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PubMedDate not supplied

User interface paradigms for patient-specific surgical planning: lessons learned over a decade of research.

This paper covers work in virtual reality-based, patient-specific surgical planning over the past decade. It aims to comprehensively examine the user interface paradigms and system designs during that period of time and to objectively analyze their effectiveness for the task. The goal is to provide useful feedback on these interface and implementation paradigms to aid other researchers in this field. First, specialized systems for specific clinical use were produced with a limited set of visualization tools. Later, through collaboration with NASA, an immersive virtual environment was created to produce high-fidelity images for surgical simulation, but it underestimated the importance of collaboration. The next system, a networked, distributed virtual environment, provided immersion and collaboration, but the immersive paradigm was found to be of a disadvantage and the uniqueness of the framework unwieldy. A virtual model, workbench-style display was then created using a commercial package, but limitations of each were soon apparent. Finally, a specialized display, with an integrated visualization and simulation system is described and evaluated. Lessons learned include: surgical planning is an abstract process unlike surgical simulation; collaboration is important, as is stereo visualization; and that high-resolution preoperative images from standard viewpoints are desirable, but interaction is truly the key to planning.

Patient-Centered Care↗

PubMed1991

[Three dimensional CT reconstruction system on a personal computer].

A new computer system to produce three dimensional surface image from CT scan has been invented. Although many similar systems have been already developed and reported, they are too expensive to be set up in routine clinical services because most of these systems are based on high power mini-computer systems. According to the opinion that a practical 3D-CT system should be used in daily clinical activities using only a personal computer, we have transplanted the 3D program into a personal computer working in MS-DOS (16-bit, 12 MHz). We added to the program a routine which simulates surgical dissection on the surface image. The time required to produce the surface image ranges from 40 to 90 seconds. To facilitate the simulation, we connected a 3D system with the neuronavigator. The navigator gives the position of the surgical simulation when the surgeon places the navigator tip on the patient's head thus simulating the surgical excision before the real dissection.

Brain↗

PubMed1998

Virtual reality applied to hepatic surgery simulation: the next revolution.

OBJECTIVE: This article describes a preliminary work on virtual reality applied to liver surgery and discusses the repercussions of assisted surgical strategy and surgical simulation on tomorrow's surgery. SUMMARY BACKGROUND DATA: Liver surgery is considered difficult because of the complexity and variability of the organ. Common generic tools for presurgical medical image visualization do not fulfill the requirements for the liver, restricting comprehension of a patient's specific liver anatomy. METHODS: Using data from the National Library of Medicine, a realistic three-dimensional image was created, including the envelope and the four internal arborescences. A computer interface was developed to manipulate the organ and to define surgical resection planes according to internal anatomy. The first step of surgical simulation was implemented, providing the organ with real-time deformation computation. RESULTS: The three-dimensional anatomy of the liver could be clearly visualized. The virtual organ could be manipulated and a resection defined depending on the anatomic relations between the arborescences, the tumor, and the external envelope. The resulting parts could also be visualized and manipulated. The simulation allowed the deformation of a liver model in real time by means of a realistic laparoscopic tool. CONCLUSIONS: Three-dimensional visualization of the organ in relation to the pathology is of great help to appreciate the complex anatomy of the liver. Using virtual reality concepts (navigation, interaction, and immersion), surgical planning, training, and teaching for this complex surgical procedure may be possible. The ability to practice a given gesture repeatedly will revolutionize surgical training, and the combination of surgical planning and simulation will improve the efficiency of intervention, leading to optimal care delivery.

Computer Simulation↗

PubMed2001

The design and testing of a force feedback dental simulator.

