A Cost-Effective and Smart Sensing Tissue-like Testbed for Surgical Training

A low-cost tissue-like testbed with six nodes of varying stiffness was developed for surgical training to provide pressure and force feedback data through image reception to human operators. Using SolidWorks, a 3D model of the box trainer housing was created. A pad for the distribution of smartsensing nodes and microcontroller connections was designed with open spaces for the respective components. The pad was 3D-printed with PLA filament. Flat piezoelectric pressure sensors were fabricated with conductive materials and velostat sensor material. Using static and dynamic analyses, three top sensors were chosen to be used in three pressure sensing nodes. A calibration process was performed on the pressure sensors to find the linear relationship between voltage and pressure, which was then used to create a conversion equation for each sensor. These equations were used to collect data at the three pressure sensing nodes on the silicone testbed pad. Conductive TPU filament was used to 3D-print vertical force sensors, which were designed using SolidWorks. The force sensors were calibrated with a squeezing mechanism to find a relationship between voltage and force and to subsequently develop a conversion equation for each sensor. We used these equations to collect force data from the three force sensing nodes on the testbed pad. Through static and dynamic analyses, the force sensors were found to be functional, but to need improvements in accuracy. The mechatronic system was designed and developed to integrate all six sensors and to collect data from the testbed pad using an Arduino microcontroller. The flat pressure and vertical force sensors were embedded in each node to measure the pressure and force that occurs during the deformation of the six nodes. Data was collected and imported into MATLAB. This data was used in displaying pressure and force mapping of the nodes over a live video of the silicone pad. Pressure and force mapping was realized by drawing color-coded circles on each of the six nodes that correspond to a range of force or pressure values. From this development, the surgical testbed provides multi-stiffness tissue training with live pressure and force mapping overlaid on a live video of the emulated surgical field

Pre-clinical Training for New Notes Procedures: From Ex-vivo Models to Virtual Reality Simulators

Natural orifice transluminal endoscopic surgery (NOTES) is a newer field of endoscopic surgery that allows for scarless treatment of pathologic entities, using novel transluminal approaches. There has been a shift of focus from a clinical and research standpoint from the development and dissemination of "first-generation" NOTES procedures to "new NOTES" procedures that traverse the mucosa of luminal structures, yet do not stray far into the peritoneal cavity. It has been a challenge to find appropriate and effective ways to train gastroenterologists and surgeons in these novel approaches. We review the importance of simulation in training and discuss available simulation options

Advanced Augmented Reality Telestration Techniques With Applications In Laparoscopic And Robotic Surgery

The art of teaching laparoscopic or robotic surgery currently has a primary reliance on an expert surgeon tutoring a student during a live surgery. During these operations, surgeons are viewing the inside of the body through a manipulatable camera. Due to the viewpoint translation and narrow field of view, these techniques have a substantial learning curve in order to gain the mastery necessary to operate safely. In addition to moving and rotating the camera, the surgeon must also manipulate tools inserted into the body. These tools are only visible on camera, and pass through a pivot point on the body that, in non-robotic cases, reverses their directions of motion when compared to the surgeon\u27s hands. These difficulties spurred on this dissertation. The main hypothesis of this research is that advanced augmented reality techniques can improve telementoring for use between expert surgeons and surgical students. In addition, it can provide a better method of communication between surgeon and camera operator. This research has two specific aims: (1) Create a head-mounted direction of focus indicator to provide non-verbal assistance for camera operation. A system was created to track where the surgeon is looking and provides augmented reality cues to the camera operator explaining the camera desires of the surgeon. (2) Create a hardware / software environment for the tracking of a camera and an object, allowing for the display of registered pre-operative imaging that can be manipulated during the procedure. A set of augmented reality cues describing the translation, zoom, and roll of a laparoscopic camera were developed for Aim 1. An experiment was run to determine whether using augmented reality cues or verbal cues was faster and more efficient at acquiring targets on camera at a specific location, zoom level, and roll angle. The study found that in all instances, the augmented reality cues resulted in faster completion of the task with better economy of movement than with the verbal cues. A large number of environmentally registered augmented reality telestration and visualization features were added to a hardware / software platform for Aim 2. The implemented manipulation of pre-operative imaging and the ability to provide different types of registered annotation in the working environment has provided numerous examples of improved utility in telementoring systems. The results of this work provide potential improvements to the utilization of pre-operative imaging in the operating room, to the effectiveness of telementoring as a surgical teaching tool, and to the effective communication between the surgeon and the camera operator in laparoscopic surgery

