In Response to Augmented Reality‐Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency

We thank Daungsupawong et al.1 for their interest in our publication "Augmented Reality-Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency"2 and for taking the time to comment on our work. Regarding the sample size, we concur that the statistical strength of this study would be enhanced with a more significant number of participants. A follow-up study is currently being conducted to address this issue. As for the use of the modified Welling scale, it is, to our knowledge, the most validated and reliable scoring system to assess mastoidectomy performance and the most widely employed in the literature, as referenced in our manuscript.3-6 Concerning the potential impact of participants' prior experience with traditional training methods on the differences in outcomes between groups, we considered this when designing the study. The participants were medical students who had not previously practiced drilling a temporal bone. Additionally, the randomization process ensured that any incidental exposure to otolaryngology was evenly distributed between the two study groups. Finally, the question of whether skills learned in a controlled environment with a 3D-printed model can be translated into a real-world surgical circumstance is addressed in the manuscript. As we elaborated in our study limitations, the training environment does not replicate the operating room conditions, making it challenging to predict the real-life impact accurately. Despite these constraints, we believe that the platform's real-time presentation and anatomy teaching enabled the participants to gain spatial perception, which is crucial for mastoidectomy surgery. We agree that further training utilizing technologies such as immersive virtual reality with haptic feedback is beneficial and will add to augmented reality (AR) training, and such systems are already commercially available (VOXEL-MAN simulator).7 We are currently conducting a follow-up study to address the issues raised in our manuscript and by Daungsupawong et al. This study involves recruiting more experienced participants and assessing their improvement over time in mastoidectomy proficiency, both with and without AR guidance.