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PubMedDate not supplied

Computer simulations of patellofemoral joint surgery. Patient-specific models for tuberosity transfer.

BACKGROUND: Variable clinical outcomes of tibial tuberosity transfer surgery have been reported. HYPOTHESES: The biomechanical outcome of surgery is patient-specific; no single procedure produces superior results for all patients. Use of patient-specific computer models can optimize choice of procedure. STUDY DESIGN: Computer simulation study using clinical data. METHODS: We used patient-specific multibody models of the patellofemoral joints of 20 patients with a diagnosis of patellar subluxation and osteoarthritis. Four tibial tuberosity transfer procedures (two anterior and two anteromedial) were simulated for each patient and compared with their preoperative model. RESULTS: When results for all patients were averaged, all simulated operations produced a statistically significant decrease in surface-wide mean contact stress, although no significant difference was found among them. CONCLUSIONS: The simulated surgical outcomes were patient-specific: no single procedure was consistently superior at decreasing peak or mean stress and each procedure produced a potentially detrimental outcome, an increase in either mean stress or peak stress, in at least one patient. CLINICAL RELEVANCE: Computer simulation may serve as a valuable tool for tailoring procedures to specific patients.

Biomechanical Phenomena↗

PubMed2001

Aortic aneurysm: construction of a life-size model by rapid prototyping.

Development of new endovascular techniques for repair of abdominal aortic aneurysm (AAA) requires the use of experimental models. Stereolithography is a rapid prototyping technique used in industry to prototype parts during the design phase. A stereolithography apparatus (STL) employs laser technology to build a digital model layer by layer with photopolymer resin. The purpose of this study was to use this technology to produce a life-size AAA model. Data were acquired by CT scan and stored in DICOM 3 format. Specifically designed software was used for 3-D imaging and conversion of data to a standard STL format. Two replicas were made: one to scale and the other 3 mm larger. The final model was made by pouring silicone rubber or polyurethane into the mold over the life-size model so as to obtain a sturdy, life-size, soft, transparent plastic casting. Arterial models made for living subjects with these rapid prototyping techniques can be used to simulate surgical procedures, calibrate imaging modalities, and design new stent grafts.

Aortic Aneurysm, Abdominal↗

PubMed2001

4D visible and palpable simulation using dynamic pressure model based on cardiac morphology.

A goal of this work is proposal and construction of ActiveHeart System: a simulation environment that enables anyone to see and touch heart beat in real time. In this paper, a method to express real-time graphic and haptic behaviour of a beating heart is mentioned. The data for the beating heart model was obtained from ECG-gated 3D MRI of a normal volunteer. The elastic information was assumed as a uniform value with clinically experienced elasticity. Using a real-time 3D graphics and a haptic device, a simulation environment of the beating heart was designed and implemented. After the construction, some cardiovascular surgeons evaluated the implemented system. Its visualization and beating expression were scored excellent, but some details in haptic expression were remained to be improved. Finally, for more realistic cardiovascular surgical simulation, future development of the method is discussed.

Cardiology↗

PubMed2026

Virtual, Augmented, and Mixed Reality Technologies in Neurosurgical Training: Enhancing Skills and Surgical Outcomes: A Systematic Review.

OBJECTIVE: To systematically review the role of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in neurosurgical education and training. DESIGN: Systematic review conducted in accordance with the PRISMA guidelines. SETTING: A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English-language studies published between 1 January 2020 and 30 April 2026. PARTICIPANTS: Studies involving neurosurgeons, fellows, residents, and medical students (maximum sample size: n = 48) were included. RESULTS: Of 7,204 initially identified studies, 25 met the inclusion criteria. VR was primarily used for surgical simulation (100% of VR studies) and anatomical education (62.5%). AR demonstrated broader applications, including preoperative planning (40%) and intraoperative support (30%). MR was evenly distributed across simulation, planning, and intraoperative support (40% each). The most frequently improved outcomes were training effectiveness (52%) and technical proficiency (44%). Methodological quality scores, assessed using the Modified Medical Education Research Study Quality Instrument (MMERSQI), ranged from 39.5 to 84.5, indicating varied rigor. CONCLUSION: VR, AR, and MR technologies show potential to enhance surgical precision, technical skills, and educational outcomes in neurosurgical training. However, standardization of methodologies and cost-effective solutions remain essential. Future research should focus on long-term clinical impact and integration of AI-driven training models.