The Iowa Dental Surgical Simulator is a haptic simulator to train dental students in the haptic skills of dentistry. The initial design emphasizes the detection of carious lesions. This work describes the software and implementation of the prototype system, the design tradeoffs' and the technical issues associated with haptic and graphics subsystems. The work also describes the current system performance, including a formal evaluation by practicing dentists and performance measures. A discussion of the limitations of the current system is followed by an analysis of opportunities to improve the quality of the simulator. The results should be of interest to designers of medical haptic simulation systems and other simulation designers.

Biophysical Phenomena↗

PubMed1992

[Methods for simulation of surgical interventions in head and neck surgery].

Preoperative evaluation of the operating site is essential in planning surgical procedures. The relationship of pathology to adjacent tissues and vital anatomical structures needs to be analyzed to determine the intraoperative procedures required. For this the surgeon mentally simulates the procedure planned. For complicated conditions or reconstructive surgery in extensive bony defects, surgery can be simulated with three-dimensional reconstruction on either a monitor screen or on an individually manufactured plastic model of the patient. For this purpose different procedures for 3 D representation and manipulation of tomographic image data have been developed in our departments and the technique of stereolithography used experimentally to create custom-made plastic model of patients. A computerized video image manipulator was also developed for simulation of aesthetic plastic surgical procedures.

Computer Graphics↗

PubMed2000

Computer-assisted three-dimensional surgical planing and simulation. 3D soft tissue planning and prediction.

The purpose of this paper is to report a new technique for three-dimensional facial soft-tissue-change prediction after simulated orthognathic surgical planning. A scheme for soft tissue deformation, "Computer-assisted three-dimensional virtual reality soft tissue planning and prediction for orthognathic surgery (CASP)", is presented. The surgical planning was based on three-dimensional reconstructed CT visualization. Soft tissue changes were predicted by two newly devised algorithms: Surface Normal-based Model Deformation Algorithm and Ray Projection-based Model Deformation Algorithm. A three-dimensional color facial texture-mapping technique was also used for generating the color photo-realistic facial model. As a final result, a predicted and simulated patient's color facial model can be visualized from arbitrary viewing points.

Algorithms↗

PubMed2005

A real time finite element based tissue simulation method incorporating nonlinear elastic behavior.

This paper presents a new finite element simulation approach for surgical simulators. Based on the solution of the algebraic equations derived from a nonlinear elastic model, we propose a real time simulation rule based on the implicit relation between the displacements of contacted and free nodes. This rule is an analytic expression in the linear case, and an approximation of the implicit relation in the non-linear case. We also remove some of the restrictions on flexibility exhibited by previous linear and nonlinear approaches. In the linear case, real time reconfiguration of the contacted nodes and the boundary constraints is realized using the simulation rule, while in the nonlinear case, a similar result is obtained by employing affine mapping. These methods allow nonlinear material properties to be applied to real time tissue simulation, with an efficiency comparable to that of the tensor matrix method for linear elastic models.

Biomechanical Phenomena↗

PubMed1998

The clinical advantages of editable real-time volume rendering in a medical virtual environment: VolMed.

Segmentation for a medical virtual environment is a process of image diagnosis. It should be performed by clinical doctors, otherwise the data may be meaningless for using clinical purposes. At the National Cancer Center, in Japan, we have recently developed interactive, editable real-time volume rendering software (VolMed), based on Volren-6 software, with the ability to interactively edit the 3D images of a patient's virtual cancer and virtual organs, in a virtual environment. Doctors can see proposed solutions to clinical problems as 3D images, using real-time volume rendering. We conclude that interactive editing is very important for clinical use, and also decreases the time required to create the virtual cancer images used for surgical simulation, pre-surgical planning and 3D invasion diagnoses.

Algorithms↗

PubMed2003

Simulators, first experiences.

