bone in the first step of anatomy education. Auris Nasus Larynx 2016; 44:277-281. [PMID: 27544628 DOI: 10.1016/j.anl.2016.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE (1) To compare temporal bone anatomy comprehension taught to speech therapy students with or without a papercraft model. (2) To explore the effect of papercraft simulation on the understanding of surgical approaches in first-year residents. METHODS (1) One-hundred and ten speech therapy students were divided into three classes. The first class was taught with a lecture only. The students in the second class were given a lecture and a papercraft modeling task without instruction. The third class modeled a papercraft with instruction after the lecture. The students were tested on their understanding of temporal bone anatomy. (2) A questionnaire on the understanding of surgical approaches was completed by 10 residents before and after the papercraft modeling. The papercraft models were cut with scissors to simulate surgical approaches. RESULTS (1) The average scores were 4.4/8 for the first class, 4.3/8 for the second class, and 6.3/8 for the third class. The third class had significantly better results than the other classes (p<0.01, Kruskal-Wallis test). (2) The average scores before and after the papercraft modeling and cutting were 2.6/7 and 4.9/7, respectively. The numerical rating scale score significantly improved (p<0.01, Wilcoxon signed-rank test). CONCLUSION The instruction of the anatomy using a papercraft temporal bone model is effective in the first step of learning temporal bone anatomy and surgical approaches.
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Affiliation(s)
- Harukazu Hiraumi
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, Morioka, Japan; Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Kyoto College of Medical Health, Kyoto, Japan.
| | - Hiroaki Sato
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, Morioka, Japan
| | - Juichi Ito
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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24
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Bhutta MF. A review of simulation platforms in surgery of the temporal bone. Clin Otolaryngol 2016; 41:539-45. [PMID: 26453455 DOI: 10.1111/coa.12560] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgery of the temporal bone is a high-risk activity in an anatomically complex area. Simulation enables rehearsal of such surgery. The traditional simulation platform is the cadaveric temporal bone, but in recent years other simulation platforms have been created, including plastic and virtual reality platforms. OBJECTIVE OF REVIEW To undertake a review of simulation platforms for temporal bone surgery, specifically assessing their educational value in terms of validity and in enabling transition to surgery. TYPE OF REVIEW Systematic qualitative review. SEARCH STRATEGY Search of the Pubmed, CINAHL, BEI and ERIC databases. EVALUATION METHOD Assessment of reported outcomes in terms of educational value. RESULTS A total of 49 articles were included, covering cadaveric, animal, plastic and virtual simulation platforms. Cadaveric simulation is highly rated as an educational tool, but there may be a ceiling effect on educational outcomes after drilling 8-10 temporal bones. Animal models show significant anatomical variation from man. Plastic temporal bone models offer much potential, but at present lack sufficient anatomical or haptic validity. Similarly, virtual reality platforms lack sufficient anatomical or haptic validity, but with technological improvements they are advancing rapidly. CONCLUSIONS At present, cadaveric simulation remains the best platform for training in temporal bone surgery. Technological advances enabling improved materials or modelling mean that in the future plastic or virtual platforms may become comparable to cadaveric platforms, and also offer additional functionality including patient-specific simulation from CT data.
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Affiliation(s)
- M F Bhutta
- Specialist Registrar, Royal National Throat Nose and Ear Hospital, London, UK.
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