From virtual reality to the operating room: The endoscopic sinus surgery simulator experiment
Received 15 September 2009; received in revised form 12 November 2009; accepted 16 November 2009.
Abstract
Objective
Establish the feasibility of a predictive validity study in sinus surgery simulation training and demonstrate the effectiveness of the Endoscopic Sinus Surgery Simulator (ES3) as a training device.
Four tertiary academic centers with accredited otolaryngology-head and neck surgery residency programs.
Subjects
Twelve ES3-trained novice residents were compared with 13 control novice residents.
Methods
Subjects were assessed on the performance of basic sinus surgery tasks. Their first in vivo procedure was video recorded and submitted to a blinded panel of independent experts after the panel established a minimum inter-rater reliability of 80 percent. The recordings were reviewed by using a standardized computer-assisted method and customized metrics. Results were analyzed with the Mann-Whitney U test. Internal rater consistency was verified with Pearson moment correlation.
Results
Completion time was significantly shorter in the experimental group (injection P = 0.003, dissection P < 0.001), which, according to the rater panel, also demonstrated higher confidence (P = 0.009), demonstrated skill during instrument manipulation (P = 0.011), and made fewer technical mistakes during the injection task (P = 0.048) compared with the control group. The raters' post hoc internal consistency was deemed adequate (r > 0.5 between serial measurements).
Conclusion
The validity of the ES3 as an effective surgical trainer was verified in multiple instances, including those not depending on subjective rater evaluations. The ES3 is one of the few virtual reality simulators with a comprehensive validation record. Advanced simulation technologies need more rapid implementation in otolaryngology training, as they present noteworthy potential for high-quality surgical education while meeting the necessity of patient safety.
aDepartment of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
bDepartment of Otolaryngology, New York University, New York, NY
cDepartment of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT
dDepartment of Otolaryngology, New York Eye and Ear Infirmary, New York, and New York Medical College, Valhalla, NY
Corresponding author: Marvin P. Fried, MD, Department of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, 3rd Flr, Bronx, NY 10467
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT