In Reply In their analysis of our study,1 Dr Favier and colleagues suggest improvements in methodology to focus on haptic feedback fidelity through mechanical testing. We appreciate this thoughtful commentary and agree that both subjective and quantifiable measures are needed to optimally evaluate surgical simulators. As seen in their study evaluating mechanical characteristics of 3-dimensionally (3D)-printed material for skull base procedures, certain 3D-printed materials may differ in mechanical forces compared with human cadaver bone.2 Further, cadaver bone may not realistically represent in vivo sinus lamellae. Accordingly, although objective measurements of mechanical force are ideal, the intended audience of the simulator must also participate in the evaluation to assist in determining realism of the haptic feedback. Although we acknowledge that study participants were mostly resident physicians, surgical trainees are frequently the intended audience for surgical simulation and should be included in the development of such simulators. One method for evaluating the qualifications of study participants would be to choose a set number of live surgical experiences and statistically evaluate whether surgical experience affects participant rating of haptic feedback. Unfortunately, given the small sample size in our study, meaningful conclusions would be difficult to draw with these limited data.
Hsieh T, Cervenka B, Steele TO. Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation—Reply. JAMA Otolaryngol Head Neck Surg. 2018;144(12):1185–1186. doi:10.1001/jamaoto.2018.1811
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