It is increasingly being recognized that laparoscopic surgery poses specific strains on the surgical novice. Specific psychomotor skills are required, which cannot easily be acquired by extrapolation from open surgery. Also, limited teaching time in the strict surgical training curricula makes it difficult to acquire such skills. Two surgical simulation platforms, the Advanced Dundee Psychomotor Tester (ADEPT(R)), and the Xitact LS500(R), are objects of study in our hospital for the training and objective assessment of laparoscopic task performance. Multiple validation studies, both at our center and at other institutions, are ongoing. Face-construct and content validity of the two systems under investigation have been established at our skills laboratory. This article highlights the most important findings of our studies using simulative surgical lapraoscopic technologies.

Journal Article↗

PubMed1995

Usefulness of simulation of surgical approaches to cerebral aneurysms by helical scanning CT (HES-CT).

Using multiplanar reconstruction (MPR) CT imaging method, virtual views of various surgical approaches were compared preoperatively. With this technique, not only virtual surgical views of aneurysms and related vasculature, but also surgical views after virtual resection of skull base bone to a desirable extent are freely available. We operated four aneurysm cases after comparing various surgical approaches by this imaging method. It was found that these preoperative simulated images were very useful at surgery of complicated aneurysm cases.

Adult↗

PubMed2026

Artificial Intelligence for Colorectal Surgeons-Part II: Research Applications, Challenges in Adoption, and Practical Resources.

BACKGROUND: This is part II of a 2-part series examining artificial intelligence in colorectal surgery. Part I established foundational concepts and clinical applications. Implementation, however, requires understanding research methodologies, available resources, and the specific challenges currently limiting widespread adoption. These topics are the focus of part II. OBJECTIVE: To examine artificial intelligence's transformation of surgical research, provide practical implementation resources, address adoption challenges, and explore future directions in colorectal surgery. METHODS: Comprehensive literature review focusing on artificial intelligence research methodology, implementation barriers, educational resources, and emerging technologies relevant to colorectal surgeons. RESULTS: Artificial intelligence streamlines clinical trial design through predictive modeling and natural language processing, reducing enrollment challenges that contribute to failed or inadequate trial accrual. Machine learning enables heterogeneity analysis within clinical trials, identifying treatment-responsive subgroups. Foundation models unlock analysis of unstructured electronic health record data at scale. Professional societies and universities offer specialized artificial intelligence education programs, with open-access data sets facilitating research participation. However, implementation faces multifaceted challenges: technical infrastructure demands, with real-time processing requiring dedicated graphics processing unit clusters; regulatory frameworks struggling with continuously evolving algorithms; undefined liability distribution for artificial intelligence-assisted decisions; algorithmic bias risking health care disparities; and the "black box" problem limiting clinical trust. Economic barriers include substantial initial costs without clear reimbursement pathways. Future directions include multimodal artificial intelligence integrating imaging, genomics, and histopathology; cognitive robotic systems with real-time decision support; digital twin technology for patient-specific surgical simulation; and global surgical artificial intelligence networks enabling distributed learning across institutions. CONCLUSIONS: Although artificial intelligence offers transformative potential for colorectal surgery research and practice, successful implementation requires addressing technical, regulatory, ethical, and economic challenges. The surgeon's evolving role demands both traditional expertise and computational fluency. Future advances in multimodal integration, autonomous systems, and global collaboration will fundamentally reshape surgical practice but will require thoughtful implementation prioritizing patient benefit and clinical value.

Humans↗

PubMed2003

Surgery, surgical education and surgical diagnostic procedures in the digital era.

Computers have quickly proven to be an essential part of routine, everyday clinical work. New disciplines are being developed: telesurgery (surgery at a distance), computer- and robotic-aided surgery, image-guided surgery, medical teleconsultations, postoperative telefollow-up, etc. What are the future directions of computer-aided medicine? The digital revolution in medicine, which we are currently witnessing, is leading towards the development of new surgical treatment modalities, toward surgical simulation and improved surgical teaching. The old surgical teaching rule, 'See one, do one, teach one' promulgated by Halsted is fading into history. There are new diagnostic tools expanding the available diagnostic modalities and turning their results into a more comprehensible form. Neural networks are being successfully introduced into differential diagnostics. The capacity of human hands is being increased by telemanipulation and movement downscaling. The cost of useful applications of computers is in many cases not as high as might be expected. Analogue telephone lines are often good enough for telemedical purposes, which is particularly important for developing countries. We review the current status of computer-aided surgery. It is presumed that surgery in the future will rely on computers to a much larger extent than today. All surgery will be to some extent computer-aided, or even completely robotic, but it can never be performed without human professional guidance, supervision and control.