Virtual Reality↗

PubMed1997

Virtual reality: teaching tool of the twenty-first century?

Virtual reality (VR) is gaining recognition for its enormous educational potential. While not yet in the mainstream of academic medical training, many prototype and first-generation VR applications are emerging, with target audiences ranging from first- and second-year medical students to residents in advanced clinical training. Visualization tools that take advantage of VR technologies are being designed to provide engaging and intuitive environments for learning visually and spatially complex topics such as human anatomy, biochemistry, and molecular biology. These applications present dynamic, three-dimensional views of structures and their spatial relationships, enabling users to move beyond "real-world" experiences by interacting with or altering virtual objects in ways that would otherwise be difficult or impossible. VR-based procedural and surgical simulations, often compared with flight simulators in aviation, hold significant promise for revolutionizing medical training. Already a wide range of simulations, representing diverse content areas and utilizing a variety of implementation strategies, are either under development or in their early implementation stages. These new systems promise to make broad-based training experiences available for students at all levels, without the risks and ethical concerns typically associated with using animal and human subjects. Medical students could acquire proficiency and gain confidence in the ability to perform a wide variety of techniques long before they need to use them clinically. Surgical residents could rehearse and refine operative procedures, using an unlimited pool of virtual patients manifesting a wide range of anatomic variations, traumatic wounds, and disease states. Those simulated encounters, in combination with existing opportunities to work with real patients, could increase the depth and breadth of learners' exposure to medical problems, ensure uniformity of training experiences, and enhance the acquisition of clinical skills.

Anatomy↗

PubMed1984

The rediscovery of host defense enhancement.

The innate limitations of sterile technique, vaccines, and antibiotics apparent in host defense enhancement provide fertile ground for the study of other concepts. The goals of this new research are to avoid infection or facilitate recovery in the surgical setting and to develop new, safe, and efficient host defense stimulants. Current laboratory work with surgically simulated infection suggests that nonspecific host defense enhancement may offer genuine improvement in selected clinical situations.

Acetylmuramyl-Alanyl-Isoglutamine↗

PubMed1990

Effect on force transmission across the carpus in procedures used to treat Kienböck's disease.

A simplified two-dimensional articulating force analysis (rigid body spring model) examined how different surgical procedures used for treating Kienböck's disease modify the force distribution across the carpus. A two-dimensional model of a carpus was loaded through the metacarpals by forces of up to 143 Newtons. The resulting intercarpal displacement and joint loadings were calculated for the intact wrist and for different simulated surgical procedures. The predicted total amount of force transmitted through the radio-lunate joint of the intact wrist averaged a 32% of the total radio-ulno-carpal joint load. Limited intercarpal fusions were found to reduce compressive loading at the radio-lunate joint by no more than 15% of the original load. Capitate shortening was successful in relieving radio-lunate forces, however, it dramatically overloaded the adjacent scapho-trapezial and triquetral-hamate joints. By contrast, a 4 mm lengthening of the ulna (or shortening of the radius) resulted in a 45% reduction of radio-lunate load with only moderate changes in force at the midcarpal and radio-scaphoid joints. On the basis of this study, radial shortening or ulnar lengthening significantly unload the lunate and are rationale procedures in the treatment of Kienböck's disease. Limitations regarding direct clinical application of this mathematical model are also discussed.

Analysis of Variance↗

PubMed2005

Image-guided neurosurgery system integrating AR-based navigation and open-MRI monitoring.

As endoscopic surgery has become a popular form of minimally invasive surgery, it increasingly requires useful imaging tools to help the surgeons perform safe and secure operations. Our navigation system provides surgeons with visual information by overlaying 3D wire frame models of tumor onto live images, as well as by displaying relative the positions of surgical tools and the target tumor. Such 3D wire frame models are generated from pre-operative CT/MR images with the help of a 3D surgical simulation software. Another important function of our system is real-time volume rendering of intra-operative MR images for the target tumor. This function allows surgeons to carefully observe the vicinity of the tumor regions to be removed, by rendering the sectional views with respect to the surgical tool position, so that surgical performance can be easily monitored during the operation. We tested this navigation system in more than 10 clinical operations and verified the effectiveness of the navigation and surgical performance.

Brain Diseases↗

PubMed1994

[A study of computer aided simulation system for orthognathic surgery].

