Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: AHNS22
Session Name: Scientific Session 5 - Technology & Education
Session Date: Thursday, May 15, 2025
Session Time: 10:15 AM - 11:00 AM
Virtual Reality Simulation for Fibula Free Flap Planning among an Otolaryngology-Head and Neck Surgery Resident Cohort
Hannah L Kenny, MD; Kathryn Nunes, BS; Kelly M Bridgham, MD; Eric V Mastrolonardo, MD; Joseph M Curry, MD; Richard A Goldman, MD; Thomas Jefferson University HospitalIntroduction: Virtual reality (VR) has expanded opportunities for surgical trainees to hone surgical skills in a low-risk setting; a recent systematic review highlighted, among several surgical subspecialties, implementation of VR/AR technology to enrich surgical education.1,2 This survey study aimed to evaluate the feasibility and efficacy of using a VR platform to practice fibula free flap (FFF) planning among Otolaryngology-Head and Neck Surgery (OHNS) trainees.
Methods: Post-graduate year 3 (PGY-3) OHNS residents attending a simulation course completed a FFF reconstruction module, consisting of a hands-on activity creating osteotomies in a fibula model to reconstruct a mandibular defect, as well as a virtual reality (VR) activity, using the ImmersiveTouch software, in which a mandibular defect and a fibula was displayed; participants adjusted angles of simulated osteotomies to create 2 segments to fit within the defect. The chosen angles were then displayed on the fibula template for users to reference. Residents completed surveys before and after the hands-on and VR activities, consisting of a total of 14 5-point Likert Scale questions, and 2 free response questions.
Results: 33 OHNS PGY-3 residents completed the VR activity and associated pre- and post-surveys. Of surveyed residents, experience with FFF reconstruction was variable: 30% reported having scrubbed into a FFF case 1 to 3 times. 48% reported assisting with FFF harvest 1 to 3 times. The surveyed residents most commonly had seen Virtual Surgical Planning (VSP) utilized when planning a FFF; 33% reported having never seen a technique other than VSP during planning (Table 1). 33% had never used VR software previously. On pre-survey, 42% were neutral when asked if they have a basic understanding of how to manipulate a fibula or plan fibula osteotomies for the purpose of reconstruction. On post-survey, 52% agreed when asked if they have a basic understanding of how to manipulate a fibula (Table 2). Accordingly, 88.9% agreed or strongly agreed that the VR exercise improved their ability to plan a FFF reconstruction, and 75.0% agreed or strongly agreed that it improved their ability to plan osteotomies. 92.6% agreed or strongly agreed that they would regularly use VR software for surgical planning if they had access to it.
Conclusion: Among a cohort of OHNS PGY-3 resident trainees, understanding of how to manipulate a fibula and plan fibula osteotomies was improved after a VR exercise, based on survey responses; the majority of surveyed participants reported they would use VR software for surgical planning if they had access to it. While further study is needed, the results of this survey highlight the potential for VR simulation to complement OHNS surgical training and optimize surgical planning.
