Virtual Training Simulator for Endoscopic Middle Ear and Stapes Surgery

MSc assignment

Background

Endoscopic middle ear surgery, particularly stapes surgery for otosclerosis, has gained traction due to its enhanced visualization capabilities compared to traditional microscopic techniques [1]. However, challenges such as single-handed instrument handling, limited depth perception, and a steep learning curve make training difficult for ENT residents and surgeons [2].

Currently, cadaveric specimens are considered the gold standard for training, but their availability is limited due to ethical, cultural, and logistical constraints [3]. However, specimens are only available in a limited number of countries worldwide, amongst others due to deontological and cultural concerns. The possibility for young ENT surgeons to practice is provided during temporal bone courses but there is only limited availability of these courses in terms of capacity and costs. Hence, the accessibility of alternative and affordable materials for training could be highly beneficial.

A promising direction for further exploration is the integration of augmented reality (AR) in middle ear surgery training. AR has the potential to improve the visualization of middle ear structures, particularly in relation to inner ear structures like the promontory, round and oval window, and the relationship with the facial nerve, thereby enhancing the training experience. Notably, the integration of 3D-printed models and AR technology, offers interesting prospects. It provides haptic feedback through 3D-printed models while simultaneously delivering crucial anatomical insights via AR, including structures like the facial nerve and jugular bulb.

Overall, virtual reality (VR) and augmented reality (AR)-based surgical simulators provide a promising, accessible, and cost-effective solution for training ENT surgeons in a risk-free environment. By integrating VR with patient-specific 3D models, trainees can enhance their surgical skills and gain familiarity with anatomical structures before performing real procedures.

Objective

The goal of this thesis is to develop a virtual training simulator for endoscopic middle ear and stapes surgery that provides a realistic and interactive learning environment. The simulator will replicate surgical challenges, provide step-by-step guidance, and allow trainees to practice instrument handling and procedural techniques in a virtual setting.

Thesis roadmap:

  1. Literature Review: Study existing surgical training methods and limitations of current simulation models. Explore VR/AR applications in medical training, focusing on ENT surgery.
  2. 3D Model Development: Create patient-specific or generic anatomical models of the middle ear using medical imaging (CT/MRI) and 3D reconstruction techniques;  Integrate structures such as the promontory, round and oval windows, and the facial nerve.
  3. VR/AR Simulation Design: Develop a fully virtual training module for ENT residents and surgeons. Implement interactive features such as haptic feedback (if applicable), instrument simulation, and real-time guidance.
  4. User Interaction & Realism Enhancement: Improve depth perception and instrument control to mimic real surgical challenges. Integrate procedural steps for stapes surgery, including visualization and interaction with the virtual model.
  5. System Validation & Usability Testing: Evaluate the system’s effectiveness through usability tests with medical professionals or trainees. Compare performance metrics with traditional training methods.
  6. Thesis writing: Provide a comprehensive thesis detailing system design, methodology, experimental results, and future improvements.

Expected Outcomes

  • A functional VR-based surgical training simulator for endoscopic middle ear and stapes surgery.
  • Enhanced accessibility to surgical training without reliance on cadaveric models.
  • Improved skill acquisition for ENT residents and validation through user testing.

Requirements

  • Background in medical imaging, computer vision, or AR/VR development.
  • Experience in programming (e.g., Unity or Unreal Engine, Python, C#).
  • Interest in surgical simulation and medical training technologies.

This thesis offers an exciting opportunity to advance ENT surgical education by developing an innovative, cost-effective training tool for future surgeons. It is collaborative work amongst RAM-UT, ENT department and 3D medical lab from UMC Utrecht.

 

References:

  1. Tu LJ, Fina M, Golub JS, et al. Current trends in endoscopic ear surgery. Otology & Neurotology Open. 2022;2(4):e023. https://explore.openaire.eu/search/result?id=doi_________::37b19d5707b146f864c0cde83c4e24d8. doi: 10.1097/ONO.0000000000000023.
  2. Dedmon M, O’Connell B, Kozin E, et al. Development and validation of a modular endoscopic ear surgery skills trainer. Otology & neurotology. 2017;38(8):1193–1197. https://www.ncbi.nlm.nih.gov/pubmed/28692591. doi: 10.1097/MAO.0000000000001485.
  3. Kennedy EJ, Cleere EF, Crotty TJ, Keogh IJ. Training in endoscopic ear surgery: A scoping review. The Laryngoscope. 2023;133(12):3269–3278. https://www.ncbi.nlm.nih.gov/pubmed/37098824. doi: 10.1002/lary.30717.