Virtual Reality Based Simulation of Hysteroscopic Interventions

Virtual reality based simulation is an appealing option to supplement traditional clinical education. However, the formal integration of training simulators into the medical curriculum is still lacking. Especially, the lack of a reasonable level of realism supposedly hinders the widespread use of this technology. Therefore, we try to tackle this situation with a reference surgical simulator of the highest possible fidelity for procedural training. This overview describes all elements that have been combined into our training system as well as first results of simulator validation. Our framework allows the rehearsal of several aspects of hysteroscopy—for instance, correct fluid management, handling of excessive bleeding, appropriate removal of intrauterine tumors, or the use of the surgical instrument

Pressure-dependent hydrometra dimensions in hysteroscopy

AIM: To investigate the relation between intrauterine pressures and volumes for virtual-reality-based surgical training in hysteroscopy. MATERIAL AND METHODS: Ten fresh extirpated uteri were insufflated by commercial hysteroscopy pump and imaged by computer tomography (CT) under intrauterine air pressure in distension-collapse cycles between 0 , 20 (150 mmHg), and 0 kPa, performing a CT scan at every step at about 2.7 kPa (20 mmHg). RESULTS: An initial threshold pressure to distend the cavity was avoided by introducing the insufflation tube up to the fundus. The filling and release phases of seven uteri that were completely distended showed the typical characteristics of a hysteresis curve which is expected from a viscoelastic, nonlinear, anisotropic soft tissue organ like the uterus. In three cases tightening the extirpated uterus especially at the lateral resection lines caused significant problems that inhibited registration of a complete distension-collapse cycle. Interpolated volumes for complete distended cavities and extrapolated for incomplete data sets, derived from the digitally reconstructed three-dimensional (3D) geometries, ranged from 0.6 to 11.4 mL at 20 kPa. These values highly correlate with the uterine volume (not insufflated) considering different biometric data of the uteri and patient data. Linear (R (2) = 0.66) and quadratic least-squares fits (R (2) = 0.74) were used to derive the formulas y = 0.069x and y = 0.00037x (2) + 0.036x, where x is the uterine volume in mL (not insufflated) and y is the cavity volume in mL at 20 kPa intrauterine pressure. CONCLUSIONS: Our experimental hysteroscopical setup enabled us to reconstruct the changes in volumes of insufflated uteri under highly realistic conditions in 3D. The relation between intrauterine pressure and cavity volume in distension-collapse cycles describes a typical hysteresis curve

I Simulatori in realtà virtuale: un ausilio nella formazione chirurgica

Negli ultimi anni la necessità di formazione in campo laparoscopico ha spinto verso la creazione di simulatori chirurgici di diversa fattura e diversa complessità. Al momento molti di questi sono disponibili in commercio. Ognuna di questi ha il proprio design, struttura e programma di formazione. L'evoluzione è rappresentata dall’utilizzo della Realtà Virtuale, che mima l'azione reale e lavora sulle diverse competenze acquisite durante i corsi di formazione e l’esperienza chirurgica al campo operatorio. Il ruolo della formazione "sicura ed efficiente" è necessario nel corso di una specializzazione in chirurgia e durante la formazione continua. La simulazione in realtà virtuale è in grado di offrire un numero infinito di scenari chirurgici. I simulatori chirurgici in realtà virtuale di ultima generazione sono forniti di percorsi di formazione graduali che guidano lo specializzando nell’acquisizione di manualità “fine” nei singoli tasks fino alla procedura completa “full task” di un intervento chirurgico, ad esempio una colecistectomia. In questo studio abbiamo voluto testare la validità di un’acquisizione graduale di tecnica manuale “step by step” rispetto all’esercizio diretto solo su una procedura completa mediante l’ausilio di un simulatore in Virtual Reality, il LapMentor®(Simbionix,Israele). Specializzandi in Chirurgia Generale privi di esperienza precedente in laparoscopia hanno ottenuto risultati migliori sulla procedura completa della colecistectomia laparoscopica procedendo durante il corso step by step rispetto a coloro che hanno eseguito la procedura completa “full task” direttamente. Il nostro studio conferma che una buona esperienza e la conoscenza delle capacità tecniche di base nel campo della formazione laparoscopica migliorano le prestazioni nella procedura completa.In the last years the need for training in laparoscopy has led to the creation of surgical simulators of varying complexity and different bill. Currently, many of these are commercially available. Each of these has its own design, structure and training program. The trend is the use of virtual reality, which mimics the real action and work on various skills acquired during the training and experience in the surgical operating field. The role of training on safe and efficient "is necessary in the course of specialization in surgery and during the training. The simulation in virtual reality is able to offer an infinite number of surgical scenarios. The surgical simulators in virtual reality are equipped with the latest training courses that guide the gradual specializing in the acquisition of manual skills "end" in the individual tasks to complete procedure "full task" for surgery, such as a cholecystectomy. In this study we wanted to test the validity of the gradual acquisition of technical manual "step by step" only on a direct comparison with the whole procedure with the help of a mortgage in Virtual Reality, the LapMentor ® (Simbionix, Israel) .Specializing in general surgery with no previous experience in laparoscopy have performed better on the whole procedure of laparoscopic cholecystectomy during the course of proceeding step by step than those who performed the procedure complete "full task" directly. Our study confirms that a good experience and knowledge of basic technical skills in training laparoscopic improve performance in the whole procedure