Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy

Gilad Feinmesser, David Yogev*, Tomer Goldberg, Yisrael Parmet, Shay Illouz, Oliana Vazgovsky, Yael Eshet, Shai Tejman-Yarden, Eran Alon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Sentinel lymph node biopsy (SLNB) is crucial for managing head and neck skin cancer. However, variable lymphatic drainage can complicate SLN detection when using Single-Photon Emission Computed Tomography (SPECT) or lymphoscintigraphy. Virtual Reality (VR) can contribute to pre-operative planning by simulating a realistic 3D model, which improves orientation. VR can also facilitate real-patient training outside the operating room. This study explored using a VR platform for pre-operative planning in head and neck skin cancer patients undergoing SLNBs and assessed its value for residential training. Materials and methods: In this prospective technology pilot study, attending surgeons and residents who performed 21 SLNB operations on patients with head and neck skin cancers (81% males, mean age 69.2 ± 11.3) used a VR simulation model based on each patient's pre-operative SPECT scan to examine patient-specific anatomy. After surgery, they completed a questionnaire on the efficiency of the VR simulation as a pre-operative planning tool and training device for residents. Results: The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10. Three-quarters (76%) of residents reported increased confidence after using VR. The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10. Conclusion: A VR SLNB simulation can accurately portray marked sentinel lymph nodes. It was rated high as a surgical planning and teaching tool among attending surgeons and residents alike and may play a role in pre-operative planning and resident training. Further studies are needed to explore its applications in practice.

Original languageEnglish
Article number103976
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number6
StatePublished - 1 Nov 2023


  • Computed tomography
  • Pre-operative simulation
  • Residential training
  • Sentinel lymph node biopsy
  • Virtual reality


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