Mastoidectomy Simulator for Surgical Training and Rehearsal

乳突切除术是一项复杂的外科手术，切除部分颅骨以治疗耳部感染、植入人工耳蜗和切除肿瘤。全世界每年进行数十万例乳突切除术，手术并发症发生率高达20%。手术失误是灾难性的，包括面神经麻痹、听力丧失、耳鸣、眩晕和味觉改变。掌握这一程序需要大量的培训。然而，训练受到尸体材料短缺的阻碍。为了提供另一种培训方法，我们开发了一种虚拟现实模拟器，允许用户在单个3D数字头部模型上操作。在单一模型上的练习并不能让受训者为患者解剖结构的巨大变化做好准备，但创建额外的模型是困难的。此外，需要对模拟器进行仔细的评估以进行验收。我们的目标是：(1)开发软件，从患者图像自动构建数字模型；(2)实施自动化绩效评估方法；(3)评估技能发展和从虚拟环境到现实环境的转移。我们将开发软件，自动扭曲模板数字解剖模型来匹配特定的患者图像，从而为新患者生成模型。我们将实施软件，在虚拟头部模型上操作时自动评估每个受训者的表现。该软件将基于教师在当前实践中使用的经过验证的度量标准。为了评估技能的发展和转移，耳鼻喉科专家小组将在模拟器训练前后用尸体头骨对受训者进行评估。该模拟器将增加和改善各种患者类型的培训机会。此外，它将允许在特定解剖结构的手术前在数字模型上进行排练，从而提高手术效果。

Mastoidectomy is a complex surgical procedure in which portions of the skull are drilled awayto treat ear infections, to place cochlear implants and to remove tumours. Hundreds ofthousands of mastoidectomies are performed worldwide each year with surgical complicationrates as high as 20%. Surgical mistakes are disastrous and include facial nerve paralysis,hearing loss, tinnitus, vertigo and altered taste. Significant training is required to master theprocedure. However, training is hampered by a shortage of cadaveric materials. To providean alternative training approach, we have developed a virtual-reality simulator that allows theuser to operate on a single 3D digital head model. Practice on a single model does notprepare trainees for the large variability in patient anatomy, but creating additional models isdifficult. Moreover, careful evaluation of the simulator is required for acceptance.Our objectives are to (1) develop software to automatically construct digital models frompatient images, (2) implement automated performance assessment methods, and (3)evaluate skill development and transfer from the virtual environment to realistic settings.We will develop software to automatically warp a template digital anatomical model to matcha specific patient image, thus generating models for new patients. We will implementsoftware that automates evaluation of each trainees performance when operating on virtualhead models. The software will be based on well validated metrics that are used in currentpractice by instructors. To evaluate skill development and transfer, an expert panel ofOtolaryngologists will evaluate trainees on cadaveric skulls before and after training using thesimulator.The simulator will result in increased and improved training opportunities on a wide variety ofpatient types. Moreover, it will allow rehearsal on a digital model prior to surgery on a specificanatomy, leading to improved surgical performance.