Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Virtual Reality Simulator for Training in Myringotomy with Tube Placement

Myringotomy refers to a surgical incision in the eardrum, and it is often followed by ventilation tube placement to treat middle-ear infections. The procedure is difficult to learn; hence, the objectives of this work were to develop a virtual-reality training simulator, assess its face and content validity, and implement quantitative performance metrics and assess construct validity. A commercial digital gaming engine (Unity3D) was used to implement the simulator with support for 3D visualization of digital ear models and support for major surgical tasks. A haptic arm co-located with the stereo scene was used to manipulate virtual surgical tools and to provide force feedback. A questionnaire was developed with 14 face validity questions focusing on realism and 6 content validity questions focusing on training potential. Twelve participants from the Department of Otolaryngology were recruited for the study. Responses to 12 of the 14 face validity questions were positive. One concern was with contact modeling related to tube insertion into the eardrum, and the second was with movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses were positive, 21% were neutral, and 15% were negative. In the final phase of this work, automated performance metrics were programmed and a construct validity study was conducted with 11 participants: 4 senior Otolaryngology consultants and 7 junior Otolaryngology residents. Each participant performed 10 procedures on the simulator and metrics were automatically collected. Senior Otolaryngologists took significantly less time to completion compared to junior residents. Junior residents had 2.8 times more errors as compared to experienced surgeons. The senior surgeons also had significantly longer incision lengths, more accurate incision angles, and lower magnification keeping both the umbo and annulus in view. All metrics were able to discriminate senior Otolaryngologists from junior residents with a significance of p \u3c 0.002. The simulator has sufficient realism, training potential and performance discrimination ability to warrant a more resource intensive skills transference study

Topology-based Physical Simulation

International audienceThis paper presents a framework to design mechanical models relying on a topological basis. Whereas naive topological models such as adjacency graphs provide low topological control, the use of efficient topological models such as generalized maps guarantees the quasi-manifold property of the manipulated object: Topological inquiries or changes can be handled robustly and allow the model designer to focus on mechanical aspects. Even if the topology structure is more detailed and consumes more memory, we show that an efficient implementation does not impact computation time and still enables real-time simulation and interaction. We analyze how a simple mass/spring model can be embedded within this framework

Real-time simulation of surgery by Proper Generalized Decomposition techniques

La simulación quirúrgica por ordenador en tiempo real se ha convertido en una alternativa muy atractiva a los simuladores quirúrgicos tradicionales. Entre otras ventajas, los simuladores por ordenador consiguen ahorros importantes de tiempo y de costes de mantenimiento, y permiten que los estudiantes practiquen sus habilidades quirúrgicas en un entorno seguro tantas veces como sea necesario. Sin embargo, a pesar de las capacidades de los ordenadores actuales, la cirugía computacional sigue siendo un campo de investigación exigente. Uno de sus mayores retos es la alta velocidad a la que se tienen que resolver complejos problemas de mecánica de medios continuos para que los interfaces hápticos puedan proporcionar un sentido del tacto realista (en general, se necesitan velocidades de respuesta de 500-1000 Hz).Esta tesis presenta algunos métodos numéricos novedosos para la simulación interactiva de dos procedimientos quirúrgicos habituales: el corte y el rasgado (o desgarro) de tejidos blandos. El marco común de los métodos presentados es el uso de la Descomposición Propia Generalizada (PGD en inglés) para la generación de vademécums computacionales, esto es, metasoluciones generales de problemas paramétricos de altas dimensiones que se pueden evaluar a velocidades de respuesta compatibles con entornos hápticos.En el caso del corte, los vademécums computacionales se utilizan de forma conjunta con técnicas basadas en XFEM, mientras que la carga de cálculo se distribuye entre una etapa off-line (previa a la ejecución interactiva) y otra on-line (en tiempo de ejecución). Durante la fase off-line, para el órgano en cuestión se precalculan tanto un vademécum computacional para cualquier posición de una carga, como los desplazamientos producidos por un conjunto de cortes. Así, durante la etapa on-line, los resultados precalculados se combinan de la forma más adecuada para obtener en tiempo real la respuesta a las acciones dirigidas por el usuario. En cuanto al rasgado, a partir de una ecuación paramétrica basada en mecánica del daño continuo, se obtiene un vademécum computacional. La complejidad del modelo se reduce mediante técnicas de Descomposición Ortogonal Propia (POD en inglés), y el vademécum se incorpora a una formulación incremental explícita que se puede interpretar como una especie de integrador temporal.A modo de ejemplo, el método para el corte se aplica a la simulación de un procedimiento quirúrgico refractivo de la córnea conocido como queratotomía radial, mientras que el método para el rasgado se centra en la simulación de la colecistectomía laparoscópica (la extirpación de la vesícula biliar mediante laparoscopia). En ambos casos, los métodos implementados ofrecen excelentes resultados en términos de velocidades de respuesta y producen simulaciones muy realistas desde los puntos de vista visual y háptico.The real-time computer-based simulation of surgery has proven to be an appealing alternative to traditional surgical simulators. Amongst other advantages, computer-based simulators provide considerable savings on time and maintenance costs, and allow trainees to practice their surgical skills in a safe environment as often as necessary. However, in spite of the current computer capabilities, computational surgery continues to be a challenging field of research. One of its major issues is the high speed at which complex problems in continuum mechanics have to be solved so that haptic interfaces can render a realistic sense of touch (generally, feedback rates of 500–1 000 Hz are required). This thesis introduces some novel numerical methods for the interactive simulation of two usual surgical procedures: cutting and tearing of soft tissues. The common framework of the presented methods is the use of the Proper Generalised Decomposition (PGD) for the generation of computational vademecums, i. e. general meta-solutions of parametric high-dimensional problems that can be evaluated at feedback rates compatible with haptic environments. In the case of cutting, computational vademecums are used jointly with XFEM-based techniques, and the computing workload is distributed into an off-line and an on-line stage. During the off-line stage, both a computational vademecum for any position of a load and the displacements produced by a set of cuts are pre-computed for the organ under consideration. Thus, during the on-line stage, the pre-computed results are properly combined together to obtain in real-time the response to the actions driven by the user. Concerning tearing, a computational vademecum is obtained from a parametric equation based on continuum damage mechanics. The complexity of the model is reduced by Proper Orthogonal Decomposition (POD) techniques, and the vademecum is incorporated into an explicit incremental formulation that can be viewed as a sort of time integrator. By way of example, the cutting method is applied to the simulation of a corneal refractive surgical procedure known as radial keratotomy, whereas the tearing method focuses on the simulation of laparoscopic cholecystectomy (i. e. the removal of the gallbladder). In both cases, the implemented methods offer excellent performances in terms of feedback rates, and produce.<br /

