Development and Validation of a Virtual Reality Simulator for Thyroid Surgery Training: A High-Fidelity System Featuring CT-Derived Deformable Tissues and Photorealistic Volumetric Operating Room Environment (Preprint)

BACKGROUND Thyroid surgery entails significant challenges due to the intricate anatomical structure of the region, including the recurrent laryngeal nerve and the parathyroids. OBJECTIVE To support the training of resident surgeons through the development of a virtual reality simulator for thyroid surgery. METHODS We created an anatomical model integrating structures segmented from CT data with manually inserted elements not clearly visible in CT scans (e.g., nerves, parathyroids). The model was integrated into a photorealistic operating room environment created using photogrammetry. The simulation incorporates organ and tissue deformation consistent with clinical observations and surgical exploration. RESULTS The prototype simulator enables users to manipulate key anatomical components and explore the positioning of parathyroids, nerves (e.g., the recurrent laryngeal nerve), and relevant vascular structures, creating an immersive learning experience. CONCLUSIONS We have developed a proof-of-concept virtual reality simulator for thyroid surgery training that has received initial qualitative validation and feedback from experienced thyroid surgeons. CLINICALTRIAL This study primarily involved the development and qualitative assessment of an immersive virtual reality simulator for thyroid surgery training. The anatomical models were created using anonymized publicly available CT scan data, ensuring no identifiable patient information was utilized. For simulator validation, three surgeons, who are also co-authors of this paper, with varying levels of experience participated in the evaluation after receiving a brief explanation of the simulator functionality. Written informed consent was obtained from all participating surgeons prior to their involvement. The photogrammetry process for creating the virtual operating room environment and patient positioning utilized a surgical training mannequin rather than actual patients. No experimental procedures were performed on human subjects or animals, and no sensitive personal data was collected during the research process. This type of technological development and simulator validation research does not typically require formal institutional review board approval according to our institutional guidelines. All research activities were conducted in compliance with the principles outlined in the Declaration of Helsinki and adhered to the institutional regulations for educational technology development and evaluation. The surgeons' feedback was documented and analyzed with their consent, with responses presented in an anonymized format to maintain confidentiality while preserving the educational value of their expert assessment.