A validation study of a virtual-based haptic system for endoscopic sinus surgery training.

BACKGROUND: The development of endoscopic sinus surgery (ESS) training simulators for clinical environment applications has reduced the existing shortcomings in conventional teaching methods, creating a standard environment for trainers and trainees in a more accurate and repeatable fashion. MATERIALS AND METHODS: In this research, the validation study of an ESS training simulator has been addressed. It is important to consider components that guide trainees to improve their hand movements control in the orbital floor removal in an ESS operation. Therefore, we defined three tasks to perform: pre-experiment learning, training, and evaluation. In these tasks, the critical regions introduced in the virtual training environment are forbidden to be touched. Recruiting 20 participants, divided into two groups, we investigated the performance metrics: quality (the percentage of the realism for the generated force for orbital floor removal and the usefulness of the proposed training system for the surgical educational curricula.), efficiency (time, path length), and safety (touching the goal and forbidden wall). RESULTS: All recruited participants answered a post-evaluation questionnaire regarding their perceptions of training system realism, potential educational benefits, and practiced skills. We investigate the differences between groups' performance metrics by utilizing the analysis of variance-Kruskal-Wallis test. Acquired results indicate that training before the actual process of the surgery has a significant effect on the accuracy and validity of the process for surgeons. CONCLUSIONS: Utilizing a standardized environment, trainers and trainees are able to carry out a process with regular features. In addition to traditional education methods, trainees can learn the risk of surgical operations. The training simulators can, also, provide a standard method for assessing the skills of surgical and medical students.

Feasibility Assessment of Optical Coherence Tomography-Guided Laser Labeling in Middle Cranial Fossa Approach.

INTRODUCTION: Different approaches have been developed to find the position of the internal auditory canal (IAC) in middle cranial fossa approach. A feasibility study was performed to investigate the combination of cone beam computed tomography (CBCT), optical coherence tomography (OCT), and laser ablation to assist a surgeon in a middle cranial fossa approach by outlining the internal auditory canal (IAC). MATERIALS AND METHODS: A combined OCT laser setup was used to outline the position of IAC on the surface of the petrous bone in cadaveric semi-heads. The position of the hidden structures, such as IAC, was determined in MATLAB software using an intraoperative CBCT scan. Four titanium spheres attached to the edge of the craniotomy served as reference markers visible in both CBCT and OCT images in order to transfer the plan to the patient. The integrated erbium-doped yttrium aluminum garnet laser was used to mark the surface of the bone by shallow ablation under OCT-based navigation before the surgeon continued the operation. RESULT: The technical setup was feasible, and the laser marking of the border of the IAC was performed with an overall accuracy of 300 µm. The depth of each ablation phase was 300 µm. The marks indicating a safe path supported the surgeon in the surgery. CONCLUSION: The technique investigated in the present study could decrease the surgical risks for the mentioned structures and improve the pace and precision of operation.