Modeling and rendering for development of a virtual bone surgery system

A virtual bone surgery system is developed to provide the potential of a realistic, safe, and controllable environment for surgical education. It can be used for training in orthopedic surgery, as well as for planning and rehearsal of bone surgery procedures...Using the developed system, the user can perform virtual bone surgery by simultaneously seeing bone material removal through a graphic display device, feeling the force via a haptic deice, and hearing the sound of tool-bone interaction --Abstract, page iii

Adaptive Resolution for Topology Modifications in Physically-based Animation

This paper shows the interest of basing a mechanical mesh upon an efficient topological model in order to give any simulation the ability to refine this mesh locally and apply topological modifications such as cutting, tear and matter destruction.Refinement and modifications can indeed be combined in order to get a more precise result.The powerful combinatorial map model provides the mathematical background which ensures that the quasi-manifold property is guaranteed for the mesh after any topological modification.The obtained results offer the versatility and time efficiency that are expected in applications such as surgical simulation

Appearance Modelling and Reconstruction for Navigation in Minimally Invasive Surgery

Minimally invasive surgery is playing an increasingly important role for patient care. Whilst its direct patient benefit in terms of reduced trauma, improved recovery and shortened hospitalisation has been well established, there is a sustained need for improved training of the existing procedures and the development of new smart instruments to tackle the issue of visualisation, ergonomic control, haptic and tactile feedback. For endoscopic intervention, the small field of view in the presence of a complex anatomy can easily introduce disorientation to the operator as the tortuous access pathway is not always easy to predict and control with standard endoscopes. Effective training through simulation devices, based on either virtual reality or mixed-reality simulators, can help to improve the spatial awareness, consistency and safety of these procedures. This thesis examines the use of endoscopic videos for both simulation and navigation purposes. More specifically, it addresses the challenging problem of how to build high-fidelity subject-specific simulation environments for improved training and skills assessment. Issues related to mesh parameterisation and texture blending are investigated. With the maturity of computer vision in terms of both 3D shape reconstruction and localisation and mapping, vision-based techniques have enjoyed significant interest in recent years for surgical navigation. The thesis also tackles the problem of how to use vision-based techniques for providing a detailed 3D map and dynamically expanded field of view to improve spatial awareness and avoid operator disorientation. The key advantage of this approach is that it does not require additional hardware, and thus introduces minimal interference to the existing surgical workflow. The derived 3D map can be effectively integrated with pre-operative data, allowing both global and local 3D navigation by taking into account tissue structural and appearance changes. Both simulation and laboratory-based experiments are conducted throughout this research to assess the practical value of the method proposed

Development of cyclic biomechanical stimulation on a microfluidic chip

A novel microfluidic chip that allows real time analysis of cyclically stretched cultured cells was designed and develope