How easily to stimulate the orthognathic surgery with high accuracy and good reliability and visually explain the prediction of surgery to the patient with maxillomandibular deformities remains a key focus in oral and maxillofacial surgery. A Computer Aided Simulation System for Orthognathic Surgery (CASSOS) was developed by means of the technique of digital image processing, with which a detailed analysis could automatically be performed, including 71 measurements of distance, degree and ratio for frontal cephalograms and 68 measurements for lateral one with a computer aided diagnosis. A quantitatively surgical simulation for prediction of operation could satisfactorily be done for the clinical use. All data and images were printed by laserjet and color video printer. All procedures were finished in 20 minutes.

Computer Simulation↗

PubMed2004

Robotics in neurosurgery.

Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image-guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed.

Diagnostic Imaging↗

PubMed1997

Surgical smoke evacuation systems.

Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff protection.

Carcinogens↗

PubMed2002

NeuRobot: telecontrolled micromanipulator system for minimally invasive microneurosurgery-preliminary results.

OBJECTIVE: Microneurosurgery can be performed less invasively with the recent advances in neuronavigation and neuroendoscopy. For even less invasive microneurosurgery, we have developed a telecontrolled micromanipulator system. METHODS: The NeuRobot telecontrolled micromanipulator system was developed. With the use of this system, surgical simulations were performed with a human cadaveric head. RESULTS: The system consists of four main parts, i.e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a three-dimensional display monitor. Three 1-mm forceps and a three-dimensional endoscope, which could be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. All surgical procedures were accurately performed with this system. CONCLUSION: The use of telecontrolled manipulator systems in neurosurgery is very promising, and we are convinced that this system will facilitate more accurate, less invasive microneurosurgery. The details of the NeuRobot system and preliminary results are presented.

Cadaver↗

PubMed1976

Airborne bacterial contamination of operative wounds.

Both the numbers and species of airborne bacteria were studied during 263 surgical procedures. The numbers of bacteria isolated were reduced by 95 percent in a horizontal laminar flow room compared with a conventional room and a further 4 percent reduction occurred when a suction-mask system was used. The species of bacteria isolated differed notably at the operative site where a slit sampler was used, as compared with the instrument table and the periphery of the room where settling plates were used. Studies done during simulated surgical operation suggested that light fixtures, pass-through doors, floor contamination and the draped patient were not important sources of airborne contamination in this horizontal laminar flow system. The exact role of airborne bacterial contamination of operative wounds in the development of clinical wound infections is still unknown. Therefore, installation of laminar flow systems must be considered unnecessary at this time.

Air Microbiology↗

PubMed1987

Free radical scavengers improve functional recovery of stunned myocardium in a model of surgical coronary revascularization.

This study examined whether treatment with the oxygen free radical scavengers, superoxide dismutase and catalase, could improve functional recovery in hearts subjected to regional ischemia and global cardioplegic arrest. Regional left ventricular (LV) function was assessed in open chest pigs with sonomicrometry and micromanometry to calculate an index of regional work from the LV pressure-segment length relationship. After measuring baseline preischemic function, the left anterior descending artery was occluded, creating a region-at-risk in 20% of the LV mass. Cardiopulmonary bypass was begun 15 minutes after initiation of regional ischemia and was followed immediately by cardioplegic arrest for 45 minutes, after which time the coronary artery occluder was removed to simulate coronary revascularization. Starting just before removal of the aortic cross-clamp and continuing for the first 30 minutes of reflow, animals received an aortic root infusion of either superoxide dismutase (3600 U/kg) and catalase (20,000 U/kg) or a control saline solution infusion. In each group, seven animals were successfully weaned from cardiopulmonary bypass without inotropic support. After 2 hour of reperfusion, the recovery of baseline function in the region-at-risk was 44% +/- 7% in the treated animals and 4% +/- 13% in the untreated animals (p less than 0.05). In this experimental model, oxygen free radical scavengers were effective in preserving functional recovery in regionally ischemic myocardium reperfused under conditions simulating surgical revascularization in the setting of acute myocardial ischemia.

Animals↗

PubMed2002

Changes in postural mechanics associated with different types of minimally invasive surgical training exercises.

