1. Design and Evaluation of a Virtual Reality Simulation Module for Training Advanced Temporal Bone Surgery
Sudanthi Wijewickrema
Department of Surgery (Otolaryngology)
The University of Melbourne, Australia

2. Overview Background Simulation platform Application
The University of Melbourne virtual reality (VR) temporal bone surgery simulator
Application
Training advanced temporal bone surgery (Cochlear implant surgery)
Design of the training module
Based on principles of surgical curriculum development
Evaluation of the training module
Conclusions and future work

3. VR Surgery Simulation A complement to traditional (cadaver) training
Scarcity of cadavers
Promote self-guided surgical training
Extra training opportunities for trainees
A practice platform for experienced surgeons
Surgical Simulation
Cadaveric Dissection
Operating Room

4. Benefits of VR simulation
Risk-free environment
Repeatability
Practice until minimum standards are met
Standardized curriculum
Exposure to complex or rare pathologies
Availability
Self-guided learning
Automated feedback and performance tracking
Reduced need for expert supervision
Low running costs
No material replacement

5. The University of Melbourne Temporal Bone Surgery Simulator
Virtual model of a temporal bone
Impression of a 3D operating space
Visual feedback
Colour changes near structures
Tactile feedback
Through haptic device
Force and vibrations
The University of Melbourne VR Temporal Bone Surgery Simulator
Auditory feedback
Buzz of the drill
Beep when structures are damaged
Multiple cases of varying difficulty

6. Cochlear Implant Surgery
Insertion of an electrode into the Cochlea to preserve hearing
Prepare the temporal bone for electrode insertion
Avoid damaging anatomical structures
We focus on the final (more critical) stages of the procedure
Anatomical Structures of the Temporal Bone
Drilled Temporal Bone Ready for Electrode Insertion

7. Cochlear Implant Surgery Training Module
Initial video tutorial on how to perform the procedure
Specimens of varying difficulty levels
Two training modes used in concert with each other
Instruction mode
Real-time visual guidance on procedural steps
Auditory information on why each step is performed
Practice mode
Practice without any guidance
Submit dissected bone for summative feedback

8. Cochlear Implant Surgery Training Module
Real-Time Guidance in the Instruction mode
Summative Feedback in the Practice mode

9. Demo Video

10. Design based on Principles of Curriculum Development
Deliberate practice and learner motivation
Repeated goal-oriented practice
Performance feedback
Real-time and summative guidance
Task demonstration
Video instructions
Task distribution and practice variability
Specimens of varying difficulty
Practice distribution
Sessions spaced at intervals of choice
Proficiency based training
Guidance on procedural steps derived from expert performances
Stefanidis (2010), ‘Optimal acquisition and assessment of proficiency on simulators in surgery’

11. Evaluation of the Training Module
12 ENT registrars (residents)
2 sessions a week apart
Pre-test (no guidance)
Bone 0
Training: instruction and practice modes
Session 1: bones 1-3
Session 2: mirrors of bones 1-3
Post-tests (no guidance)
Post-test 1: mirror of bone 0
Post-test 2: bone 4
Questionnaire
Study Design

12. Evaluation of Effectiveness
Videos of pre- and post-test performances evaluated
By a blinded expert surgeon
Based on a validated scale: global rating and task-based scores
Structure damage was calculated by the simulator
Wilcoxon signed-rank test was used to compare pre- and post-test results
Pre – Post1
Pre – Post2
Global rating score
p = 0.026
p = 0.003
Task-based score
p = 0.008
p = 0.027
Structure damage
p = 0.023
p = 0.010
Copson et al (2017), ‘Supporting skill acquisition in cochlear implant surgery through virtual reality simulation’

13. Evaluation of Usability
Questions in the questionnaire were based on the Likert scale
Residents felt strongly that the module was suitable for training Cochlear implant surgery
Analysis of the questionnaire answers

14. Conclusions and Future Work
A simulation module for training Cochlear implant surgery was designed based on principles of surgical curriculum development
A study of ENT residents was conducted to test its effectiveness and usability
Participants showed significantly improved performance after training on the simulation module
Participants felt that the simulation module was highly useful for training Cochlear implant surgery
Future work
Studies to test skill transfer to the operating room
Studies to test retention of surgical skills

15. Acknowledgements Surgery Prof Stephen O’Leary A/Prof Robert Briggs
Dr Bridget Copson
Education
Prof Gregor Kennedy
Funded through a grant from:
Computer Science
Prof James Bailey
Dr Sudanthi Wijewickrema
Dr Yun Zhou
Mr Xingjn Ma

16. Thank you