Table 1.

The virtual simulators for endoscopic sinus and skull base surgery

No.	Simulator	Year	Application and main focusing object	Hardware, haptic device characters	Software characters	References and validation study
1	Endoscopic sinus surgery simulator (ES3; Lockheed Martin, Bethesda, MD, USA)	1997	• FESS	• Workstation simulation platform (Silicon Graphics, Mountain View, CA, USA)	• Three modes (novice, intermediate, and advanced) associated with task complexity	[3-15]
			• Surgical training	• PC-based haptic controller	• The most extensively validated simulator
				• Unilateral haptic manipulators
				• Haptic feedback to instruments (except to the endoscope)
				• A mannequin head
2	Nasal endoscopy simulator (Regensburg University Hospital, Regensburg, Germany)	1997	• FESS	• Electromagnetic tracking system (sensors on the endoscope, instruments, and mannequin head)	• Real-time collision detection and simulation of tissue deformation	[16,17]
			• Surgical training	• No haptic feedback
				• A mannequin head
3	Dextroscope (Volume Interactions, Singapore)	2003	• FESS	• Workstation; mirrored display, stereoscopic glasses, stylus, and control handle (joystick)	• Endoscope can turn from 0° to 360° or possible to magnify or reduce the objects	[18,19]
			• EETSA	• No mannequin head
			Other endoscopic skull-base surgery
			• Surgical rehearsal
4	Simulation of transsphenoidal endoscopic pituitary surgery (Medical University Vienna and VRVis Research Center, Vienna, Austria)	2004	• EETSA	• Integrated into the Impax EE PACS system (Agfa Healthcare, Bonn, Germany)	• Collision detection and force feedback	[20-23]
			• Surgical rehearsal	• Stealth Station image-guided navigation system (Medtronic, Minneapolis, MN, USA); the endoscope and instruments are optically tracked	• Can simulate angled endoscopes
				• Control handle (joystick)	• Preoperative visualization of important anatomical structures
5	CardinalSim (Stanford University, Stanford, CA, USA)	2009	• FESS	• R니ns on standard PC hardware	• Rapid reconstruction of patient-specific endonasal anatomy (1-2 hours)	[24,25]
			• EETSA	• Features one haptic device	• Real-time collision detection, simulation of tissue deformation, and force feedback
			Other endoscopic skull-base surgery	• Accepts various commercial haptic devices
			• Surgical rehearsal
6	VOXEL-MAN SinuSurg (University of Wurzburg, Wurzburg, Germany; Voxel-Man Group, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Helios Hospital Krefeld, Krefeld, Germany)	2010	• FESS	• Runs on standard PC hardware	• Customized algorithms for subvoxel visualization, volume cutting, and haptic rendering	[26]
			• Surgical training	• Affords a stereoscopic view	• Can accommodate angled endoscopes
				• Fitted with the Phantom Omni haptic device (SensAble Technologies, Woburn, MA, USA)
7	Flinders sinus surgery simulator (Flinders University, Adelaide, Australia)	2013	• FESS	• Bimanual haptic manipulators: Phantom Omni haptic devices (SensAble Technologies) and Novint Falcon (Novint Technologies, DE, USA)	• Realistic mucosal texture and tissue deformation using voxel- and triangle-based surface mesh models	[28-31]
			• Surgical training	• Runs on a laptop	• Collision detection and force feedback
				• No mannequin head	• Shading algorithms
					• Computer-generated effects of vasoconstrictive drugs
8	NeuroTouch Endo (National Research Council of Canada, Ottawa, Canada)	2013	• EETSA	• Bimanual haptic manipulators: Phantom Omni devices	• VR stereovision system; real-time physics-based computation of tissue deformation	[32,33]
			• Other endoscopic skull-base surgery	• No mannequin head	• Algorithms managing instrument-tissue contacts
			• Surgical training
9	McGill simulator for endoscopic sinus surgery (National Research Council of Canada)	2014	• FESS	• NeuroTouch platform	• VR stereovision system; real-time physics-based computation of tissue deformation	[34,35]
			• Surgical training	• Bimanual haptic manipulators: Phantom Omni devices with customized shafts	• Algorithms managing instrument-tissue contacts
				• A mannequin head

FESS, functional endoscopic sinus surgery; EETSA, endoscopic endonasal transsphenoidal approach; PACS, picture archiving and communication system; VR, virtual reality.