Learning Through Surgeon's Eyes: Design, Development, and Evaluation of an Immersive Virtual Reality Training Tool for Oral and Maxillofacial Surgery

Background: Reduced training hours, over-crowded operating rooms, and lack of focus on non-technical skills are severely affecting surgical training. In specialities such as Oral and Maxillofacial Surgery, there is an increasing need for innovation in training. On the other hand, despite the application of technological advancements including virtual reality (VR) and augmented reality (AR), twenty-eight to forty percent of novice trainees are not confident in performing major surgery. The current research aims to address these challenges by finding a suitable way to develop an evidence-based immersive virtual reality (iVR) experience. Further, the research investigates the impact of this solution on the learning and confidence of trainees. This research introduces VR Surgery, an iVR experience, to address the gaps in the knowledge. VR Surgery is the first multi-sensory, holistic surgical training experience demonstrating Le Fort I osteotomy, a type of maxillofacial surgery, using Oculus Rift and Leap Motion devices. This research demonstrates the design, development and evaluation of VR Surgery and provides a way for future studies on the use of immersive technologies for surgical education. Methods: A design science research approach was followed to identify the problem, build the solution in collaboration with expert surgeons and evaluate it. Using a combination of multimedia, VR Surgery enables trainee surgeons to experience a realistic operating room environment, and interact with the patient’s anatomy while watching the surgery in a close-up stereoscopic 3D view. Consultant oral and maxillofacial surgeons in the UK evaluated VR Surgery for Face and Content validity. Surgeons commented on the content, usability and applicability of VR Surgery to surgical training. Further, to investigate the impact of VR Surgery on the perceived self-confidence of trainees, a single-blinded, parallel, randomised controlled trial (RCT) was performed. Surgical trainees (95) from seven dental schools took part in one of the first experiments to test the role of iVR on self-confidence. Experimental group participants learnt about the Le Fort I procedure using VR Surgery on an Oculus Rift. The control group used similar content in a standard PowerPoint presentation. The primary outcome measures were the self-assessment scores of trainees’ confidence as measured on a Likert scale and objective assessment based on the knowledge. Outcomes: The expert surgeons agreed with the validity of VR Surgery. The participants of the RCT were randomly divided into the experimental (51) and control (44) groups. Trainees had a mean age of 27∙14, and they were 45∙3% female students and 50∙5% male students. A repeated measures multivariate ANOVA was applied to the data to assess the overall impact of receiving the VR surgery intervention over conventional means on the confidence of trainees. Experimental group participants showed higher perceived self-confidence levels compared to those in the control group (p=0∙034, =0∙05). Novices in the first year of their training showed the highest improvement in their confidence, compared to those in the second and third year. Interpretation: Surgical trainees improve their knowledge and self-confidence levels after using an iVR training experience. The study proves that virtual reality applications such as VR Surgery have a substantial potential to bridge the differences in the quality of global surgical training. This research provides a framework for future researchers who use mixed reality for healthcare

The application of virtual reality and augmented reality in oral & maxillofacial surgery

Background: Virtual reality is the science of creating a virtual environment for the assessment of various anatomical regions of the body for the diagnosis, planning and surgical training. Augmented reality is the superimposition of a 3D real environment specific to individual patient onto the surgical filed using semi-transparent glasses to augment the virtual scene.. The aim of this study is to provide an over view of the literature on the application of virtual and augmented reality in oral & maxillofacial surgery. Methods: We reviewed the literature and the existing database using Ovid MEDLINE search, Cochran Library and PubMed. All the studies in the English literature in the last 10 years, from 2009 to 2019 were included. Results: We identified 101 articles related the broad application of virtual reality in oral & maxillofacial surgery. These included the following: Eight systematic reviews, 4 expert reviews, 9 case reports, 5 retrospective surveys, 2 historical perspectives, 13 manuscripts on virtual education and training, 5 on haptic technology, 4 on augmented reality, 10 on image fusion, 41 articles on the prediction planning for orthognathic surgery and maxillofacial reconstruction. Dental implantology and orthognathic surgery are the most frequent applications of virtual reality and augmented reality. Virtual planning improved the accuracy of inserting dental implants using either a statistic guidance or dynamic navigation. In orthognathic surgery, prediction planning and intraoperative navigation are the main applications of virtual reality. Virtual reality has been utilised to improve the delivery of education and the quality of training in oral & maxillofacial surgery by creating a virtual environment of the surgical procedure. Haptic feedback provided an additional immersive reality to improve manual dexterity and improve clinical training. Conclusion: Virtual and augmented reality have contributed to the planning of maxillofacial procedures and surgery training. Few articles highlighted the importance of this technology in improving the quality of patients’ care. There are limited prospective randomized studies comparing the impact of virtual reality with the standard methods in delivering oral surgery education

Design and Development of Sur-Face: An interactive mobile app for educating patients regarding corrective surgery of facial deformities

