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

SmartSIM - a virtual reality simulator for laparoscopy training using a generic physics engine

International audienceVirtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand–eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in lapa-roscopy, i.e. SmartSIM, which has been developed using a generic open‐source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy‐to‐fabricate custom‐built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graph-ical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning

Use of Robots on Cardiac Surgery

Surgical robots are computer-assisted electromechanical devices that aid surgeons and are designed to replicate human movements into more steady precise motions, giving more accurate and delicate operations. The purpose of this research was to study the evolution of technical features of surgical robots on cardiology to determine technical advantages and barriers of these technologies. In one study out of all 50 patients that had endoscopic atraumatic coronary artery bypass robotic surgery, 49 reported they would recommend the surgery to another. Features make instrument manipulation more intuitive by eliminating the fulcrum effect, which removes the surgeon from twisting and turning in awkward positions. In another research, operative times were longer with robot-assisted surgery with an average of 97.1 minutes compared to traditional laparoscopy with an average of 82.1 minutes. Additionally, scars are eliminated with robot-assisted surgeries, which decrease blood loss, length of stay, postoperative pain, and narcotic use. The results of this study suggest that the benefits of advancement in technical features of robotic cardiac surgery outweigh the barriers

Task Dynamics of Prior Training Influence Visual Force Estimation Ability During Teleoperation

The lack of haptic feedback in Robot-assisted Minimally Invasive Surgery (RMIS) is a potential barrier to safe tissue handling during surgery. Bayesian modeling theory suggests that surgeons with experience in open or laparoscopic surgery can develop priors of tissue stiffness that translate to better force estimation abilities during RMIS compared to surgeons with no experience. To test if prior haptic experience leads to improved force estimation ability in teleoperation, 33 participants were assigned to one of three training conditions: manual manipulation, teleoperation with force feedback, or teleoperation without force feedback, and learned to tension a silicone sample to a set of force values. They were then asked to perform the tension task, and a previously unencountered palpation task, to a different set of force values under teleoperation without force feedback. Compared to the teleoperation groups, the manual group had higher force error in the tension task outside the range of forces they had trained on, but showed better speed-accuracy functions in the palpation task at low force levels. This suggests that the dynamics of the training modality affect force estimation ability during teleoperation, with the prior haptic experience accessible if formed under the same dynamics as the task.Comment: 12 pages, 8 figure

Laparoscopic motor learning and workspace exploration

Background: Laparoscopic surgery requires operators to learn novel complex movement patterns. However, our understanding of how best to train surgeons’ motor skills is inadequate and research is needed to determine optimal laparoscopic training regimes. This difficulty is confounded by variables inherent in surgical practice – e.g. the increasing prevalence of morbidly obese patients presents additional challenges related to restriction of movement due to abdominal wall resistance and reduced intra-abdominal space. The aim of this study was to assess learning of a surgery related task in constrained and unconstrained conditions using a novel system linking a commercially available robotic arm with specialised software creating the novel kinematic assessment tool (Omni-KAT). Methods: We created an experimental tool that records motor performance by linking a commercially available robotic arm with specialised software that presents visual stimuli and objectively measures movement outcome (kinematics). Participants were given the task of generating aiming movements along a horizontal plane to move a visual cursor on a vertical screen. One group received training that constrained movements to the correct plane whilst the other group was unconstrained and could explore the entire ‘action space’. Results: The tool successfully generated the requisite force fields and precisely recorded the aiming movements. Consistent with predictions from structural learning theory, the unconstrained group produced better performance after training as indexed by movement duration (p < .05). Conclusion: The data showed improved performance for participants who explored the entire action space, highlighting the importance of learning the full dynamics of laparoscopic instruments. These findings, alongside the development of the Omni-KAT, open up exciting prospects for better understanding of the learning processes behind surgical training and investigating ways in which learning can be optimised

A Six Degrees of Freedom Haptic Interface for Laparoscopic Training

We present the novel kinematics, workspace characterization, functional prototype and impedance control of a six degrees of freedom haptic interface designed to train surgeons for laparoscopic procedures, through virtual reality simulations. The parallel kinematics of the device is constructed by connecting a 3RRP planar parallel mechanism to a linearly actuated modified delta mechanism with a connecting link. The configuration level forward and inverse kinematics of the device assume analytic solutions, while its workspace can be shaped to enable large end-effect or translations and rotations, making it well-suited for laparoscopy operations. Furthermore, the haptic interface features a low apparent inertia with high structural stiffness, thanks to its parallel kinematics with grounded actuators.A model-based open-loop impedance controller with feed-forward gravity compensation has been implemented for the device and various virtual tissue/organ stiffness levels have been rendered

Minimally Invasive Surgery in Gynecology

The first laparoscopic procedure was performed by 1901 by Georg Kelling in dogs while the first laparoscopic procedure in humans was performed by Hans Chrisitan Jacobaeus in 1910. Minimally invasive surgery offers multiple advantages over conventional laparotomy and is associated with reduced estimated blood loss, a lower incidence of complications and a shorter hospital stay and recovery. Over a century later, the vast majority of surgical procedures in gynecology are performed via minimal invasive technique. These include laparoscopy, minilaparoscopy, robotic surgery, laparoendoscopic single site surgery (LESS) and natural orifices transluminal endoscopic surgery. In this chapter we review these surgical techniques, analyze the main differences among these techniques and comment on their advantages and disadvantages