Journal of Surgical Simulation 2015; 2: 68 - 75

Published: 01 December 2015


Original article

Novices perform better in virtual reality simulation than in traditional cadaveric dissection training of mastoidectomy

Steven Arild Wuyts Andersen, Per Cayé-Thomasen and Mads Sølvsten Sørensen
Corresponding author: Steven Arild Wuyts Andersen, Department of Otorhinolaryngology—Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Email:


Background: Temporal bone surgery requires integration of complex knowledge and technical skills. This can be difficult to accomplish with traditional cadaveric dissection training, which is often organized as single-instance participation in a temporal bone course. Simulator-integrated tutoring in virtual reality (VR) surgical simulators can visually guide the procedure and facilitate self-directed surgical skills acquisition. This study aims to explore the performances of novice otorhinolaryngology residents in a freeware VR simulator and in cadaveric dissection training of mastoidectomy.

Methods: Thirty-four novice otorhinolaryngology residents performed a single and self-directed mastoidectomy procedure in a freeware VR temporal bone simulator before performing a similar procedure on a cadaveric temporal bone. VR simulation and cadaveric dissection performances were assessed by two blinded expert raters using final product analysis.

Results: Participants achieved a higher mean final product score in VR simulation compared with cadaveric dissection (14.9 and 13.2, respectively; P = 0.02). Significantly more of the participants had their best performance in VR simulation (P = 0.04). No differences in computer experience and interest were found between the group that performed better in VR simulation and the group that performed better in cadaveric dissection.

Conclusions: Novice performance in a freeware VR temporal bone simulator was significantly better than in cadaveric dissection. The simulator-integrated tutor function and reduced complexity of the procedure in VR simulation could be possible explanations for this finding. VR simulation training could be used in the initial training of novices, reserving dissection training for more advanced training after basic competencies have been acquired with VR simulation.


Virtual reality simulation; technical skills training; self-directed learning; mastoidectomy; temporal bone surgery; surgical simulation