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Results for “Surgical simulation”

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At least 325 records · Page 18Linked to original sources

PubMed2000

Three-dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery.

A new integrated computer system, the 3-dimensional (3D) virtual reality surgical planning and simulation workbench for orthognathic surgery (VRSP), is presented. Five major functions are implemented in this system: post-processing and reconstruction of computed tomographic (CT) data, transformation of 3D unique coordinate system geometry, generation of 3D color facial soft tissue models, virtual surgical planning and simulation, and presurgical prediction of soft tissue changes. The basic mensuration functions, such as linear and spatial measurements, are also included. The surgical planning and simulation are based on 3D CT reconstructions, whereas soft tissue prediction is based on an individualized, texture-mapped, color facial soft tissue model. The surgeon "enters" the virtual operatory with virtual reality equipment, "holds" a virtual scalpel, and "operates" on a virtual patient to accomplish actual surgical planning, simulation of the surgical procedure, and prediction of soft tissue changes before surgery. As a final result, a quantitative osteotomy-simulated bone model and predicted color facial model with photorealistic quality can be visualized from any arbitrary viewing point in a personal computer system. This system can be installed in any hospital for daily use.

Cephalometry↗

PubMed2004

Disruptive visions: surgical education.

Technological change, decreased financial support for medical education, and social oversight (in the form of the "To Err Is Human" report, HIPPA, and reduced work hours) are forcing a rethinking of the traditional model of surgical education to improve patient safety. New approaches to evaluating surgical competence, such as objective assessment, in combination with new technologies, such as the Internet and surgical simulators, provide the tools to effect a revolution in surgical education and training. Competency based upon quantifiable criteria measures must replace the traditional subjective assessment. The implementation requires accurately defining the elements of training, establishing new quantifiable metrics, stringently measuring performance against criterion, and reporting outcomes throughout the career of a surgeon.

Clinical Competence↗

PubMed2004

A rabbit model for evaluation of surgical anesthesia and analgesia: characterization and validation with isoflurane anesthesia and fentanyl analgesia.

PURPOSE: With a clamp test, quantitative estimation of the level of surgical anesthesia/analgesia is not easy. We have developed a rabbit pain model allowing for quantitative evaluation of the level of surgical anesthesia/analgesia using both electrical and mechanical stimuli as simulated surgical stimuli. We evaluated whether this model allows for accurate tracing of dynamically changing levels of surgical anesthesia/analgesia induced by isoflurane and fentanyl. METHODS: Eight rabbits tracheotomized and vascularly cannulated under 3% isoflurane anesthesia were placed on a sling that allowed for free movement of the head and extremities. After the isoflurane concentration was reduced stepwise to 1.5% and then to 0%, four graded doses of fentanyl (5, 10, 20, and 40 microg.kg(-1)) were injected intravenously at intervals of 120 min. At each dose, anesthetic/analgesic end-point variables were determined, including the number of animals behaviorally unresponsive to clamping the forepaw (nonresponders) and the threshold voltage of subcutaneous electrical stimulation (2, 5, and 50 Hz) required to evoke the head lift (HLT: pain detection/arousal threshold: sedative/hypnotic index) and the escape movement (EMT: pain tolerance threshold: analgesic index). RESULTS: With increasing doses of isoflurane and fentayl, HLTs and EMTs, especially those at 5 Hz, increased dose-dependently and proportionately to increases in the number of nonresponders to clamping the forepaw, a standard indicator of the anesthetic/analgesic level. CONCLUSION: Using the HLT and EMT, especially at 5 Hz, combined with a clamp test, this rabbit model allows for repeated, quantitative, and distinctive evaluation of the dynamically changing levels of both sedative/hypnotic and analgesic components of surgical anesthesia/analgesia.

Analgesia↗

PubMed1999

[Prophylactic analgesia in functional endoscopic sinus surgery. Hemodynamics, surgical conditions, stress response].

OBJECTIVE: Sufficient control of intraoperative bleeding in functional endoscopic sinus surgery is essential for obtaining adequate surgical results. The necessity of hypotensive anesthetic techniques is a controversial topic among anesthesiologists and ENT-surgeons. This prospective, randomized study compared N2O-supplemented intravenous anesthesia with propofol and fentanyl or sufentanil with respect to hemodynamic reactions, endocrine stress response, blood loss and surgical conditions, and recovery. METHODS: After obtaining informed consent, 32 patients undergoing endoscopic sinus procedures were anesthetized with N2O, propofol, and fentanyl or sufentanil (dosage ratio fentanyl:sufentanil = 7:1). Arterial blood pressure was measured via an arterial line, blood samples for ACTH, AVP, and cortisol were obtained pre-, intra-, and post-operatively, and a psychomotor function test was conducted pre- and postoperatively. The ENT-surgeon estimated the dryness of the surgical field on a numeric scale ranging from 1 to 5, and intraoperative blood loss was measured. RESULTS: Hemodynamic reactions to surgical simulation were blunted more sufficiently in the sufentanil group. Surgical conditions were satisfactory in all patients, but significantly better in the sufentanil group; differences in blood loss did not prove statistically significant. The endocrine stress response was efficiently blunted without significant differences between the groups. Post-operative psychomotor testing showed better recovery in the sufentanil group. CONCLUSIONS: N2O-supplemented intravenous anesthesia is suitable for functional endoscopic sinus procedure without any further need for induced hypotension; sufentanil seems to be superior in regard to hemodynamic stability, surgical conditions, and psychomotor recovery.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Chronic sinusitis: a surgical perspective.