BACKGROUND: Doctors who perform minimally invasive surgery commonly report upper extremity fatigue or joint and muscle pain. The goal of this study was to investigate the changes in postural parameters associated with different laparoscopic training tasks and graspers. METHODS: Three different training tasks (targeted object release, rope passing, and cable tying) were performed with three types of laparoscopic graspers. Joint angles were determined using video analysis, and centers of pressure (COP) were measured with force platforms. RESULTS: Cable tying proved to be the most challenging training task and involved greater joint angle excursions and COP excursions and velocities. Grasper 2 reduced shoulder and wrist flexion-extension over the selected tasks. CONCLUSION: Training tasks should be designed to simulate surgical procedures because different tasks require distinct combinations of joint rotations. Joint rotations and postural balance should be considered when an optimal grasper is selected for a particular training task.

Analysis of Variance↗

PubMed2006

Stem damage during implantation of modular hip prostheses.

Modular hip prostheses are commonly used today. Dedicated surgical auxiliary instrumentation is indispensable. A correct coupling between the prosthesis and the instrument is necessary to avoid damage. Based on a specific commercial design (AnCAFit, Wright Cremascoli Ortho, Toulon, France), the aim of this work was to assess if stem holders of modular prostheses can induce any stem damage, and if so, to identify the features that provide minimal damage. Two different stem holder connector designs were investigated. The surface of the stem cavity was inspected to identify the damage caused by the use of the two connectors after a simulated surgical handling. Both connectors induced some damage, with significantly more damage being caused by a supposedly improved design. Scars due to contact with the stem holder were observed on the stem cavity surface. This may be sufficient to trigger increased fretting damage during service life, causing the production of fretting debris.

Hip Prosthesis↗

PubMed2003

Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study.

STUDY DESIGN: A surgical simulation study in human cadaver spine specimens was conducted to evaluate the accuracy of thoracic vertebral body screw placement using four different intraoperative imaging techniques. OBJECTIVE: To compare standard fluoroscopy, fluoroscopy-based image guidance with two different referencing methods, and computed tomography-based image guidance by the measuring the time required for screw placement, the radiation exposure to specimen and surgeon, and the accuracy of screw position in the thoracic spine. SUMMARY OF BACKGROUND DATA: Image guidance provides additional anatomic information to the surgeon and may improve safety of technically difficult surgical procedures. The placement of screws in the thoracic spine is a technically demanding procedure in which inaccurate screw positioning places the spinal cord, nerve roots, and paraspinal structures such as the aorta and pleural space at risk for injury. Image-guided surgery may improve the accuracy of thoracic screw placement. METHODS: Using four different intraoperative imaging methods, two experienced surgeons placed 337 vertebral body screws through the pedicles of thoracic vertebrae in 20 human cadaver thoracic spine specimens. The specimens then were examined with radiographs, computed tomography, and anatomic dissection to determine screw position. Measurements included procedure setup and screw insertion time, radiation exposure to the specimen, the surgeon's hand, the surgeon's body, frequency, direction, and magnitude of screw perforation through the cortical margins of thoracic vertebrae. RESULTS: As compared with surgery using standard fluoroscopy, fluoroscopy-based image guidance that uses multiple reference marks and computed tomography-based image guidance improves the accuracy of thoracic vertebral body screws, but increases the time required for screw placement and the specimen radiation exposure. Exposure to radiation is minimal at the surgeon's body level and dependent on surgical technique at the surgeon's hand level. Screw perforation occurs most frequently in the lateral direction. CONCLUSIONS: Fluoroscopy-based image guidance that uses only a single reference marker for the entire thoracic spine is highly inaccurate and unsafe. Systems with registration based on the instrumented vertebrae provide more accurate placement of thoracic vertebral body screws than standard fluoroscopy, but expose the patient to more radiation and require more time for screw insertion.

Adult↗

PubMed2004

A parallel framework for the FE-based simulation of knee joint motion.

We present an object-oriented framework for the finite-element (FE)-based simulation of the human knee joint motion. The FE model of the knee joint is acquired from the patients in vivo by using magnetic resonance imaging. The MRI images are converted into a three-dimensional model and finally an all-hexahedral mesh for the FE analysis is generated. The simulation environment uses nonlinear finite-element analysis (FEA) and is capable of handling contact of the model to handle the complex rolling/sliding motion of the knee joint. The software strictly follows object-oriented concepts of software engineering in order to guarantee maximum extensibility and maintainability. The final goal of this work-in-progress is the creation of a computer-based biomechanical model of the knee joint which can be used in a variety of applications, ranging from prosthesis design and treatment planning (e.g., optimal reconstruction of ruptured ligaments) over surgical simulation to impact computations in crashworthiness simulations.

Computer Simulation↗