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

Des preuves récentes sur les habiletés visuo- spatiales pour la formation en chirurgie : revue exploratoire

Background: Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. Methods: We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. Results: We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. Conclusions: It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.Contexte :  Il est fondamental pour les chirurgiens en formation de comprendre les liens qui unissent les diverses structures corporelles. Étant donné l’hétérogénéité de la littérature portant sur les habiletés visuo-spatiales (HVS) nécessaires en chirurgie, les éducateurs ont de la difficulté à prendre des décisions éclairées quant à l’enseignement des HVS dans leurs programmes. On a effectué une étude exploratoire de la littérature sur les HVS en chirurgie afin de répertorier la littérature et de cerner des lacunes pouvant faire l’objet de recherches ultérieures. Méthodologie : On a interrogé des bases de données jusqu’à décembre 2019 à l’aide de mots-clés reliés aux HVS et à la chirurgie.  Les articles trouvés ont été évalués de façon indépendante par deux chercheurs pour déterminer leur inclusion à la revue. Résultats :  Au total, 117 articles ont été inclus dans la revue finale. Cinquante-neuf faisaient état d’importantes corrélations entre les tests d’évaluation des HVS et la performance chirurgicale. Cette association est étayée par les résultats d’études en neuro-imagerie.   Il n’est pas clair cependant si les HVS devraient faire partie des critères de sélection des résidents et si une formation sur les techniques de visualisation en trois dimensions (3D) est préférable à une formation sur les techniques de visualisation en deux dimensions (2D). Conclusions : Il semble exister un lien entre les HVS et la performance chirurgicale en contexte de simulation, particulièrement chez les apprenants novices. À la lumière de nos résultats, nous présentons des recommandations sur la façon dont les formateurs en chirurgie pourraient se servir des HVS pour aider les apprenants novices. D’autres travaux de recherche devraient permettre de savoir si les HVS restent reliés à la performance chirurgicale lorsque les stagiaires passent à un environnement opératoire réel

SmartSIM - a virtual reality simulator for laparoscopy training using a generic physics engine

International audienceVirtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand–eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in lapa-roscopy, i.e. SmartSIM, which has been developed using a generic open‐source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy‐to‐fabricate custom‐built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graph-ical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning

Understanding Perceptual Boundaries in Laparoscopic Surgery

Human perceptual capabilities related to the laparoscopic interaction paradigm are not well known. Its study is important for the design of virtual reality simulators, and for the specification of augmented reality applications that overcome current limitations and provide a supersensing to the surgeon. As part of this work, this article addresses the study of laparoscopic pulling forces. Two definitions are proposed to focalize the problem: the perceptual fidelity boundary, limit of human perceptual capabilities, and the Utile fidelity boundary, that encapsulates the perceived aspects actually used by surgeons to guide an operation. The study is then aimed to define the perceptual fidelity boundary of laparoscopic pulling forces. This is approached with an experimental design in which surgeons assess the resistance against pulling of four different tissues, which are characterized with both in vivo interaction forces and ex vivo tissue biomechanical properties. A logarithmic law of tissue consistency perception is found comparing subjective valorizations with objective parameters. A model of this perception is developed identifying what the main parameters are: the grade of fixation of the organ, the tissue stiffness, the amount of tissue bitten, and the organ mass being pulled. These results are a clear requirement analysis for the force feedback algorithm of a virtual reality laparoscopic simulator. Finally, some discussion is raised about the suitability of augmented reality applications around this surgical gesture

Design of a User Interface to Investigate the Role of 3D Spatial Reasoning in Surgical Training

In this thesis, a 3D interactive environment for measurement of spatial ability using Mental Rotation Test was designed and implemented. The spatial ability of two groups of participants (novices and experts) was evaluated using the implemented software and compared to the result from Embedded Figure Test. In Embedded Figure Test, only 15.63% of the experts’ responses were incorrect (with score of 6.75 ± 1.50 out of 8), compared to 57.00% for novices (with score of 3.44 ± 1.51). No significant difference was found between scores of the two group from Mental Rotation Test; however, experts responded significantly faster than novices (P \u3c 0.05). The response time found to be a more suitable metric to quantify the spatial ability of surgical trainees. Calot’s Triangle Test was used to measure practical surgical knowledge of the candidates. Experts’ surgical knowledge was found significantly higher than that of novices (P \u3c 0.05). Results from both spatial reasoning tests and Calot’s Triangle test confirm the capability of the 3D Mental Rotation Test to measure the spatial ability of trainees, and therefore it may be used during the training to indirectly evaluate improvements in their practical surgical knowledge