A Review of Virtual Reality Based Training Simulators for Orthopaedic Surgery

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator

A review of virtual reality based training simulators for orthopaedic surgery

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordThis review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator.Wessex Academic Health Science Network (Wessex AHSN) Innovation and Wealth Creation Accelerator Fund 2014/15Bournemouth Universit

Modeling and rendering for development of a virtual bone surgery system

A virtual bone surgery system is developed to provide the potential of a realistic, safe, and controllable environment for surgical education. It can be used for training in orthopedic surgery, as well as for planning and rehearsal of bone surgery procedures...Using the developed system, the user can perform virtual bone surgery by simultaneously seeing bone material removal through a graphic display device, feeling the force via a haptic deice, and hearing the sound of tool-bone interaction --Abstract, page iii

Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer

With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high-fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform

Investigation of a holistic human-computer interaction (HCI) framework to support the design of extended reality (XR) based training simulators

In recent years, the use of Extended Reality (XR) based simulators for training has increased rapidly. In this context, there is a need to explore novel HCI-based approaches to design more effective 3D training environments. A major impediment in this research area is the lack of an HCI-based framework that is holistic and serves as a foundation to integrate the design and assessment of HCI-based attributes such as affordance, cognitive load, and user-friendliness. This research addresses this need by investigating the creation of a holistic framework along with a process for designing, building, and assessing training simulators using such a framework as a foundation. The core elements of the proposed framework include the adoption of participatory design principles, the creation of information-intensive process models of target processes (relevant to the training activities), and design attributes related to affordance and cognitive load. A new attribute related to affordance of 3D scenes is proposed (termed dynamic affordance) and its role in impacting user comprehension in data-rich 3D training environments is studied. The framework is presented for the domain of orthopedic surgery. Rigorous user-involved assessment of the framework and simulation approach has highlighted the positive impact of the HCI-based framework and attributes on the acquisition of skills and knowledge by healthcare users

Da Vinci robot at Hospital Clinic. Manoeuvrability devices and performance in robotic tech

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Tutor: Manel Puig Vidal.Robot-assisted surgical systems are becoming increasingly common in medical procedures as they embrace many of the benefits of minimally invasive surgery including less trauma, recovery time and financial costs associated to the treatment after surgery. These robotic systems allow the surgeons to navigate within confined spaces where an operator’s human hand would normally be greatly limited. This dexterity is further strengthened through motion scaling, which translates large motions by the operator into diminutive actions of the robotic end effector. An example of this is the Da Vinci System which is coupled to the EndoWrist end effector tool. Nevertheless, these systems also have some drawbacks such as the high cost of the surgery itself and the lack of tactile or haptic feedback. This means that as the surgeon is performing the procedures outside the patient’s body, he/she can not feel the resistance of the human tissue’s when cutting. Therefore, one can risk damaging healthy tissues if force is not controlled or, when sewing, one can exert an exaggerated force and break the thread. In this project, a new system is created based on the UR5 robot (Universal Robots) and an EndoWrist needle to mimic the behaviour of the Da Vinci System and implement some improvements regarding the manoeuvrability and haptic feedback performance

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

Development of a Force-Based Ream Vector Measurement System For Glenoid Reaming Simulation

Glenoid reaming is a technically challenging step during total shoulder arthroplasty surgery that may be improved through frequent practice and exposure to simulation training. At our institution, a vibration haptic glenoid reaming simulator is being developed that simulates the vibrations felt during glenoid reaming. This thesis presents the development of a force-based reamer vector measurement system that allows the simulator to measure the user’s net applied force and reamer angle of approach. This capability allows for the simulation of eccentric reaming maneuvers commonly used to adjust the glenoid orientation. The system error was characterized and evaluated using a robot to operate a surgical reaming tool. Finally, a study was performed that assessed the ability of surgeons to correct glenoid retroversion while using the haptic vibration simulator. Overall, the surgeons were able to correct glenoid orientation within 1 degree of the target orientation, according to the simulator’s reaming vector measurement system

Development of a Physical Shoulder Simulator for the Training of Basic Arthroscopic Skills