Rhinosinusitis is one of the most common chronic diseases with significant symptoms and impact on the quality of life. Surgery is indicated when appropriate medical treatment fails. A review of the clinical presentations of rhinosinusitis is presented, as well as an overview of current medical and surgical treatment options. Although external approaches are still mandated in some selected instances, endoscopic sinus surgery has become the standard for surgical treatment of sinonasal pathologies, by aiming at restoring the physiological functions of the nasal and paranasal cavities. This technique presents numerous advantages with a minimally invasive approach, better visualization of structures, camera magnification of the surgical field, and allows thorough exploration of difficult-to-reach areas. The risks and complications of endoscopic sinus surgery are well identified and may be reduced significantly by the adjunct use of computer-assisted image guidance and intraoperative fluoroscopy. Surgical simulation also is a promising tool to help reduce surgical errors and improve surgeon training in the future.

Chronic Disease↗

PubMed2004

StapSim: a virtual reality-based stapling simulator for laparoscopic hemiorrhaphy.

The growing interest in laparoscopic hernia surgery and in surgical simulators has motivated our current research. In this paper, we present our work in simulating the process of stapling used in laparoscopic herniorrhaphy. By connecting two separate deformable preperitoneal meshes together, our model has simulated the repair process for a bilateral hernia correction. The task of mesh placement and stapling of corners was simulated, to allow surgeons to practice their hand-eye coordination. Various deformable models and numerical methods were researched to comply with the real time requirements. The stapling simulator can either be independently used as a part-task (sub-task) trainer or be integrated as a module of a complete VR-based simulator. A phantom device was used to provide haptic-based force feedback during task rehearsals.

Computer Simulation↗

PubMed2006

A hip surgery simulator based on patient specific models generated by automatic segmentation.

The use of surgical simulator systems for education and preoperative planning is likely to increase in the future. A natural course of development of these systems is to incorporate patient specific anatomical models. This step requires some kind of segmentation process in which the different anatomical parts are extracted. Anatomical datasets are, however, usually very large and manual processing would be too demanding. Hence, automatic, or semi-automatic, methods to handle this step are required. The framework presented in this paper uses nonrigid registration, based on the morphon method, to automatically segment the hip anatomy and generate models for a hip surgery simulator system.

Computer Simulation↗

PubMed2002

How virtual reality may enhance training in obstetrics and gynecology.

OBJECTIVE: Contemporary training in obstetrics and gynecology is aimed at the acquisition of a complex set of skills oriented to both the technical and personal aspects of patient care. The ability to create clinical simulations through virtual reality (VR) may facilitate the accomplishment of these goals. The purpose of this paper is 2-fold: (1) to review the circumstances and equipment in industry, science, and education in which VR has been successfully applied, and (2) to explore the possible role of VR for training in obstetrics and gynecology and to suggest innovative and unique approaches to enhancing this training. MATERIAL AND METHODS: Qualitative assessment of the literature describing successful applications of VR in industry, law enforcement, military, and medicine from 1995 to 2000. Articles were identified through a computer-based search using Medline, Current Contents, and cross referencing bibliographies of articles identified through the search. RESULTS: One hundred and fifty-four articles were reviewed. This review of contemporary literature suggests that VR has been successfully used to simulate person-to-person interactions for training in psychiatry and the social sciences in a variety of circumstances by using real-time simulations of personal interactions, and to launch 3-dimensional trainers for surgical simulation. These successful applications and simulations suggest that this technology may be helpful and should be evaluated as an educational modality in obstetrics and gynecology in two areas: (1) counseling in circumstances ranging from routine preoperative informed consent to intervention in more acute circumstances such as domestic violence or rape, and (2) training in basic and advanced surgical skills for both medical students and residents. CONCLUSION: Virtual reality is an untested, but potentially useful, modality for training in obstetrics and gynecology. On the basis of successful applications in other nonmedical and medical areas, VR may have a role in teaching essential elements of counseling and surgical skill acquisition.

Clinical Competence↗

PubMed2005

An integrated environment for plastic surgery support: building virtual patients, simulating interventions, and supporting intraoperative decisions.

