A Randomized Pilot Trial of Virtual Reality Surgical Planning for Head and Neck Oncologic Resection.

Authors

• Kathryn L Nunes
• Victor Jegede
• Derek S Mann
• Pablo Llerena
• Richard Wu
• Leonard Estephan
• Ayan Kumar
• Sana Siddiqui
• Raphael Banoub
• Scott W Keith
• Madalina Tuluc
• Arielle G Thal
• Richard Goldman
• Leila J Mady
• David M Cognetti
• Adam J Luginbuhl
• Michael C Topf
• Joseph M Curry

Publication/Presentation Date

3-1-2025

Abstract

OBJECTIVE: Application of virtual reality (VR) for surgical planning may improve clinical outcomes for head and neck cancer (HNC) resection. There is a lack of randomized trials and meaningful metrics to assess such technological applications. Our objective was to evaluate the feasibility of a VR protocol for oncologic surgical planning and assess the impact on surgical outcomes.

METHODS: A randomized controlled trial utilizing a VR Case Enhancement Protocol (VRCEP) versus standard of care (SOC) surgical planning was conducted. The primary endpoint was feasibility, defined as >80% successful VRCEPs. Metrics included surgeon task-load burden (TLB) using the NASA Task-Load Index and "margin events," defined as "the need for defect-driven margins, positive frozen margins, and/or positive final margins." Margin events were used to calculate a margin event score (MES) per case and margin event rate (MER) per cohort.

RESULTS: Thirty-four patients were included in the final analysis (17 VRCEP, 17 SOC) with 94.4% of eligible VRCEP cases completed (17/18). Surgeon TLB was unchanged with VRCEP. Cases undergoing VRCEP were associated with a lower mean MES (0.27 vs. 0.94, p = 0.014) and MER (11.6% vs. 35.6%, p = 0.0041). VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032). Although not statistically significant, positive frozen and final margin rates were lower in VRCEP.

CONCLUSION: Completion of the VRCEP was feasible with no significant increase in surgeon TLB appreciated. VRCEP yielded fewer MEs. Further investigation into the benefit of VR in HNC resection is warranted. Margin events may represent useful metrics for assessing novel surgical technologies.

LEVEL OF EVIDENCE: 2 Laryngoscope, 135:1090-1097, 2025.

Volume

135

Issue

3

First Page

1090

Last Page

1097

ISSN

1531-4995

Published In/Presented At

Nunes, K. L., Jegede, V., Mann, D. S., Llerena, P., Wu, R., Estephan, L., Kumar, A., Siddiqui, S., Banoub, R., Keith, S. W., Tuluc, M., Thal, A. G., Goldman, R., Mady, L. J., Cognetti, D. M., Luginbuhl, A. J., Topf, M. C., & Curry, J. M. (2025). A Randomized Pilot Trial of Virtual Reality Surgical Planning for Head and Neck Oncologic Resection. The Laryngoscope, 135(3), 1090–1097. https://doi.org/10.1002/lary.31874

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

39530249

Department(s)

Administration and Leadership

Document Type

Article