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Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance. JAMA Facial Plast Surg 2018 Jan 01;20(1):63-69



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2-s2.0-85040970438   12 Citations


Importance: Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery.

Objective: To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making.

Design, Setting, and Participants: For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making.

Main Outcomes and Measures: Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making.

Results: Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively.

Conclusions and Relevance: Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction.

Level of Evidence: NA.

Author List

Vanhille DL, Garcia GJM, Asan O, Borojeni AAT, Frank-Ito DO, Kimbell JS, Pawar SS, Rhee JS


Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin
Sachin S. Pawar MD Chief, Associate Professor in the Otolaryngology department at Medical College of Wisconsin
John S. Rhee MD Chair, Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Attitude of Health Personnel
Clinical Decision-Making
Cross-Sectional Studies
Directive Counseling
Imaging, Three-Dimensional
Models, Anatomic
Nasal Obstruction
Patient Selection
Pilot Projects
Preoperative Care
Qualitative Research
Surgery, Computer-Assisted
Tomography, X-Ray Computed
Virtual Reality
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a