NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator

Purpose: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. Methods: We developed NOViSE - the first force-feedback enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom built and the behaviour of the virtual flexible endoscope is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. Results: We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES Conclusions: VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype and the initial results indicate that it provides promising foundations for further development

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented

ViBreathe: Heart Rate Variability Enhanced Respiration Training for Workaday Stress Management via an Eyes-free Tangible Interface

Slow breathing guiding applications increasingly emerge, showing promise for helping knowledge workers to better cope with workaday stress. However, standard breathing guidance is non-interactive, with rigid paces. Despite their effects being proved, they could cause respiratory fatigue, or lack of training motivation, especially for novice users. To explore new design possibilities, we investigate using heart rate variability (HRV) data to mediate breathing guidance, which results in two HRV-enhanced guidance modes: (i) responsive breathing guidance and (ii) adaptive breathing guidance. These guidance modes are implemented on a soft haptic interface named “ViBreathe”. We conducted a user test (N\ua0=\ua024), and a one-week field deployment (N\ua0=\ua04) with knowledge workers, to understand the user experience of our design. The HRV-enhanced modes were generally experienced to reduce tiresome and improve engagement and comfort. And Vibreathe showed great potential for seamlessly weaving slow breathing practice into work routines. We thereby summarize related design insights and opportunities

Establishing a Framework for the development of Multimodal Virtual Reality Interfaces with Applicability in Education and Clinical Practice

The development of Virtual Reality (VR) and Augmented Reality (AR) content with multiple sources of both input and output has led to countless contributions in a great many number of fields, among which medicine and education. Nevertheless, the actual process of integrating the existing VR/AR media and subsequently setting it to purpose is yet a highly scattered and esoteric undertaking. Moreover, seldom do the architectures that derive from such ventures comprise haptic feedback in their implementation, which in turn deprives users from relying on one of the paramount aspects of human interaction, their sense of touch. Determined to circumvent these issues, the present dissertation proposes a centralized albeit modularized framework that thus enables the conception of multimodal VR/AR applications in a novel and straightforward manner. In order to accomplish this, the aforesaid framework makes use of a stereoscopic VR Head Mounted Display (HMD) from Oculus Rift©, a hand tracking controller from Leap Motion©, a custom-made VR mount that allows for the assemblage of the two preceding peripherals and a wearable device of our own design. The latter is a glove that encompasses two core modules in its innings, one that is able to convey haptic feedback to its wearer and another that deals with the non-intrusive acquisition, processing and registering of his/her Electrocardiogram (ECG), Electromyogram (EMG) and Electrodermal Activity (EDA). The software elements of the aforementioned features were all interfaced through Unity3D©, a powerful game engine whose popularity in academic and scientific endeavors is evermore increasing. Upon completion of our system, it was time to substantiate our initial claim with thoroughly developed experiences that would attest to its worth. With this premise in mind, we devised a comprehensive repository of interfaces, amid which three merit special consideration: Brain Connectivity Leap (BCL), Ode to Passive Haptic Learning (PHL) and a Surgical Simulator