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Training Surgeons for Skull-base Procedures with Virtual Reality Simulator

People with diseases or conditions that affect the base of the skull, such as otologic abnormalities, cancerous tumours and birth defects, might need to undergo skull base surgery at some point in their life. Surgeons must skillfully operate on and within a person’s skull, accessing specific regions using drills to successfully conduct these challenging procedures.

Researchers at Johns Hopkins University (JHU) have recently developed a new system that could be used to train surgeons to complete skull base surgeries, as well as potentially other complex surgical procedures. This system, presented in a paper published in Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualisation, is based on the use of a virtual reality (VR) simulator.

The process of drilling requires surgeons to remove minimal amounts of bone while ensuring that important structures (such as nerves and vessels) housed within the bone are not harmed. Therefore, skull base surgeries require high skill, absolute precision, and sub-millimetre accuracy. Achieving these surgical skills requires diligent training to ensure the safety of patients.

Currently, most resident surgeons are trained to complete skull base surgeries and other procedures on cadavers or on live people under the supervision of experienced doctors. However, realistic computer simulations and virtual environments could significantly enhance the training of surgeons, offering a cost-effective, safe and reproducible alternative to traditional training methods.

In addition to allowing surgeons to practice their skills in a safe and realistic setting, simulation tools enable the collection of valuable data that would otherwise be harder to attain. This includes optimal trajectories for surgical tools, the forces that are imparted during a procedure, or the position of cameras/endoscopes.

This data is beneficial for two purposes. Firstly, it could be used to train Artificial Intelligence (AI) algorithms that can assist surgeons in the operating room and make procedures safer. Secondly, by comparing surgical data from residents in training and expert surgeons, educators could individualise training and make the limited time trainees have for education more efficient.

– Adnan Munawar

The VR-based system created by the researchers allows resident and experienced surgeons to practise complex surgical procedures within simulated environments that are based on the computer tomography (CT) scans of real patients. In addition, the simulator can be used to record structured data. This data could eventually be used to assess the skills of trainees or to train machine learning algorithms that could assist surgeons during complex procedures.

So far, the system provides an immersive simulation environment where the surgeons can interact with a virtual skull which is generated from a patient CT (Computer Tomography) scan. A virtual drill that is controlled via a haptic device (or a keyboard) is used to drill through the virtual skull. The interaction between the drill and the skull is used to generate force feedback which is provided via the haptic device for realistic tactility. Finally, for visual realism and depth perception, stereoscopic video is displayed on a VR (Virtual Reality) headset.

The immediate plan is to deploy the system in the Johns Hopkins Otolaryngology – Head and Neck Surgery department to be used by skilled surgeons as well as residents for practice and data collection. The collected data will be used to establish a quantitative evaluation protocol to characterise surgical performance, which is not presented by prior works. We shall also use the data for developing artificial intelligence algorithms for computer-assisted surgeries, such as tool/tissue tracking and 3D reconstruction algorithms.”

U.S. researchers have been creating advanced technologies in medicine, such as a new robotic neck brace. As reported by OpenGov Asia, this robotic neck brace may help doctors analyse the impact of cancer treatments on the neck mobility of patients and guide their recovery. Head and neck cancer was the seventh most common cancer worldwide in 2018, with 890,000 new cases and 450,000 deaths, accounting for 3% of all cancers and more than 1.5% of all cancer deaths in the United States.


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