Development of a Training System Using Virtual Reality for Partial Glossectomy

The tongue is the most common site for oral cancers. Skillful resection is very difficult for clinicians, particularly for beginners, because the form and location of the lesion change three-dimensionally during the operation due to factors such as the direction and strength of traction, and the site, size, and stiffness of the lesion. Several surgical technique training systems using virtual reality (VR) have recently been developed in the medical field. However, the modality has yet to be introduced for glossectomy, and operative skill can thus only be acquired through clinical experience. We report herein a prototype training system using VR for partial glossectomy. As a first step, software allowing visualization of the deformation and resection of the tongue was developed from a three-dimensional physiological computational model of the tongue. Next, we made a simulator system that is able to transduce the force feedback to the operators using three-dimensional haptic interfaces. The system comprises the following two elements working simultaneously: a monitor that visualizes deformation of the tongue by pulling and cutting; and haptic devices that convey physical forces produced by traction and resection. We introduce herein an outline of the prototype system and clarify the remaining obstacles to clinical application.