Surgical simulation training improves speed and confidence in residents learning endoscopic sinus surgery
A study of otolaryngology (ear, nose, and throat) residents confirms the value of using a virtual reality simulator as part of learning to do sinus surgery with an endoscope. Endoscopic sinus surgery (ESS) is one of the most common procedures done by otolaryngologists, but is also the most frequent cause of litigation for these practitioners. Current training in ESS involves the use of instructional videos, cadaver dissection when available, and direct observation in the operating room. The researchers compared a group of residents who used standard training and a virtual reality training device, the Endoscopic Sinus Surgery Simulator (ES3), with a comparable group of residents who underwent only standard training.
The ES3 group performed mucosal injection in 3 minutes less than the control group (mean of 1.7 min. vs. 4.7 min.) and with less variability in performance. ES3-trained residents also spent half as much time doing dissection as residents in the control group (mean of 7.4 min. vs. 15.4 min.). When rated by experienced surgeons, the ES3-trained residents also showed much higher confidence and dexterity of instrument use during the dissection (6.6 and 6.8, respectively, on a 10-point scale) than did the control residents (2.7 and 2.8, respectively).
The researchers enrolled 25 residents who had no prior experience with ESS in the study and randomly assigned them to the experimental or control groups. The first procedure each resident performed on a live patient was video recorded and reviewed by three senior academic otolaryngologists. They later compared the recorded procedures standardized around the completion of a set of basic tasks (navigation, injection, and dissection) between the two groups. For each task, the raters measured variables that included time to completion of task, case difficulty, tool manipulation, tissue respect (care in dealing with the sinus tissue), task completion rate, surgical confidence, and number of errors.
Based on this study and other studies of surgical simulators in medical education, the researchers recommend that advanced simulation technologies should be rapidly integrated into surgical training. Their study was funded in part by the Agency for Healthcare Research and Quality (HS11866).
More details are in "From virtual reality to the operating room: The endoscopic sinus surgery simulator experiment," by Marvin P. Fried, M.D., Babak Sadoughi, M.D., Marc J. Gibber, M.D., and others in the February 2010, Otolaryngology—Head and Neck Surgery 142(2), pp. 202-207.
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