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

Visuohaptic Simulation of a Borescope for Aircraft Engine Inspection

Consisting of a long, fiber optic probe containing a small CCD camera controlled by hand-held articulation interface, a video borescope is used for remote visual inspection of hard to reach components in an aircraft. The knowledge and psychomotor skills, specifically the hand-eye coordination, required for effective inspection are hard to acquire through limited exposure to the borescope in aviation maintenance schools. Inexperienced aircraft maintenance technicians gain proficiency through repeated hands-on learning in the workplace along a steep learning curve while transitioning from the classroom to the workforce. Using an iterative process combined with focused user evaluations, this dissertation details the design, implementation and evaluation of a novel visuohaptic simulator for training novice aircraft maintenance technicians in the task of engine inspection using a borescope. First, we describe the development of the visual components of the simulator, along with the acquisition and modeling of a representative model of a {PT-6} aircraft engine. Subjective assessments with both expert and novice aircraft maintenance engineers evaluated the visual realism and the control interfaces of the simulator. In addition to visual feedback, probe contact feedback is provided through a specially designed custom haptic interface that simulates tip contact forces as the virtual probe intersects with the {3D} model surfaces of the engine. Compared to other haptic interfaces, the custom design is unique in that it is inexpensive and uses a real borescope probe to simulate camera insertion and withdrawal. User evaluation of this simulator with probe tip feedback suggested a trend of improved performance with haptic feedback. Next, we describe the development of a physically-based camera model for improved behavioral realism of the simulator. Unlike a point-based camera, the enhanced camera model simulates the interaction of the borescope probe, including multiple points of contact along the length of the probe. We present visual comparisons of a real probe\u27s motion with the simulated probe model and develop a simple algorithm for computing the resultant contact forces. User evaluation comparing our custom haptic device with two commonly available haptic devices, the Phantom Omni and the Novint Falcon, suggests that the improved camera model as well as probe contact feedback with the 3D engine model plays a significant role in the overall engine inspection process. Finally, we present results from a skill transfer study comparing classroom-only instruction with both simulator and hands-on training. Students trained using the simulator and the video borescope completed engine inspection using the real video borescope significantly faster than students who received classroom-only training. The speed improvements can be attributed to reduced borescope probe maneuvering time within the engine and improved psychomotor skills due to training. Given the usual constraints of limited time and resources, simulator training may provide beneficial skills needed by novice aircraft maintenance technicians to augment classroom instruction, resulting in a faster transition into the aviation maintenance workforce

Innovations to Improve Lung Isolation Training for Thoracic Anesthesia: A Narrative Review.

A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up exciting new horizons and possibilities. In this narrative review, we examine the latest development of existing training modalities while investigating, in particular, the use of emergent techniques such as virtual reality bronchoscopy simulation, virtual airway endoscopy, or the preoperative 3D printing of airways. The goal of this article is, therefore, to summarize the role of existing and future applications of training models/simulators and virtual reality simulators for training flexible bronchoscopy and lung isolation for thoracic anesthesia

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

An Endoscope Interface for Immersive Virtual Reality

This is the accepted version of the following article: John, N.W., Day, T.W., & Wardle, T. (2020). An Endoscope Interface for Immersive Virtual Reality. Eurographics Workshop on Visualization for Biology and Medicine, Eurographics Association, which has been published in final form at http://onlinelibrary.wiley.com. This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving PolicyThis is a work in progress paper that describes a novel endoscope interface designed for use in an immersive virtual reality surgical simulator. We use an affordable off the shelf head mounted display to recreate the operating theatre environment. A hand held controller has been adapted so that it feels like the trainee is holding an endoscope controller with the same functionality. The simulator allows the endoscope shaft to be inserted into a virtual patient and pushed forward to a target position. The paper describes how we have built this surgical simulator with the intention of carrying out a full clinical study in the near future

A Novel Haptic Simulator for Evaluating and Training Salient Force-Based Skills for Laparoscopic Surgery

Laparoscopic surgery has evolved from an \u27alternative\u27 surgical technique to currently being considered as a mainstream surgical technique. However, learning this complex technique holds unique challenges to novice surgeons due to their \u27distance\u27 from the surgical site. One of the main challenges in acquiring laparoscopic skills is the acquisition of force-based or haptic skills. The neglect of popular training methods (e.g., the Fundamentals of Laparoscopic Surgery, i.e. FLS, curriculum) in addressing this aspect of skills training has led many medical skills professionals to research new, efficient methods for haptic skills training. The overarching goal of this research was to demonstrate that a set of simple, simulator-based haptic exercises can be developed and used to train users for skilled application of forces with surgical tools. A set of salient or core haptic skills that underlie proficient laparoscopic surgery were identified, based on published time-motion studies. Low-cost, computer-based haptic training simulators were prototyped to simulate each of the identified salient haptic skills. All simulators were tested for construct validity by comparing surgeons\u27 performance on the simulators with the performance of novices with no previous laparoscopic experience. An integrated, \u27core haptic skills\u27 simulator capable of rendering the three validated haptic skills was built. To examine the efficacy of this novel salient haptic skills training simulator, novice participants were tested for training improvements in a detailed study. Results from the study demonstrated that simulator training enabled users to significantly improve force application for all three haptic tasks. Research outcomes from this project could greatly influence surgical skills simulator design, resulting in more efficient training

Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer

With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high-fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform

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

Instrumentation of a Clinical Colonoscope for Surgical Simulation

This paper describes the instrumentation of a clinical colonoscope needed for a novel colonoscopy simulation framework. The simulator consists of a compact and portable haptic interface and a virtual reality environment to provide real-time visualization. The proposed instrumentation enables tracking different functions of the colonoscope while keeping the ergonomic unchanged

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