Virtual reality training and assessment in laparoscopic rectum surgery

Background: Virtual-reality (VR) based simulation techniques offer an efficient and low cost alternative to conventional surgery training. This article describes a VR training and assessment system in laparoscopic rectum surgery. Methods: To give a realistic visual performance of interaction between membrane tissue and surgery tools, a generalized cylinder based collision detection and a multi-layer mass-spring model are presented. A dynamic assessment model is also designed for hierarchy training evaluation. Results: With this simulator, trainees can operate on the virtual rectum with both visual and haptic sensation feedback simultaneously. The system also offers surgeons instructions in real time when improper manipulation happens. The simulator has been tested and evaluated by ten subjects. Conclusions: This prototype system has been verified by colorectal surgeons through a pilot study. They believe the visual performance and the tactile feedback are realistic. It exhibits the potential to effectively improve the surgical skills of trainee surgeons and significantly shorten their learning curve. © 2014 John Wiley & Sons, Ltd

Development of a Reality-Based, Haptics-Enabled Simulator for Tool-Tissue Interactions

The advent of complex surgical procedures has driven the need for finite element based surgical training simulators which provide realistic visual and haptic feedback throughout the surgical task. The foundation of a simulator stems from the use of accurate, reality-based models for the global tissue response as well as the tool-tissue interactions. To that end, ex vivo and in vivo tests were conducted for soft-tissue probing and in vivo tests were conducted for soft-tissue cutting for the purpose of model development. In formulating a surgical training system, there is a desire to replicate the surgical task as accurately as possible for haptic and visual realism. However, for many biological tissues, there is a discrepancy between the mechanical characteristics of ex vivo and in vivo tissue. The efficacy of utilizing an ex vivo model for simulation of in vivo probing tasks on porcine liver was evaluated by comparing the simulated probing task to an identical in vivo probing experiment. The models were then further improved upon to better replicate the in vivo response. During the study of cutting modeling, in vivo cutting experiments were performed on porcine liver to derive the force-displacement response of the tissue to a scalpel blade. Using this information, a fracture mechanics based approach was applied to develop a fully defined cohesive zone model governing the separation properties of the liver directly in front of the scalpel blade. Further, a method of scaling the cohesive zone parameters was presented to minimize the computational expense in an effort to apply the cohesive based cutting approach to real-time simulators. The development of the models for the global tissue response and local tool-tissue interactions for probing and cutting of soft-tissue provided the framework for real-time simulation of basic surgical skills training. Initially, a pre-processing approach was used for the development of reality-based, haptics enabled simulators for probing and cutting of soft tissue. Then a real-time finite element based simulator was developed to simulate the probing task without the need to know the tool path prior to simulation

Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

A comprehensive review of haptic feedback in minimally invasive robotic liver surgery: Advancements and challenges

Background: Liver medical procedures are considered one of the most challenging because of the liver's complex geometry, heterogeneity, mechanical properties, and movement due to respiration. Haptic features integrated into needle insertion systems and other medical devices could support physicians but are uncommon. Additional training time and safety concerns make it difficult to implement in robot-assisted surgery. The main challenges of any haptic device in a teleoperated system are the stability and transparency levels required to develop a safe and efficient system that suits the physician's needs. Purpose: The objective of the review article is to investigate whether haptic-based teleoperation potentially improves the efficiency and safety of liver needle insertion procedures compared with insertion without haptic feedback. In addition, it looks into haptic technology that can be integrated into simulators to train novice physicians in liver procedures. Methods: This review presents the physician's needs during liver interventions and the consequent requirements of haptic features to help the physician. This paper provides an overview of the different aspects of a teleoperation system in various applications, especially in the medical field. It finally presents the state-of-the-art haptic technology in robot-assisted procedures for the liver. This includes 3D virtual models of the liver and force measurement techniques used in haptic rendering to estimate the real-time position of the surgical instrument relative to the liver. Results: Haptic feedback technology can be used to navigate the surgical tool through the desired trajectory to reach the target accurately and avoid critical regions. It also helps distinguish between various textures of liver tissue. Conclusion: Haptic feedback can complement the physician's experience to compensate for the lack of real-time imaging during Computed Tomography guided (CT-guided) liver procedures. Consequently, it helps the physician mitigate the destruction of healthy tissues and takes less time to reach the target.</p

Virtual environments for medical training : graphic and haptic simulation of tool-tissue interactions

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2004.Includes bibliographical references (leaves 122-127).For more than 2,500 years, surgical teaching has been based on the so called "see one, do one, teach one" paradigm, in which the surgical trainee learns by operating on patients under close supervision of peers and superiors. However, higher demands on the quality of patient care and rising malpractice costs have made it increasingly risky to train on patients. Minimally invasive surgery, in particular, has made it more difficult for an instructor to demonstrate the required manual skills. It has been recognized that, similar to flight simulators for pilots, virtual reality (VR) based surgical simulators promise a safer and more comprehensive way to train manual skills of medical personnel in general and surgeons in particular. One of the major challenges in the development of VR-based surgical trainers is the real-time and realistic simulation of interactions between surgical instruments and biological tissues. It involves multi-disciplinary research areas including soft tissue mechanical behavior, tool-tissue contact mechanics, computer haptics, computer graphics and robotics integrated into VR-based training systems. The research described in this thesis addresses many of the problems of simulating tool-tissue interactions in medical virtual environments. First, two kinds of physically based real time soft tissue models - the local deformation and the hybrid deformation model - were developed to compute interaction forces and visual deformation fields that provide real-time feed back to the user. Second, a system to measure in vivo mechanical properties of soft tissues was designed, and eleven sets of animal experiments were performed to measure in vivo and in vitro biomechanical properties of porcine intra-abdominal organs. Viscoelastic tissue(cont.) parameters were then extracted by matching finite element model predictions with the empirical data. Finally, the tissue parameters were combined with geometric organ models segmented from the Visible Human Dataset and integrated into a minimally invasive surgical simulation system consisting of haptic interface devices inside a mannequin and a graphic display. This system was used to demonstrate deformation and cutting of the esophagus, where the user can haptically interact with the virtual soft tissues and see the corresponding organ deformation on the visual display at the same time.by Jung Kim.Ph.D

