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Int J Surg. 2014;12(2):141-5. doi: 10.1016/j.ijsu.2013.11.019. Epub 2013 Dec 6.

Virtual reality case-specific rehearsal in temporal bone surgery: a preliminary evaluation.

Author information

  • 1Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK. Electronic address:
  • 2Department of Otolaryngology Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
  • 3Department of ENT, Surrey and Sussex NHS Trust, Redhill RH1 5RH, UK.
  • 4Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, W2 1NY, UK.
  • 5Department of Otolaryngology, Northwick Park Hospital, London HA1 3UJ, UK.



1. To investigate the feasibility of performing case-specific surgical rehearsal using a virtual reality temporal bone simulator. 2. To identify potential clinical applications in temporal bone surgery.


Prospective assessment study.


St Mary's Hospital, Imperial College NHS Trust, London UK.


Sixteen participants consisting of a trainer and trainee group.


Twenty-four cadaver temporal bones were CT-scanned and uploaded onto the Voxelman simulator. Sixteen participants performed a 90-min temporal bone dissection on the generic simulation model followed by 3 dissection tasks on the case simulation and cadaver models. Case rehearsal was assessed for feasibility. Clinical applications and usefulness were evaluated using a 5-point Likert-type scale.


The upload process required a semi-automated system. Average time for upload was 20 min. Suboptimal reconstruction occurred in 21% of cases arising when the mastoid process and ossicular chain were not captured (n = 2) or when artefact was generated (n = 3). Case rehearsal rated highly (Likert score >4) for confidence (75%), facilitating planning (75%) and training (94%). Potential clinical applications for case rehearsal include ossicular chain surgery, cochlear implantation and congenital anomalies. Case rehearsal of cholesteatoma surgery is not possible on the current platform due to suboptimal soft tissue representation.


The process of uploading CT data onto a virtual reality temporal bone simulator to perform surgical rehearsal is feasible using a semi-automated system. Further clinical evaluation is warranted to assess the benefit of performing patient-specific surgical rehearsal in selected procedures.

Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.


Otology; Surgical rehearsal; Training; Virtual reality simulation

[PubMed - indexed for MEDLINE]
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