ABSTRACT

Rhinoplasty,known as one of the most complex procedures, continues to be one of the most requested interventions nowadays. According to the International Society of Plastic and Aesthetic Surgery, in 2019, 821,890 rhinoplasties were performed worldwide, increasing 13.1% compared to the previous year.

The learning curve described as "the time and the number of procedures that an average surgeon needs to be able to perform a procedure independently, with a reasonable result," has a slow rise, and at times, it can be a some what bumpy experience.

Repetition improves motor skills that surgeons develop as they execute surgical techniques. Virtual reality (VR) opens an opportunity for surgeons to develop and enhance their surgical skills in a safe environment. We aimed to provide a narrative review of VR software that simulates an open rhinoplasty procedure to facilitate understanding the different components of the nose and enhance surgical motor training.

INTRODUCTION

More than 20 years ago, research on Virtual Reality (VR) showed applications in medicine.However, its use began when the hardware was efficient enough to provide good quality and mass accessibility.

InApril 2016, VR was used for the first time to broadcast a live surgery. Users with a VR viewer could experience a 360-degree view of the operation room and stand next to the surgeon while performing the procedure.

Trainees must gain proficiency in a variety of challenging surgical techniques. Traditional teaching has relied on the use of cadavers; however, this method is resource-intensive and does not allow for repeated practice. Virtual reality surgical training is a growing field that is increasingly being adopted in Otolaryngology.

OBJECTIVE

To provide a narrative review of a virtual reality software that simulates an open rhinoplasty procedure that shortens the learning curve in the novice surgeon and encourages continuous practice in the already experienced surgeon.

PROCEDURE

Facial analysis: taking advantage of augmented reality and 3D images, the surgeon would be able to take measurements of the different reference points of the face to perform facial analysis, including calculating projection and rotation of the tip of the nose, estimate dimensions of the nasal base and alar base.

Surgical plan: following the facial analysis, the surgeon would design the surgical plan and simulate surgical outcomes.

Open rhinoplasty: a guided approach is used to navigate the surgeon among the different steps of the open rhinoplasty,including incision marking, marginal and columellar incisions.

Remote guidance: the surgeon can share the facial analysis, surgical plan, and procedure with other users to improve decisiónmaking and evaluate progress.

DISCUSSION

Halted's apprenticeship model, where residents and fellows learn under the supervision of a senior trainee or surgeon, is the keystone of modern surgical training. This model is characterized by repetition and graduated responsibility. VR leverages the power of simulation before exposing trainees to live situations. Successful surgical skill development through simulation has been well documented.Simulation has been shown to accelerate learning curves for surgical trainees in multiple specialties, including neurosurgery, gynecology, general surgery,and orthopedics [10,11,12,13].

CONCLUSION

Virtual and augmented reality are taking an increasingly important role in surgical education as well as in surgical care. Numerous studies have demonstrated that VR improves skill mastery outside the operating room, though translating these skills to the clinical environment is challenging to assess. Virtual reality shows promise in open rhinoplasty training. More studies are needed to assess training effectiveness.