Characterization of soft tissue cutting for haptic display: experiments and computational models

Real-time medical simulation for robotic surgery planning and surgery training requires realistic yet computationally fast models of the mechanical behavior of soft tissue. This work presents a study to develop such a model to enable fast haptics display in simulation of softtissue cutting. An apparatus was developed and experiments were conducted to generate force-displacement data for cutting of soft tissue such as pig liver. The force-displacement curve of cutting pig liver revealed a characteristic pattern: the overall curve is formed by repeating units consisting of a local deformation segment followed by a local crack-growth segment. The modeling effort reported here focused on characterizing the tissue in the local deformation segment for fast haptic display. The deformation resistance of the tissue was quantified in terms of the local effective modulus (LEM) consistent with experimental forcedisplacement data. An algorithm was developed to determine LEM by solving an inverse problem with iterative finite element models. To enable faster simulation of cutting of a threedimensional (3D) liver specimen of naturally varying thickness, three levels of model order reduction were studied. Additionally, the variation of the LEM with cutting speed was determined. The values of LEM decreased as the cutting speed increased. This thesis also includes the characteristic response of soft tissue to the growth of a cut (cracking) with a scalpel blade. The experimentally measured cut-force versus cut-length data was used to determine the soft tissue’s resistance to fracture (resistance to crack extension) in scalpel cutting. The resistance to fracture of the soft tissue is defined as the amount of mechanical work needed to cause a cut (crack) to extend for a unit length in a soft-tissue sample of unit thickness. The equipment, method, and model are applicable for all soft tissue.Finally, the method of determining the property of the pig liver tissue during cutting was verified. Dual C-arm fluoroscopes were used to obtain the motion of the beads embedded inside the specimen during cutting. The experimentally measured displacement field was compared to the displacement field obtained through finite element model based on the LEM values at each localized area.Ph.D., Mechanical Engineering and Mechanics -- Drexel University, 200

3D and 2D finite element analysis in soft tissue cutting for haptic display

Paper presented at the 2005 International Conference on Advanced Robotics, ICAR '05, Seattle, WA.Real-time medical simulation for robotic surgery planning and surgery training requires realistic yet computationally fast models of the mechanical behavior of soft tissue. This paper presents a study to develop such a model to enable fast haptics display in simulation of softtissue cutting. An apparatus was developed and experiments were conducted to generate force-displacement data for cutting of soft tissue such as pig liver. The forcedisplacement curve of cutting pig liver revealed a characteristic pattern: the overall curve is formed by repeating units consisting of a local deformation segment followed by a local crack-growth segment. The modeling effort reported here focused on characterizing the tissue in the local deformation segment in a way suitable for fast haptic display. The deformation resistance of the tissue was quantified in terms of the local effective modulus (LEM) consistent with experimental force-displacement data. An algorithm was developed to determine LEM by solving an inverse problem with iterative finite element models. To enable faster simulation of cutting of a three-dimensional (3D) liver specimen of naturally varying thickness, three levels of model order reduction were studied. Firstly, a 3D quadratic-element model reduced to uniform thickness but otherwise haptics-equivalent (have identical forcedisplacement feedback) to a 3D model with varying thickness matching that of the liver was used. Next, hapticsequivalent 2D quadratic-element models were used. Finally, haptics-equivalent 2D linear-element models were used. These three models had a model reduction in the ratio of 1.0:0.3:0.04 but all preserved the same input-output (displacement, force) behavior measured in the experiments. The values of the LEM determined using the three levels of model reduction are close to one another. Additionally, the variation of the LEM with cutting speed was determined. The values of LEM decreased as the cutting speed increased

Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators

A Virtual-Based Haptic Endoscopic Sinus Surgery (ESS) Training System: from Development to Validation

Simulated training platforms offer a suitable avenue for surgical students and professionals to build and improve upon their skills, without the hassle of traditional training methods. To enhance the degree of realistic interaction paradigms of training simulators, great work has been done to both model simulated anatomy in more realistic fashion, as well as providing appropriate haptic feedback to the trainee. As such, this chapter seeks to discuss the ongoing research being conducted on haptic feedback-incorporated simulators specifically for Endoscopic Sinus Surgery (ESS). This chapter offers a brief comparative analysis of some EES simulators, in addition to a deeper quantitative and qualitative look into our approach to designing and prototyping a complete virtual-based haptic EES training platform

Haptic feedback from human tissues of various stiffness and homogeneity

This work presents methods for haptic modelling of soft and hard tissue with varying stiffness. The model provides visualization of deformation and calculates force feedback during simulated epidural needle insertion. A spring-mass-damper (SMD) network is configured from magnetic resonance image (MRI) slices of patient’s lumbar region to represent varying stiffness throughout tissue structure. Reaction force is calculated from the SMD network and a haptic device is configured to produce a needle insertion simulation. The user can feel the changing forces as the needle is inserted through tissue layers and ligaments. Methods for calculating the force feedback at various depths of needle insertion are presented. Voxelization is used to fill ligament surface meshes with spring mass damper assemblies for simulated needle insertion into soft and hard tissues. Modelled vertebrae cannot be pierced by the needle. Graphs were produced during simulated needle insertions to compare the applied force to haptic reaction force. Preliminary saline pressure measurements during Tuohy epidural needle insertion are also used as a basis for forces generated in the simulation