Increasingly, shoulder surgeries are performed using arthroscopic techniques, leading to reduced tissue damage and shorter patient recovery times. Orthopaedic training programs are responding to the increased demand for arthroscopic surgeries by incorporating arthroscopic skills into their residency curriculums. A need for accessible and effective training tools exists. This thesis describes the design and development of a physical shoulder simulator for training basic arthroscopy skills such as triangulation, orientation, and navigation of the anatomy. The simulator can be used in either the lateral decubitus or beach chair orientation and accommodates wet or dry practice. Sensors embedded in the simulator provide a means to assess performance. A study was conducted to determine the effectiveness of the simulator. Novice subjects improved their performance after practicing with the simulator. A survey completed by experts, recognized the simulator as a valuable tool for training novice surgeons in basic arthroscopic skills

Patient Specific Systems for Computer Assisted Robotic Surgery Simulation, Planning, and Navigation

The evolving scenario of surgery: starting from modern surgery, to the birth of medical imaging and the introduction of minimally invasive techniques, has seen in these last years the advent of surgical robotics. These systems, making possible to get through the difficulties of endoscopic surgery, allow an improved surgical performance and a better quality of the intervention. Information technology contributed to this evolution since the beginning of the digital revolution: providing innovative medical imaging devices and computer assisted surgical systems. Afterwards, the progresses in computer graphics brought innovative visualization modalities for medical datasets, and later the birth virtual reality has paved the way for virtual surgery. Although many surgical simulators already exist, there are no patient specific solutions. This thesis presents the development of patient specific software systems for preoperative planning, simulation and intraoperative assistance, designed for robotic surgery: in particular for bimanual robots that are becoming the future of single port interventions. The first software application is a virtual reality simulator for this kind of surgical robots. The system has been designed to validate the initial port placement and the operative workspace for the potential application of this surgical device. Given a bimanual robot with its own geometry and kinematics, and a patient specific 3D virtual anatomy, the surgical simulator allows the surgeon to choose the optimal positioning of the robot and the access port in the abdominal wall. Additionally, it makes possible to evaluate in a virtual environment if a dexterous movability of the robot is achievable, avoiding unwanted collisions with the surrounding anatomy to prevent potential damages in the real surgical procedure. Even if the software has been designed for a specific bimanual surgical robot, it supports any open kinematic chain structure: as far as it can be described in our custom format. The robot capabilities to accomplish specific tasks can be virtually tested using the deformable models: interacting directly with the target virtual organs, trying to avoid unwanted collisions with the surrounding anatomy not involved in the intervention. Moreover, the surgical simulator has been enhanced with algorithms and data structures to integrate biomechanical parameters into virtual deformable models (based on mass-spring-damper network) of target solid organs, in order to properly reproduce the physical behaviour of the patient anatomy during the interactions. The main biomechanical parameters (Young's modulus and density) have been integrated, allowing the automatic tuning of some model network elements, such as: the node mass and the spring stiffness. The spring damping coefficient has been modeled using the Rayleigh approach. Furthermore, the developed method automatically detect the external layer, allowing the usage of both the surface and internal Young's moduli, in order to model the main parts of dense organs: the stroma and the parenchyma. Finally the model can be manually tuned to represent lesion with specific biomechanical properties. Additionally, some software modules of the simulator have been properly extended to be integrated in a patient specific computer guidance system for intraoperative navigation and assistance in robotic single port interventions. This application provides guidance functionalities working in three different modalities: passive as a surgical navigator, assistive as a guide for the single port placement and active as a tutor preventing unwanted collision during the intervention. The simulation system has beed tested by five surgeons: simulating the robot access port placemen, and evaluating the robot movability and workspace inside the patient abdomen. The tested functionalities, rated by expert surgeons, have shown good quality and performance of the simulation. Moreover, the integration of biomechanical parameters into deformable models has beed tested with various material samples. The results have shown a good visual realism ensuring the performance required by an interactive simulation. Finally, the intraoperative navigator has been tested performing a cholecystectomy on a synthetic patient mannequin, in order to evaluate: the intraoperative navigation accuracy, the network communications latency and the overall usability of the system. The tests performed demonstrated the effectiveness and the usability of the software systems developed: encouraging the introduction of the proposed solution in the clinical practice, and the implementation of further improvements. Surgical robotics will be enhanced by an advanced integration of medical images into software systems: allowing the detailed planning of surgical interventions by means of virtual surgery simulation based on patient specific biomechanical parameters. Furthermore, the advanced functionalities offered by these systems, enable surgical robots to improve the intraoperative surgical assistance: benefitting of the knowledge of the virtual patient anatomy