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

Real-time Error Control for Surgical Simulation

Objective: To present the first real-time a posteriori error-driven adaptive finite element approach for real-time simulation and to demonstrate the method on a needle insertion problem. Methods: We use corotational elasticity and a frictional needle/tissue interaction model. The problem is solved using finite elements within SOFA. The refinement strategy relies upon a hexahedron-based finite element method, combined with a posteriori error estimation driven local $h$-refinement, for simulating soft tissue deformation. Results: We control the local and global error level in the mechanical fields (e.g. displacement or stresses) during the simulation. We show the convergence of the algorithm on academic examples, and demonstrate its practical usability on a percutaneous procedure involving needle insertion in a liver. For the latter case, we compare the force displacement curves obtained from the proposed adaptive algorithm with that obtained from a uniform refinement approach. Conclusions: Error control guarantees that a tolerable error level is not exceeded during the simulations. Local mesh refinement accelerates simulations. Significance: Our work provides a first step to discriminate between discretization error and modeling error by providing a robust quantification of discretization error during simulations.Comment: 12 pages, 16 figures, change of the title, submitted to IEEE TBM

Robust interactive cutting based on an adaptive octree simulation mesh

We present an adaptive octree based approach for interactive cutting of deformable objects. Our technique relies on efficient refine- and node split-operations. These are sufficient to robustly represent cuts in the mechanical simulation mesh. A high-resolution surface embedded into the octree is employed to represent a cut visually. Model modification is performed in the rest state of the object, which is accomplished by back-transformation of the blade geometry. This results in an improved robustness of our approach. Further, an efficient update of the correspondences between simulation elements and surface vertices is proposed. The robustness and efficiency of our approach is underlined in test examples as well as by integrating it into a prototype surgical simulato

Scalable partitioning for parallel position based dynamics

We introduce a practical partitioning technique designed for parallelizing Position Based Dynamics, and exploiting the ubiquitous multi-core processors present in current commodity GPUs. The input is a set of particles whose dynamics is influenced by spatial constraints. In the initialization phase, we build a graph in which each node corresponds to a constraint and two constraints are connected by an edge if they influence at least one common particle. We introduce a novel greedy algorithm for inserting additional constraints (phantoms) in the graph such that the resulting topology is q-colourable, where ˆ qˆ ≥ 2 is an arbitrary number. We color the graph, and the constraints with the same color are assigned to the same partition. Then, the set of constraints belonging to each partition is solved in parallel during the animation phase. We demonstrate this by using our partitioning technique; the performance hit caused by the GPU kernel calls is significantly decreased, leaving unaffected the visual quality, robustness and speed of serial position based dynamics

Interactively Cutting and Constraining Vertices in Meshes Using Augmented Matrices

We present a finite-element solution method that is well suited for interactive simulations of cutting meshes in the regime of linear elastic models. Our approach features fast updates to the solution of the stiffness system of equations to account for real-time changes in mesh connectivity and boundary conditions. Updates are accomplished by augmenting the stiffness matrix to keep it consistent with changes to the underlying model, without refactoring the matrix at each step of cutting. The initial stiffness matrix and its Cholesky factors are used to implicitly form and solve a Schur complement system using an iterative solver. As changes accumulate over many simulation timesteps, the augmented solution method slows down due to the size of the augmented matrix. However, by periodically refactoring the stiffness matrix in a concurrent background process, fresh Cholesky factors that incorporate recent model changes can replace the initial factors. This controls the size of the augmented matrices and provides a way to maintain a fast solution rate as the number of changes to a model grows. We exploit sparsity in the stiffness matrix, the right-hand-side vectors and the solution vectors to compute the solutions fast, and show that the time complexity of the update steps is bounded linearly by the size of the Cholesky factor of the initial matrix. Our complexity analysis and experimental results demonstrate that this approach scales well with problem size. Results for cutting and deformation of 3D linear elastic models are reported for meshes representing the brain, eye, and model problems with element counts up to 167,000; these show the potential of this method for real-time interactivity. An application to limbal incisions for surgical correction of astigmatism, for which linear elastic models and small deformations are sufficient, is included

A Study of Speed of the Boundary Element Method as applied to the Realtime Computational Simulation of Biological Organs

In this work, possibility of simulating biological organs in realtime using the Boundary Element Method (BEM) is investigated. Biological organs are assumed to follow linear elastostatic material behavior, and constant boundary element is the element type used. First, a Graphics Processing Unit (GPU) is used to speed up the BEM computations to achieve the realtime performance. Next, instead of the GPU, a computer cluster is used. Results indicate that BEM is fast enough to provide for realtime graphics if biological organs are assumed to follow linear elastostatic material behavior. Although the present work does not conduct any simulation using nonlinear material models, results from using the linear elastostatic material model imply that it would be difficult to obtain realtime performance if highly nonlinear material models that properly characterize biological organs are used. Although the use of BEM for the simulation of biological organs is not new, the results presented in the present study are not found elsewhere in the literature.Comment: preprint, draft, 2 tables, 47 references, 7 files, Codes that can solve three dimensional linear elastostatic problems using constant boundary elements (of triangular shape) while ignoring body forces are provided as supplementary files; codes are distributed under the MIT License in three versions: i) MATLAB version ii) Fortran 90 version (sequential code) iii) Fortran 90 version (parallel code

Controlling the Error on Target Motion through Real-time Mesh Adaptation: Applications to Deep Brain Stimulation

We present an error-controlled mesh refinement procedure for needle insertion simulation and apply it to the simulation of electrode implantation for deep brain stimulation, including brain shift. Our approach enables to control the error in the computation of the displacement and stress fields around the needle tip and needle shaft by suitably refining the mesh, whilst maintaining a coarser mesh in other parts of the domain. We demonstrate through academic and practical examples that our approach increases the accuracy of the displacement and stress fields around the needle without increasing the computational expense. This enables real-time simulations. The proposed methodology has direct implications to increase the accuracy and control the computational expense of the simulation of percutaneous procedures such as biopsy, brachytherapy, regional anesthesia, or cryotherapy and can be essential to the development of robotic guidance.Comment: 21 pages, 14 figure