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

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

A Sensorized Instrument for Minimally Invasive Surgery for the Measurement of Forces during Training and Surgery: Development and Applications

The reduced access conditions present in Minimally Invasive Surgery (MIS) affect the feel of interaction forces between the instruments and the tissue being treated. This loss of haptic information compromises the safety of the procedure and must be overcome through training. Haptics in MIS is the subject of extensive research, focused on establishing force feedback mechanisms and developing appropriate sensors. This latter task is complicated by the need to place the sensors as close as possible to the instrument tip, as the measurement of forces outside of the patient\u27s body does not represent the true tool--tissue interaction. Many force sensors have been proposed, but none are yet available for surgery. The objectives of this thesis were to develop a set of instruments capable of measuring tool--tissue force information in MIS, and to evaluate the usefulness of force information during surgery and for training and skills assessment. To address these objectives, a set of laparoscopic instruments was developed that can measure instrument position and tool--tissue interaction forces in multiple degrees of freedom. Different design iterations and the work performed towards the development of a sterilizable instrument are presented. Several experiments were performed using these instruments to establish the usefulness of force information in surgery and training. The results showed that the combination of force and position information can be used in the development of realistic tissue models or haptic interfaces specifically designed for MIS. This information is also valuable in order to create tactile maps to assist in the identification of areas of different stiffness. The real-time measurement of forces allows visual force feedback to be presented to the surgeon. When applied to training scenarios, the results show that experience level correlates better with force-based metrics than those currently used in training simulators. The proposed metrics can be automatically computed, are completely objective, and measure important aspects of performance. The primary contribution of this thesis is the design and development of highly versatile instruments capable of measuring force and position during surgery. A second contribution establishes the importance and usefulness of force data during skills assessment, training and surgery

Haptic rendering for VR laparoscopic surgery simulation

Adelaide, S

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

Optical Fibre-based Force Sensing Needle Driver for Minimally Invasive Surgery

Minimally invasive surgery has been limited from its inception by insufficient haptic feedback to surgeons. The loss of haptic information threatens patients safety and results in longer operation times. To address this problem, various force sensing systems have been developed to provide information about tool–tissue interaction forces. However, the provided results for axial and grasping forces have been inaccurate in most of these studies due to considerable amount of error and uncertainty in their force acquisition method. Furthermore, sterilizability of the sensorized instruments plays a pivotal role in accurate measurement of forces inside a patient\u27s body. Therefore, the objective of this thesis was to develop a sterilizable needle-driver type grasper using fibre Bragg gratings. In order to measure more accurate and reliable tool–tissue interaction forces, optical force sensors were integrated in the grasper jaw to measure axial and grasping forces directly at their exertion point on the tool tip. Two sets of sensor prototypes were developed to prove the feasibility of proposed concept. Implementation of this concept into a needle-driver instrument resulted in the final proposed model of the sensorized laparoscopic instrument. Fibre Bragg gratings were used for measuring forces due to their many advantages for this application such as small size, sterilizability and high sensitivity. Visual force feedback was provided for users based on the acquired real-time force data. Improvement and consideration points related to the current work were identified and potential areas to continue this project in the future are discussed