In the last decade a number of environments for Computer Supported Plastic Surgery have been presented. Nevertheless, an overall approach for training and intraoperative support is still missing or has not been widely exploited yet. We developed a fully integrated system which allows surgical simulation, planning, and support for computer-guided plastic surgery procedures starting from image acquisition to final intraoperative assistance. The system also provides the user with a radiological workstation able to analyse patient medical images and case studies, with advanced bidimensional and three dimensional image processing functionalities. We intend to demonstrate that such a platform can be built at an affordable cost. The radiological workstation is capable of supporting radiologists and surgeons in real patient case studies and the simulation workstation may be adopted by plastic surgeons in teaching and training of complex surgical planning. Moreover, results of simulation can be used in the operating room with a relatively high benefit in terms of improved accuracy, reduction of surgical risks, and decrease in training costs.

Decision Support Techniques↗

PubMed2003

Dynamic deformation of elastic organ model and the VR cockpit for virtual surgery and tele-surgery.

This paper describes a deformable organ model suited for a real-time surgical simulation system. This proposed organ model allows us to perform surgical maneuvers such as pressing, pinching, various incisions, resection and to show the deformation of the inner structures such as blood vessels on our system. At the same time, we have been developing a VR cockpit suited for virtual surgery and tele-surgery. Using our cockpit, our system allows us to provide the users with an environment closely resembling the open surgery situation.

Computer Simulation↗

PubMed2005

Parametric model of the scala tympani for haptic-rendered cochlear implantation.

A parametric model of the human scala tympani has been designed for use in a haptic-rendered computer simulation of cochlear implant surgery. It will be the first surgical simulator of this kind. A geometric model of the Scala Tympani has been derived from measured data for this purpose. The model is compared with two existing descriptions of the cochlear spiral. A first approximation of the basilar membrane is also produced. The structures are imported into a force-rendering software application for system development.

Australia↗

PubMed2006

Exploiting graphics hardware for haptic authoring.

Real-time, plausible visual and haptic feedback of deformable objects without shape artifacts is important in surgical simulation environments to avoid distracting the user. We propose to leverage highly parallel stream processing, available on the newest generation graphics cards, to increase the level of both visual and haptic fidelity. We implemented this as part of the University of Florida's haptic surgical authoring kit.

Computer Graphics↗

PubMed2001

The Virtual Brain Project--development of a neurosurgical simulator.

As a joined project between Aalborg University and Aalborg Hospital Denmark, a neuro-surgical simulator is being developed. In this paper the objective of the project is outlined and an overview of the research activities within the project is given. Focus is on 3D modelling of the brain, deformable models and the development of two demonstrators, including one for training of punctuation of ventricle using visual and haptic feedback.

Anatomy, Cross-Sectional↗

PubMed2006

Evolution of surgical skills training.

Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

Clinical Competence↗

PubMed2004

Virtual reality neurosurgery: a simulator blueprint.

OBJECTIVE: This article details preliminary studies undertaken to integrate the most relevant advancements across multiple disciplines in an effort to construct a highly realistic neurosurgical simulator based on a distributed computer architecture. Techniques based on modified computational modeling paradigms incorporating finite element analysis are presented, as are current and projected efforts directed toward the implementation of a novel bidirectional haptic device. METHODS: Patient-specific data derived from noninvasive magnetic resonance imaging sequences are used to construct a computational model of the surgical region of interest. Magnetic resonance images of the brain may be coregistered with those obtained from magnetic resonance angiography, magnetic resonance venography, and diffusion tensor imaging to formulate models of varying anatomic complexity. RESULTS: The majority of the computational burden is encountered in the presimulation reduction of the computational model and allows realization of the required threshold rates for the accurate and realistic representation of real-time visual animations. CONCLUSION: Intracranial neurosurgical procedures offer an ideal testing site for the development of a totally immersive virtual reality surgical simulator when compared with the simulations required in other surgical subspecialties. The material properties of the brain as well as the typically small volumes of tissue exposed in the surgical field, coupled with techniques and strategies to minimize computational demands, provide unique opportunities for the development of such a simulator. Incorporation of real-time haptic and visual feedback is approached here and likely will be accomplished soon.

Computer Simulation↗

PubMed2004

The effect of limiting residents' work hours on their surgical training: a Canadian perspective.

Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.

Attitude of Health Personnel↗

PubMed2004

Image-guided robotic surgery.

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.

Humans↗

PubMed1996

Virtual reality enhanced surgical conference system.

We present our ongoing work on an enhanced surgical conference system with a technology of virtual reality (VR). We reported on a surgical simulation support system by using a technology of virtual reality last year. In the present time, while using our VR simulation system, we realized that many surgeons and nurses needed to see both a solid real image and a virtual image of the surgical operation at the same time. According to this reason we added a solid video system to our previous VR simulation system. The new system can display both real and virtual images on 100 inch wide screen and a console monitor of Onyx computer. The doctors can see both images with shutter glasses on the screen or console. We can now simulate various cancer surgery while watching the real solid surgical picture. We expect our enhanced surgical conference system to be beneficial for surgeons and nurses with limited experience to familiarize surgical procedures. The system could be also employed in planning a surgical procedure and educating medical staffs. Here we discuss about the aim of the system, current implementation, its limitations and its future directions.

Computer Simulation↗