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

An Intestinal Surgery Simulator: Real-Time Collision Processing and Visualization

International audienceThis research work is aimed towards the development of a VR-based trainer for colon cancer removal. It enables the surgeons to interactively view and manipulate the concerned virtual organs as during a real surgery. First, we present a method for animating the small intestine and the mesentery (the tissue that connects it to the main vessels) in real-time, thus enabling user-interaction through virtual surgical tools during the simulation. We present a stochastic approach for fast collision detection in highly deformable, self-colliding objects. A simple and efficient response to collisions is also introduced in order to reduce the overall animation complexity. Secondly, we describe a new method based on generalized cylinders for fast rendering of the intestine. An efficient curvature detection method, along with an adaptive sampling algorithm is presented. This approach, while providing improved tessellation without the classical self-intersection problem, also allows for high-performance rendering, thanks to the new 3D skinning feature available in recent GPUs. The rendering algorithm is also designed to ensure a guaranteed frame rate. Finally, we present the quantitative results of the simulations and describe the qualitative feedback obtained from the surgeons

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

Beads-on-String Model for Virtual Rectum Surgery Simulation

A beads-on-string model is proposed to handle the deformation and collision of the rectum in virtual surgery simulation. The idea is firstly inspired by the observation of the similarity in shape shared by a rectum with regular bulges and a string of beads. It is beneficial to introduce an additional layer of beads, which provides an interface to map the deformation of centreline to the associated mesh in an elegant manner and a bounding volume approximation in collision handling. Our approach is carefully crafted to achieve high computational efficiency and retain its physical basis. It can be implemented for real time surgery simulation application

Articular human joint modelling

Copyright @ Cambridge University Press 2009.The work reported in this paper encapsulates the theories and algorithms developed to drive the core analysis modules of the software which has been developed to model a musculoskeletal structure of anatomic joints. Due to local bone surface and contact geometry based joint kinematics, newly developed algorithms make the proposed modeller different from currently available modellers. There are many modellers that are capable of modelling gross human body motion. Nevertheless, none of the available modellers offer complete elements of joint modelling. It appears that joint modelling is an extension of their core analysis capability, which, in every case, appears to be musculoskeletal motion dynamics. It is felt that an analysis framework that is focused on human joints would have significant benefit and potential to be used in many orthopaedic applications. The local mobility of joints has a significant influence in human motion analysis, in understanding of joint loading, tissue behaviour and contact forces. However, in order to develop a bone surface based joint modeller, there are a number of major problems, from tissue idealizations to surface geometry discretization and non-linear motion analysis. This paper presents the following: (a) The physical deformation of biological tissues as linear or non-linear viscoelastic deformation, based on spring-dashpot elements. (b) The linear dynamic multibody modelling, where the linear formulation is established for small motions and is particularly useful for calculating the equilibrium position of the joint. This model can also be used for finding small motion behaviour or loading under static conditions. It also has the potential of quantifying the joint laxity. (c) The non-linear dynamic multibody modelling, where a non-matrix and algorithmic formulation is presented. The approach allows handling complex material and geometrical nonlinearity easily. (d) Shortest path algorithms for calculating soft tissue line of action geometries. The developed algorithms are based on calculating minimum ‘surface mass’ and ‘surface covariance’. An improved version of the ‘surface covariance’ algorithm is described as ‘residual covariance’. The resulting path is used to establish the direction of forces and moments acting on joints. This information is needed for linear or non-linear treatment of the joint motion. (e) The final contribution of the paper is the treatment of the collision. In the virtual world, the difficulty in analysing bodies in motion arises due to body interpenetrations. The collision algorithm proposed in the paper involves finding the shortest projected ray from one body to the other. The projection of the body is determined by the resultant forces acting on it due to soft tissue connections under tension. This enables the calculation of collision condition of non-convex objects accurately. After the initial collision detection, the analysis involves attaching special springs (stiffness only normal to the surfaces) at the ‘potentially colliding points’ and motion of bodies is recalculated. The collision algorithm incorporates the rotation as well as translation. The algorithm continues until the joint equilibrium is achieved. Finally, the results obtained based on the software are compared with experimental results obtained using cadaveric joints

Affordable interactive virtual reality system for the Dynamic Hip Screw surgery training in vitro

Interactive virtual reality systems provide safe and cost-effective training environment to improve the technical skills and competence of surgeons. The trainees can have as many practice sessions, without need to the trainer all the time, before even start carrying out the procedure on any real patient. In this paper, we present an affordable interactive virtual reality system for the Dynamic Hip Screw (DHS) surgery training in vitro, through 3D tracking. The system facilitates a safe (in vitro / off patient) training to improve the cognitive coordination of trainees and junior surgeons, in particular the Hands, Eyes and Brain coordination. The system is based on very cheap commercial off-the-shelf (COT) components, which are very affordable, and needs minimum setup effort and knowledge. It also provides a range of visual and quantitative feedback information and measures, such as position, orientation, insertion point, and depth of drilling. It is envisaged that improving this level of coordination, through the training system, will contribute to reducing the failure rate of the DHS procedure. This means better treatment for patients and less costs for the Health services systems (e.g. UK's NHS system)