Design and Validation of a Bimanual Haptic Epidural Needle Insertion Simulator

The case experience of anesthesiologists is one of the leading causes of accidental dural puncture and failed epidural - the most common complications of epidural analgesia. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition, and present a validation study conducted with 15 anesthesiologists of different competency levels from several hospitals in Israel. Our simulator emulates the forces applied on the epidural (Touhy) needle, held by one hand, and those applied on the Loss of Resistance (LOR) syringe, held by the second hand. The resistance is calculated based on a model of the Epidural region layers that is parameterized by the weight of the patient. We measured the movements of both haptic devices, and quantified the rate of results (success, failed epidurals and dural punctures), insertion strategies, and answers of participants to questionnaires about their perception of the realism of the simulation. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Good face and content validity were shown in experienced users' perception of the simulator as realistic and well-targeted. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages.Comment: 12 pages, 11 figure

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces

Validation of the Haptic Cow: A simulator for training veterinary students

A virtual reality simulator, the Haptic Cow, has been developed using touch feedback technology for training veterinary students to perform bovine rectal palpation of the reproductive tract. The simulator was designed to supplement existing training and address some of the difficulties associated with teaching palpation-based skills. Students need to achieve a certain level of proficiency by graduation but this has become increasingly difficult because of problems with current training methods and a reduction in the number of opportunities to practice. A simulator- based teaching tool was developed as a potential solution. The first step involved designing a simulator on the basis of requirements established through consultation with both veterinary surgeons, as teachers, and students, as learners. Research was then undertaken to validate the simulator by following a set of established criteria described for the evaluation of new technologies used in medical education. The virtual models were assessed by experts as realistic enough representations of the same structures in the cow. An experiment to assess the effect of simulator training compared the performance of one group of students, whose training was supplemented with a simulator session, with another group of traditionally trained students. The subsequent performance for finding and identifying the uterus when examining cows for the first time, was significantly better for the simulator trained group, indicating that skills learned in the simulator environment transferred to the real task. A project was also undertaken to integrate the simulator into a curriculum, with training included as part of the farm animal course at the University of Glasgow Veterinary School. The training was well received by students, useful feedback was gathered and the simulator continues to be used as part of the course. Further developments were undertaken with the aim of creating a more versatile teaching tool and addressing some of the questions and issues raised. An automated version of the Haptic Cow was designed for students to use on their own, with computer guidance replacing the instructor's role. An evaluation found that the new version of the teaching tool was both usable and an effective way of equipping students with the skills required to find and identify the uterus. The potential to use haptic technology to investigate various aspects of performance was also explored in relation to the question of hand choice for certain palpation-based skills: differentiating between objects on the basis of softness and size. Ongoing research and development options are discussed, with the aim of building on the current work by expanding the role of haptic technology in veterinary education in the future

Advances in Minimally Invasive Surgery

The minimally invasive approach in medicine is one of the most common areas of interest in surgery.Advances in Minimally Invasive Surgery describes the latest trends, indications, techniques, and approaches in minimally invasive surgery. It provides step-by-step instructions for both routine and diagnostic procedures via illustrations and video collection

Recent Advances in Minimally Invasive Surgery

Minimally invasive surgery has become a common term in visceral as well as gynecologic surgery. It has almost evolved into its own surgical speciality over the past 20 years. Today, being firmly established in every subspeciality of visceral surgery, it is now no longer a distinct skillset, but a fixed part of the armamentarium of surgical options available. In every indication, the advantages of a minimally invasive approach include reduced intraoperative blood loss, less postoperative pain, and shorter rehabilitation times, as well as a marked reduction of overall and surgical postoperative morbidity. In the advent of modern oncologic treatment algorithms, these effects not only lower the immediate impact that an operation has on the patient, but also become important key steps in reducing the side-effects of surgery. Thus, they enable surgery to become a module in modern multi-disciplinary cancer treatment, which blends into multimodular treatment options at different times and prolongs and widens the possibilities available to cancer patients. In this quickly changing environment, the requirement to learn and refine not only open surgical but also different minimally invasive techniques on high levels deeply impact modern surgical training pathways. The use of modern elearning tools and new and praxis-based surgical training possibilities have been readily integrated into modern surgical education,which persists throughout the whole surgical career of modern gynecologic and visceral surgery specialists

Online courses for healthcare professionals: is there a role for social learning?

Background: All UK postgraduate medical trainees receive supervision from trained supervisors. Training has traditionally been delivered via face to face courses, but with increasing time pressures and complex shift patterns, access to these is difficult. To meet this challenge, we developed a two-week massive open online course (MOOC) for faculty development of clinical supervisors. Summary of Work: The MOOC was developed by a group of experienced medical educators and delivered via the FutureLearn (FL) platform which promotes social learning through interaction. This facilitates building of communities of practice, learner interaction and collaboration. We explored learner perceptions of the course, in particular the value of social learning in the context of busy healthcare professionals. We analysed responses to pre- and post-course surveys for each run of the MOOC in 2015, FL course statistics, and learner discussion board comments. Summary of Results: Over 2015, 7,225 learners registered for the course, though 6% left the course without starting. Of the 3,055 learners who began the course, 35% (1073/3055) were social learners who interacted with other participants. Around 31% (960/3055) learners participated fully in the course; this is significantly higher than the FL average of 22%. Survey responses suggest that 68% learners worked full-time, with over 75% accessing the course at home or while commuting, using laptops, smart phones and tablet devices. Discussion: Learners found the course very accessible due to the bite-sized videos, animations, etc which were manageable at the end of a busy working day. Inter-professional discussions and social learning made the learning environment more engaging. Discussion were rated as high quality as they facilitated sharing of narratives and personal reflections, as well as relevant resources. Conclusion: Social learning added value to the course by promoting sharing of resources and improved interaction between learners within the online environment. Take Home Messages: 1) MOOCs can provide faculty development efficiently with a few caveats. 2) Social learning added a new dimension to the online environment