Validation of a networked virtual reality simulation of temporal bone surgery

OBJECTIVES: To assess the content validity and concurrent validity of a haptically (force feedback) rendered, virtual reality simulation of temporal bone surgery. METHODS: Eleven naive surgical trainees were given a 1-hour lesson on the operation, cortical mastoidectomy, in the virtual environment with the trainer on a networked simulator and then asked to perform this procedure on a real temporal bone. RESULTS: The simulator was found to be a convincing representation of temporal bone drilling and could be said to exhibit face validity. The simulator was an effective means of teaching both the surgical anatomy and the surgical approach as judged by oral assessments made before and after the virtual reality training session. The trainees were successful in identifying most surgical landmarks during their first temporal bone dissection, and over two thirds found the landmarks at the correct time during the procedure. Some trainees exhibited acceptable or better technique with the drill despite this being their first temporal bone dissection. Subjective assessments indicated a high level of acceptance of simulated surgery for training, and there was perceived value in specific enhancements of the virtual environment that facilitated learning. Particular enhancements of value were the networked simulation, the option to make the model semitransparent to reveal anatomic relationships, and error reporting when the sigmoid sinus or facial nerve was injured. CONCLUSIONS: Virtual reality simulation of temporal bone surgery was an effective method for teaching surgical anatomy and planning and was well accepted by trainees.