Corrective surgery of face, also known as orthognathic surgery, is a complex procedure performed to correct the underlying facial deformities. In case of elective surgeries like these, patients need to make voluntary decisions whether or not undergoing the surgery. Hence, it is very important for them to under-stand the intricacy of the techniques and potential side effects of the surgery before they sign the consent form. Conventional methods of patient education us-ing leaflet-based instructions were found to be ineffective in providing them the required information. Sur-Face, named after surgery of face is a healthcare app exploring a new dimension in patient education with the help of interactive 3D visualizations and serious gaming elements on a mobile platform. It demonstrates the surgical process and it’s after effects using high quality 3D animations. The aim of this study is to evaluate the efficacy of Sur-Face by comparing two methods of delivery of instructions: a mobile app with interactive 3D animations and an audio file containing only verbal instructions. To evaluate these methods, participant’s ability to understand and retain the instructions was analyzed using a questionnaire. The null hypothesis was that there would be no difference between the two methods of instructions. On analysis, participants of the ‘app’ group per-formed significantly better (p<0.0034) than the ‘voice’ group suggesting the role of interactive visualizations in improved understanding, intuitive knowledge transfer and communication. This paper describes the principles of design, development and potential advances of Sur-Face. Further it also explores the application of serious games in patient education and informed consent process

Oculus surgery – an Application of Oculus Rift and Stereoscopic 3D videos in training maxillofacial surgeons

With the continued application of gaming for training and education, which has seen exponential growth over the past two decades, this book offers an insightful introduction to the current developments and applications of game technologies within educational settings, with cutting-edge academic research and industry insights, providing a greater understanding into current and future developments and advances within this field. Following on from the success of the first volume in 2011, researchers from around the world presents up-to-date research on a broad range of new and emerging topics such as serious games and emotion, games for music education and games for medical training, to gamification, bespoke serious games, and adaptation of commercial off-the shelf games for education and narrative design, giving readers a thorough understanding of the advances and current issues facing developers and designers regarding games for training and education. This second volume of Serious Games and Edutainment Applications offers further insights for researchers, designers and educators who are interested in using serious games for training and educational purposes, and gives game developers with detailed information on current topics and developments within this growing area

Effectiveness of immersive virtual reality in surgical training—A randomized control trial

Purpose: Surgical training methods are evolving with the technological advancements, including the application of virtual reality (VR) and augmented reality. However, 28 to 40% of novice residents are not confident in performing a major surgical procedure. VR surgery, an immersive VR (iVR) experience, was developed using Oculus Rift and Leap Motion devices (Leap Motion, Inc, San Francisco, CA) to address this challenge. Our iVR is a multisensory, holistic surgical training application that demonstrates a maxillofacial surgical technique, the Le Fort I osteotomy. The main objective of the present study was to evaluate the effect of using VR surgery on the self-confidence and knowledge of surgical residents. Materials and Methods: A multisite, single-blind, parallel, randomized controlled trial (RCT) was performed. The participants were novice surgical residents with limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self-assessment scores of trainee confidence using a Likert scale and an objective assessment of the cognitive skills. Ninety-five residents from 7 dental schools were included in the RCT. The participants were randomly divided into a study group of 51 residents and a control group of 44. Participants in the study group used the VR surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. Repeated measures multivariate analysis of variance was applied to the data to assess the overall effect of the intervention on the confidence of the residents. Results: The study group participants showed significantly greater perceived self-confidence levels compared with those in the control group (P = .034; α = 0.05). Novices in the first year of their training showed the greatest improvement in their confidence compared with those in their second and third year. Conclusions: iVR experiences improve the knowledge and self-confidence of the surgical residents

Efficacy of 3D visualization in mobile apps for patient education regarding orthognathic surgery

‘Sur-face’ is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patient information on orthognathic surgeries and their related potential complications: a mobile app with interactive 3D animations and a voice recording containing verbal instructions only. For each method, the participants’ acquired knowledge was assessed using a custom-designed questionnaire. Participants in the ‘app’ group performed significantly better (P<0.0034) than those in the ‘voice’ group and retained more knowledge, suggesting that interactive visualizations play a key role in improving understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps

3D Head and Neck project: Development of a Novel Visualisation Tool for Education, Training and Research in Human Anatomy

The human head and neck anatomy includes core elements of respiratory, nervous and digestive systems making it the most vital zone of our body. However none of the existing visualisations realistically represent medically validated anatomy. This inspired the inception of 3D head and neck project. This ePoster presentation demonstrates the development and potential of the project in education, training and research

VR Surgery: Interactive virtual reality application for training oral and maxillofacial surgeons using Oculus Rift and Leap Motion

VR Surgery is an immersive virtual reality operating room experience for trainee surgeons in oral and maxillofacial surgery maxillofacial surgery. Using a combination of Oculus Rift head-mounted display, Leap Motion tracking devices, high-resolution stereoscopic 3D videos and 360-degree videos, this application allows a trainee to virtually participate in a surgical procedure and interact with the patient’s anatomy. VR Surgery is highly useful for surgical trainees as a visualisation aid and for senior surgeons as a practice-based learning tool. This chapter discusses the need for reforms in the existing surgical training methods and a brief review on simulation, serious games and virtual reality in surgical training. Following this, the principles of design and development of VR Surgery are presented