The Journal of International
Advanced Otology
Original Article

Developing an Evidence-Based Surgical Curriculum: Learning from a Randomized Controlled Trial of Surgical Rehearsal in Virtual Reality


Department of Surgery (Otolaryngology), University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria Australia


Department of Otolaryngology, Taunton and Somerset NHS Foundation Trust, Somerset, United Kingdom

J Int Adv Otol 2023; 19: 16-21
DOI: 10.5152/iao.2023.22851
Read: 1044 Downloads: 425 Published: 01 January 2023

BACKGROUND: Surgical rehearsal — patient-specific preoperative surgical practice — can be provided by virtual reality simulation. This study investigated the effect of surgical rehearsal on cortical mastoidectomy performance and procedure duration.

METHODS: University students (n=40) were randomized evenly into a rehearsal and control group. After watching a video tutorial on cortical mastoidectomy, participants completed the procedure on a virtual reality simulator as a pre-test. Participants completed a further 8 cortical mastoidectomies on the virtual reality simulator as training before drilling two 3-dimensional (3D) printed temporal bones. The rehearsal group received 3D printed bones they had previously operated on in virtual reality, while the control group received 2 new bones. Cortical mastoidectomy was assessed by 3 blinded graders using the Melbourne Mastoidectomy Scale.

RESULTS: There was high interrater reliability between the 3 graders (intraclass correlation coefficient, r=0.8533, P < .0001). There was no difference in the mean surgical performance on the two 3D printed bones between the control and rehearsal groups (P=.2791). There was no significant difference in the mean procedure duration between the control and rehearsal groups for both 3D printed bones (P=.8709). However, there was a significant decrease in procedure duration between the first and second 3D printed bones (P < .0001).

CONCLUSION: In this study, patient-specific virtual reality rehearsal provided no additional advantage to cortical mastoidectomy performance by novice operators compared to generic practice on a virtual reality simulator. Further, virtual reality training did not improve cortical mastoidectomy performance on 3D printed bones, highlighting the impact of anatomical diversity and changing operating modalities on the acquisition of new surgical skills.

Cite this article as: Talks BJ, Lamtara J, Wijewickrema S, et al. Developing an evidence-based surgical curriculum: Learning from a randomized controlled trial of surgical rehearsal in virtual reality. J Int Adv Otol. 2023;19(1):16-21.

EISSN 2148-3817