As a challenging and potentially risky procedure, endoscopic sinus surgery (ESS) is a prime candidate for VR simulation training. Over the past two years the HITLab has been collaborating in the construction of an ESS simulator with a group from Lockheed-Martin (formerly Loral Training and Simulation), the Ohio Supercomputer Center, and Immersion Corp., under the direction of Major Chuck Edmond, an otolaryngologist at Madigan Army Medical Center and a HITLab medical advisor.

The Lockheed-Martin ESS simulator, which incorporates a force display interface and simulated (Visible Human) anatomy and instruments, made a successful public debut at the Medicine Meets Virtual Reality conference in San Diego in January. After a few changes to the haptic interface, the prototype system was relocated to the HITLab for shakedown and evaluation, and will be installed at Madigan for further testing and clinical use later in the spring.

During the next six months, the HITLab team (led by research scientist Suzanne Weghorst and professor Bill Winn) will take the leading role in evaluating the utility of the simulator as a training environment. Technical support will be provided by HITL software engineer Peter Oppenheimer and lab assistant Chris Airola.

Otolaryngologists typically learn sinus surgery procedures by observing an experienced surgeon and then practicing under the guidance of a mentor. Using the VR simulator, a trainee will progress from a simplified "novice" task aimed at training basic endoscope navigation and instrument skill, through a more complex anatomical model enhanced with visual and auditory cues (the "intermediate" level), to an unassisted simulated procedure (the "expert" level). All trials are automatically scored by the system and can be replayed for further feedback and instruction.

Aspects of the system to be evaluated by the HITLab team include the utility of the haptic display and of the visual and auditory training aids, the correlation between performance on the simulator and performance in the operating room, and the relative impact of experience with the simulator on various components of surgical skill. This systematic evaluation will provide a valuable conceptual framework for medical training simulator design.