Virtual reality as a viable alternative to cadaveric dissection for temporal bone surgical training: a pilot crossover trial

Surgical simulation has evolved significantly, transitioning from basic models to advanced virtual reality (VR) platforms, addressing the limitations of cadaveric training such as cost, availability, and ethical concerns. VR offers a risk-free, immersive environment for trainees to practice complex procedures, providing real-time feedback and objective performance metrics. Despite its potential, VR applications in Otolaryngology (ENT), particularly temporal bone surgery, remain underexplored due to anatomical complexity and specialty size. The primary hypothesis of this pilot trial was that VR simulation would achieve comparable technical performance to cadaveric dissection, while enhancing self-perceived competency. As a pilot study, no pre-specified non-inferiority margin was established; statistical non-significance was interpreted as potential equivalence requiring validation in a powered trial. This study presents the development and pilot evaluation of a VR-based temporal bone dissection simulator, comparing its efficacy against traditional cadaveric training. A single-centre crossover trial involving 14 ENT residents was conducted, with participants randomized into two arms: one starting with VR simulation (VRS) and the other with cadaveric dissection (CD). The VR platform, developed in collaboration with I3 Simulations, incorporated haptic feedback, real-time performance tracking, and scaffolded learning modules. Outcomes were assessed using pre- and post-simulation questionnaires, System Usability Scale (SUS), Technology Acceptance Model (TAM), and Zirkle grading for procedural accuracy. Results demonstrated a 26.7% increase in self-perceived competency post-VR (p < 0.001), with no significant difference in technical performance between VRS and CD (p = 0.623). SUS scores indicated moderate usability (score = 65.9 ± 14.2), while TAM scores reflected high acceptability (69.2% ± 12.1%). Qualitative feedback revealed strong trainee endorsement, with 85.7% reporting skill improvement and 78.6% willing to reuse the simulator. The study supports VR as a viable adjunct or alternative to cadaveric training, offering comparable educational outcomes with added scalability and accessibility. Limitations include small sample size and potential evaluator bias, warranting larger multi-institutional studies. These findings underscore VR’s transformative potential in ENT surgical education, advocating for further refinement and integration into training curricula.