Virtual Reality Haptic Simulator for Endoscopic Sinus and Skull Base Surgeries

Kim, Do Hyun MD, PhD∗; Kim, Hyun Mun MS†; Park, Jae-Sung MD‡; Kim, Sung Won MD, PhD∗

Journal of Craniofacial Surgery: September 2020 – Volume 31

doi: 10.1097/SCS.0000000000006395

Objective: This paper proposes a virtual reality (VR) haptic simulator with realistic instruments, an exchangeable patient-specific three-dimensional (3D)–printed external nostril and a caudal septum model to facilitate real surgical motion for training in endoscopic sinus and skull–base surgery.

Methods: The VR simulator consists of the main simulator body, a monitor, an endoscope device, 2 haptic devices, an endoscope holder support fixture, and a pair of pedals. The location of the endoscope device is determined by an electromagnetic sensor. Two haptic devices are located so as to prevent mutual interference during application of the two-nostrils/four-hands technique for endoscopic skull-base surgery. The pedals were used for select surgical instrument and endoscopes, and operate microdebriders or microdrill. An exchangeable patient-specific external nostril and caudal septum model was created using material that mimics the texture of human tissue and a 3D printer. Graphics were rendered using Unity 3D, to which the Simulation Open Framework Architecture (SOFA) physics engine can be bolted on using the Unity3d plug-in.

Results: This VR haptic simulator enables performance of basic endoscopic sinus surgeries (eg, maxillary sinus antrostomy, ethmoidectomy, and frontostomy), as well as endoscopic endonasal transsphenoidal (including sphenoidotomy) and transclival approaches.

Conclusion: VR haptic simulators can improve the skill and confidence of surgical trainees by allowing them to accrue experience in various tasks under different conditions. The simulator introduced here comprises novel technologies and provides a realistic training environment for endoscopic sinus and skull–base surgery.