High-fidelity surgical simulator for the performance of craniofacial osteotomies

The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills.

We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback.

Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel.

The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures.