Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery

Background The utility of the virtual-reality robotic simulator in training programmes has not been clearly evaluated. Our aim was to evaluate the impact of a virtual-reality robotic simulator-training programme on basic surgical skills. Methods A simulator-training programme in robotic surgery, using the da Vinci Skills Simulator, was evaluated in a population including junior and seasoned surgeons, and non-physicians. Their performances on robotic dots and suturing-skin pod platforms before and after virtual-simulation training were rated anonymously by surgeons experienced in robotics. Results 39 participants were enrolled: 14 medical students and residents in surgery, 14 seasoned surgeons, 11 non-physicians. Junior and seasoned surgeons’ performances on platforms were not significantly improved after virtual-reality robotic simulation in any of the skill domains, in contrast to non-physicians. Conclusions The benefits of virtual-reality simulator training on several tasks to basic skills in robotic surgery were not obvious among surgeons in our initial and early experience with the simulator

Portable dVRK: an augmented V-REP simulator of the da Vinci Research Kit

The da Vinci Research Kit (dVRK) is a first generation da Vinci robot repurposed as a research platform and coupled with software and controllers developed by research users. An already quite wide community is currently sharing the dVRK (32 systems in 28 sites worldwide). The access to the robotic system for training surgeons and for developing new surgical procedures, tools and new control modalities is still difficult due to the limited availability and high maintenance costs. The development of simulation tools provides a low cost, easy and safe alternative to the use of the real platform for preliminary research and training activities. The Portable dVRK, which is described in this work, is based on a V-REP simulator of the dVRK patient side and endoscopic camera manipulators which are controlled through two haptic interfaces and a 3D viewer, respectively. The V-REP simulator is augmented with a physics engine allowing to render the interaction of new developed tools with soft objects. Full integration in the ROS control architecture makes the simulator flexible and easy to be interfaced with other possible devices. Several scenes have been implemented to illustrate performance and potentials of the developed simulator

Enhancing Fundamental Robot-Assisted Surgical Proficiency by Using a Portable Virtual Simulator

Background. The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation. Methods. Here, 14 medical students performed 2 fundamental surgical tasks—bimanual carrying (BC) and peg transfer (PT)—in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined. Results. Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P \u3c .001) tasks. The time to task completion and the total distance traveled were significantly decreased in both surgical tasks in the VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining. Conclusions. Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

A CoppeliaSim Dynamic Simulator for the Da Vinci Research Kit

The design of a physics-based dynamic simulator of a robot requires to properly integrate the robot kinematic and dynamic properties in a virtual environment. Naturally, the closer is the integrated information to the real robot properties, the more accurate the simulator predicts the real robot behaviour. A reliable robot simulator is a valuable asset for developing new research ideas; its use dramatically reduces the costs and it is available to all researchers. This letter presents a dynamic simulator of the da Vinci Research Kit (dVRK) patient-side manipulator (PSM). The kinematic and dynamic properties of the simulator rely on the parameters identified in Wang et al. With respect to the kinematic simulator previously developed by some of the authors, this work: (i) redefines the kinematic architecture and the actuation model by modeling the double parallelogram and the counterweight mechanism, to reflect the structure of the real robot; (ii) integrates the identified dynamic parameters in the simulation model. The obtained simulator enables the design and validation of control strategies relying on the robot dynamic model, including interaction force estimation and control, that are fundamental to guarantee safety in many surgical tasks

Vision-based methods for state estimation and control of robotic systems with application to mobile and surgical robots

For autonomous systems that need to perceive the surrounding environment for the accomplishment of a given task, vision is a highly informative exteroceptive sensory source. When gathering information from the available sensors, in fact, the richness of visual data allows to provide a complete description of the environment, collecting geometrical and semantic information (e.g., object pose, distances, shapes, colors, lights). The huge amount of collected data allows to consider both methods exploiting the totality of the data (dense approaches), or a reduced set obtained from feature extraction procedures (sparse approaches). This manuscript presents dense and sparse vision-based methods for control and sensing of robotic systems. First, a safe navigation scheme for mobile robots, moving in unknown environments populated by obstacles, is presented. For this task, dense visual information is used to perceive the environment (i.e., detect ground plane and obstacles) and, in combination with other sensory sources, provide an estimation of the robot motion with a linear observer. On the other hand, sparse visual data are extrapolated in terms of geometric primitives, in order to implement a visual servoing control scheme satisfying proper navigation behaviours. This controller relies on visual estimated information and is designed in order to guarantee safety during navigation. In addition, redundant structures are taken into account to re-arrange the internal configuration of the robot and reduce its encumbrance when the workspace is highly cluttered. Vision-based estimation methods are relevant also in other contexts. In the field of surgical robotics, having reliable data about unmeasurable quantities is of great importance and critical at the same time. In this manuscript, we present a Kalman-based observer to estimate the 3D pose of a suturing needle held by a surgical manipulator for robot-assisted suturing. The method exploits images acquired by the endoscope of the robot platform to extrapolate relevant geometrical information and get projected measurements of the tool pose. This method has also been validated with a novel simulator designed for the da Vinci robotic platform, with the purpose to ease interfacing and employment in ideal conditions for testing and validation. The Kalman-based observers mentioned above are classical passive estimators, whose system inputs used to produce the proper estimation are theoretically arbitrary. This does not provide any possibility to actively adapt input trajectories in order to optimize specific requirements on the performance of the estimation. For this purpose, active estimation paradigm is introduced and some related strategies are presented. More specifically, a novel active sensing algorithm employing visual dense information is described for a typical Structure-from-Motion (SfM) problem. The algorithm generates an optimal estimation of a scene observed by a moving camera, while minimizing the maximum uncertainty of the estimation. This approach can be applied to any robotic platforms and has been validated with a manipulator arm equipped with a monocular camera

Virtual Environment for the Training of the Hands in Minimally Invasive Thoracic Surgery

The hand and eye coordination of the surgeon is one of the most important factor minimally invasive thoracic surgery. Virtual Simulation is a powerful training tool in surgery. At present, the main problems of the learning process are to reduce the learning time and to improve specific skills by the simulation. There are different options to perform tests: working with animals, with artificial tissues to simulate the pressure, and even simulators through joystick. The main disadvantage is the high cost of this systems and the complexity to replicate the situation during a real operations. In this paper, a virtual reality system is presented. This system allows to reduce the learning time and to improve the hand and eye coodination of the surgeon. Moreover, it is a low cost, portable and easy-to-use solution for future surgeons

Affordable Mobile-based Simulator for Robotic Surgery

Robotic surgery and novel surgical instrumentation present great potentials towards safer, more accurate and consistent minimally invasive surgery. However, their adoption is dependent to the access to training facilities and extensive surgical training. Robotic instruments require different dexterity skills compared to open or laparoscopic. Surgeons, therefore, are required to invest significant time by attending extensive training programs. Contrary, hands on experiences represent an additional operational cost for hospitals as the availability of robotic systems for training purposes is limited. All these technological and financial barriers for surgeons and hospitals hinder the adoption of robotic surgery. In this paper, we present a mobile dexterity training kit to develop basic surgical techniques within an affordable setting. The system could be used to train basic surgical gestures and to develop the motor skills needed for manoeuvring robotic instruments. Our work presents the architecture and components needed to create a simulated environment for training sub-tasks as well as a design for portable mobile manipulators that can be used as master controllers of different instruments. A preliminary study results demonstrate usability and skills development with this system.Comment: Hamlyn Symposium on Medical Robotics 201