Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy

Gilad Feinmesser; David Yogev; Tomer Goldberg; Yisrael Parmet; Shay Illouz; Oliana Vazgovsky; Yael Eshet; Shai Tejman-Yarden; Eran Alon

doi:10.1016/j.amjoto.2023.103976

Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy

Am J Otolaryngol. 2023 Nov-Dec;44(6):103976. doi: 10.1016/j.amjoto.2023.103976. Epub 2023 Jul 15.

Authors

Gilad Feinmesser¹, David Yogev², Tomer Goldberg³, Yisrael Parmet⁴, Shay Illouz³, Oliana Vazgovsky⁵, Yael Eshet⁶, Shai Tejman-Yarden³, Eran Alon⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel.
² School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel. Electronic address: didiyogev@gmail.com.
³ School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel.
⁴ Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel.
⁵ The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel.
⁶ School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.
⁷ School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel.

PMID: 37480684
DOI: 10.1016/j.amjoto.2023.103976

Abstract

Objective: Sentinel lymph node biopsy (SLNB) is crucial for managing head and neck skin cancer. However, variable lymphatic drainage can complicate SLN detection when using Single-Photon Emission Computed Tomography (SPECT) or lymphoscintigraphy. Virtual Reality (VR) can contribute to pre-operative planning by simulating a realistic 3D model, which improves orientation. VR can also facilitate real-patient training outside the operating room. This study explored using a VR platform for pre-operative planning in head and neck skin cancer patients undergoing SLNBs and assessed its value for residential training.

Materials and methods: In this prospective technology pilot study, attending surgeons and residents who performed 21 SLNB operations on patients with head and neck skin cancers (81% males, mean age 69.2 ± 11.3) used a VR simulation model based on each patient's pre-operative SPECT scan to examine patient-specific anatomy. After surgery, they completed a questionnaire on the efficiency of the VR simulation as a pre-operative planning tool and training device for residents.

Results: The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10. Three-quarters (76%) of residents reported increased confidence after using VR. The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10.

Conclusion: A VR SLNB simulation can accurately portray marked sentinel lymph nodes. It was rated high as a surgical planning and teaching tool among attending surgeons and residents alike and may play a role in pre-operative planning and resident training. Further studies are needed to explore its applications in practice.

Keywords: Computed tomography; Pre-operative simulation; Residential training; Sentinel lymph node biopsy; Virtual reality.

MeSH terms

Aged
Aged, 80 and over
Female
Head and Neck Neoplasms* / diagnostic imaging
Head and Neck Neoplasms* / pathology
Head and Neck Neoplasms* / surgery
Humans
Lymph Nodes / pathology
Male
Melanoma* / pathology
Middle Aged
Pilot Projects
Prospective Studies
Sentinel Lymph Node Biopsy / methods
Skin Neoplasms* / pathology
Virtual Reality*