Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;13(3):186-191.
doi: 10.1177/1943387520923940. Epub 2020 May 5.

Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures

Tsung-Yen Hsieh  1 , Mena Said  2 , Raj D Dedhia  1 , Mary Roz Timbang  1 , Toby O Steele  1 , Edward Bradley Strong  1
Affiliations

Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures

Tsung-Yen Hsieh et al. Craniomaxillofac Trauma Reconstr. 2020 Sep.

Abstract

Virtual surgical planning (VSP) is becoming more widely used in maxillofacial reconstruction and can be surgeon-based or industry-based. Surgeon-based models require software training but allow surgeon autonomy. We evaluate the learning curve for VSP through a prospective cohort study in which planning times and accuracy of 7 otolaryngology residents with no prior VSP experience were compared to that of a proficient user after a single training protocol and 6 planning sessions for orbital fractures. The average planning time for the first session was 21 minutes 41 seconds ± 6 minutes 11 seconds with an average maximum deviation of 2.5 ± 0.8 mm in the lateral orbit and 2.3 ± 0.6 mm in the superior orbit. The average planning time for the last session was 13 minutes 5 seconds ± 10 minutes and 7 seconds with an average maximum deviation of 1.4 ± 0.5 mm in the lateral orbit and 1.3 ± 0.4 mm in the superior orbit. Novice users reduced planning time by 40% and decreased maximum deviation of plans by 44% and 43% in the lateral and superior orbits, respectively, approaching that of the proficient user. Virtual surgical planning has a quick learning curve and may be incorporated into surgical training.

Keywords: computer aided surgery; maxillofacial trauma; orbital fractures; surgical training; virtual surgical planning.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A, Example user interface for VSP demonstrating segmented unaffected orbit on the right and the mirrored orbit plan superimposed on the left fractured side. The red markers are fiducial points for intraoperative navigation. B, Coronal view: measurement of maximum deviation of mirrored orbit plan from bone superior (blue double-ended arrow) and lateral (yellow double-ended arrow) orbit. VSP indicates virtual surgical planning.
Figure 2.
Figure 2.
A, Exponential fitted regression analysis demonstrated a downward trend in the planning time with subsequent trials. Control: y = 298.04e 0.0224x. Participants: y = 1204.2e −0.114x. R 2 = 0.1925. P = .0037. B, The novice users’ average planning times approached a proficient user’s planning times (control). *Within 2 standard deviations; **within 1 standard deviation.
Figure 3.
Figure 3.
A, A scatter plot and exponential fitted regression analysis showed improvement in the maximum deviation in the lateral orbit in preoperative plans for orbital fractures with successive trials. Control: y = 1.2774e 0.011x. Participants: y = 2.4626e − 0.127x. R2 = 0.1393. P = .0149. B, There was no significant difference in the novice users’ average maximum deviation in the lateral orbit compared to the proficient user’s measurements for all the trials. *Within 2 standard deviations; **within 1 standard deviation.
Figure 4.
Figure 4.
A, Exponential fitted regression analysis of the maximum deviation in the superior orbit in virtual preoperative plans decreased as the number of created plans by each novice user increased. Control: y = 0.6052e −0.061x. Participants: y = 2.2291e −0.08x. R 2 = 0.1122. P = .0301. B, There was variation in the novice users’ average maximum deviation in the superior orbit compared to the proficient user’s data. *Within 2 standard deviations; **within 1 standard deviation.
See this image and copyright information in PMC

References

    1. Essig H, Dressel L, Rana M, et al. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med. 2013;9:18. - PMC - PubMed
    1. Strong EB, Fuller SC, Wiley DF, Zumbansen J, Wilson MD, Metzger MC. Preformed vs intraoperative bending of titanium mesh for orbital reconstruction. Otolaryngol Head Neck Surg. 2013;149(1):60–66. - PubMed
    1. Bell RB, Markiewicz MR. Computer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: a descriptive study in a preliminary cohort. J Oral Maxillofac Surg. 2009;67(12):2559–2570. - PubMed
    1. Kirke DN, Owen RP, Carrao V, Miles BA, Kass JI. Using 3D computer planning for complex reconstruction of mandibular defects. Cancers Head Neck. 2016;1(1):17. - PMC - PubMed
    1. Zweifel DF, Simon C, Hoarau R, Pasche P, Broome M. Are virtual planning and guided surgery for head and neck reconstruction economically viable? J Oral Maxillofac Surg. 2015;73(1):170–175. - PubMed