Essential techniques for laparoscopic surgery simulation

Laparoscopic surgery is a complex minimum invasive operation that requires long learning curve for the new trainees to have adequate experience to become a qualified surgeon. With the development of virtual reality technology, virtual reality-based surgery simulation is playing an increasingly important role in the surgery training. The simulation of laparoscopic surgery is challenging because it involves large non-linear soft tissue deformation, frequent surgical tool interaction and complex anatomical environment. Current researches mostly focus on very specific topics (such as deformation and collision detection) rather than a consistent and efficient framework. The direct use of the existing methods cannot achieve high visual/haptic quality and a satisfactory refreshing rate at the same time, especially for complex surgery simulation. In this paper, we proposed a set of tailored key technologies for laparoscopic surgery simulation, ranging from the simulation of soft tissues with different properties, to the interactions between surgical tools and soft tissues to the rendering of complex anatomical environment. Compared with the current methods, our tailored algorithms aimed at improving the performance from accuracy, stability and efficiency perspectives. We also abstract and design a set of intuitive parameters that can provide developers with high flexibility to develop their own simulators

Virtual reality training for endoscopic surgery : composing a validated training program for basic skills

Endoscopic surgery demands different specific psychomotor skills than open surgery.\ud Virtual reality simulation training has the potential to be a valuable tool in training these skills, because simulation provides the opportunity to train psychomotor skills in a safe environment. In addition to training, virtual reality simulators are capable to objectively assess the skills of a subject in training. In contrast to traditional box trainers and animal models that require human monitored evaluation resulting in subjective assessment. The LapSim virtual reality simulator is a system designed to develop and assess basic psychomotor skills and advanced laparoscopic tasks in a virtual environment. Prior to implementation of these simulation based training modalities into the surgical training curriculum the simulator has to be validated. The training programs should be developed and evaluated

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

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

Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery

Background The utility of the virtual-reality robotic simulator in training programmes has not been clearly evaluated. Our aim was to evaluate the impact of a virtual-reality robotic simulator-training programme on basic surgical skills. Methods A simulator-training programme in robotic surgery, using the da Vinci Skills Simulator, was evaluated in a population including junior and seasoned surgeons, and non-physicians. Their performances on robotic dots and suturing-skin pod platforms before and after virtual-simulation training were rated anonymously by surgeons experienced in robotics. Results 39 participants were enrolled: 14 medical students and residents in surgery, 14 seasoned surgeons, 11 non-physicians. Junior and seasoned surgeons’ performances on platforms were not significantly improved after virtual-reality robotic simulation in any of the skill domains, in contrast to non-physicians. Conclusions The benefits of virtual-reality simulator training on several tasks to basic skills in robotic surgery were not obvious among surgeons in our initial and early experience with the simulator

Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Essential techniques for improving visual realism of laparoscopic surgery simulation.

With the prevalence of laparoscopic surgery, the request for reliable training and assessment is becoming increasingly important. The traditional way of training is both time consuming and cost intensive, and may cause ethical or moral issues. With the development of computer technologies, virtual reality has entered the world of consumer electronics as a new way to enhance tactile and visual sensory experiences. Virtual reality based surgical skill training gradually becomes an effective supplementary to the traditional laparoscopic skill training in many surgical theatres. To provide high fidelity virtual surgery training experiences, the presentation of the virtual world should have the same level of realism as what surgeons see and feel during real operations. However, the weak computing power limits the potential level of details on the graphics presentation and physical behaviour of virtual objects, which will further influence the fidelity of tactile interaction. Achieving visual realism (realistic graphics presentation and accurate physical behaviour) and good user experience using limited computing resources is the main challenge for laparoscopic surgery simulation. The topic of visual realism in laparoscopic surgery simulation has not been well researched. This topic mainly relates to the area of 3D anatomy modeling, soft body simulation and rendering. Current researches in computer graphics and game communities are not tailored for laparoscopic surgery simulation. The direct use of those techniques in developing surgery simulators will often result in poor quality anatomy model, inaccurate simulation, low fidelity visual effect, poor user experience and inefficient production pipeline, which significantly influence the visual realism of the virtual world. The development of laparoscopic surgery simulator is an interdiscipline of computer graphics, computational physics and haptics. However, current researches barely focus on the study of tailored techniques and efficient production pipeline which often result in the long term research cycle and daunting cost for simulator development. This research is aiming at improving the visual realism of laparoscopic surgery simulation from the perspective of computer graphics. In this research, a set of tailor techniques have been proposed to improve the visual realism for laparoscopic surgery simulation. For anatomy modeling, an automatic and efficient 3D anatomy conversion pipeline is proposed which can convert bad quality 3D anatomy into simulation ready state while preserving the original model’s surface parameterization property. For simulation, a soft tissue simulation pipeline is pro- posed which can provide multi-layer heterogeneous soft tissue modeling and intuitive physically editable simulation based on uniform polynomial based hyperelastic material representation. For interaction, a collision detection and interaction system based on adaptive circumphere structure is proposed which supports robust and efficient sliding con- tact, energized dissection and clip. For rendering, a multi-layer soft tissue rendering pipeline is proposed which decomposed the multi-layer structure of soft tissue into corresponding material asset required by state-of-art rendering techniques. Based on this research, a system framework for building a laparoscopic surgery simulator is also proposed to test the feasibility of those tailored techniques