Computer-Assisted Instruction↗

PubMed2005

Telementoring versus on-site mentoring in virtual reality-based surgical training.

BACKGROUND: Telementoring can be an adjunct to surgical training using virtual reality surgical simulation. Telementoring is hypothesized to be as effective as a local mentor for surgical skills training. METHODS: In this study, 20 Romanian medical students trained using a virtual reality surgical simulator (LapSim) with a telementor or local mentor. All the students watched an instructional module at the beginning of the exercise. The telementor, in the United States, interacted by videoconferencing. Before and after training sessions, tool path length and time for task completion were measured. RESULTS: Instructional media and training with mentoring resulted in similar levels of performance between locally mentored and telementored groups. Right- and left-hand path length and time decreased significantly within each group from the initial to the final evaluation (p < 0.05) for most tasks (grasping, cutting, suturing). No significant difference was achieved for clip-applying. CONCLUSIONS: Integration of instructional media with telementoring can be as effective for the development of surgical skills as local mentoring.

Education, Medical↗

PubMed1997

[A new concept in digestive surgery: the computer assisted surgical procedure, from virtual reality to telemanipulation].

Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reason is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which has to include five requirements: visual fidelity, interactivity, physical properties, physiological properties, sensory input and output. In this report we will describe how to get a realistic 3D model of the liver from bi-dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction.

Computer Simulation↗

PubMed1994

Skin simulation for minor surgical procedures.

A simulated skin preparation is described which is made by bonding siliconized rubber to a latex foam base. This composite material, which simulates both the dermis/epidermis and subcutaneous fat, provides a realistic model which can be used to teach excision of skin lesions and a variety of suturing methods. We believe that this simulator is of value not only for surgeons in-training but also will allow general practitioners to improve their technical skills in performing minor surgical procedures.

Dermatologic Surgical Procedures↗

PubMed1998

[A new concept in surgery of the digestive tract: surgical procedure assisted by computer, from virtual reality to telemanipulation].

Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reasons is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which must include five requirements: a) visual fidelity, b) interactivity, c) physical properties, d) physiological properties, e) sensory input and output. In this report we describe how to obtain a realistic 3D model of the liver from bi-dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction.

Anatomy, Cross-Sectional↗

PubMed1979

Retained surgical sponge simulating a pancreatic mass.

An abdominal mass evaluated angiographically suggested either a carcinoma or a pseudocyst of the pancreas. Exploratory laparotomy revealed a cystic mass containing a surgical sponge left in the patient's abdomen during a surgical procedure 12 years previously. A review of the literature is included and complications caused by surgical foreign bodies and means of avoiding such complications are discussed.

Abdomen↗

PubMed1980

Corynebacterium parvum: immunomodulation in local bacterial infections.

Inoculation with Corynebacterium parvum 14 days before bacterial challenge produced protection against murine-simulated surgical wound infection with Escherichia coli to the same degree as had been provided by Bacillus Calmette-Guerin pretreatment. Simulated surgical wound infection induced by Staphylococcus aureus in mice followed a much more variable course; bacterial growth was depressed 7 days after C. parvum inoculation and was equivocal at a 14 day interval. Unlike E. coli infection modified by C. parvum or BCG, bacterial growth was significantly enhanced when the interval between C. parvum inoculation and S. aureus challenge was 20 or 28 days. Explanations for these differences and their possible clinical relevance are discussed.

Animals↗