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Using an approximation to the euclidean skeleton for efficient collision detection and tissue deformations in surgical simulators.

This paper describes a technique for efficient collision detection and deformation of abdominal organs in surgical simulation using an approximation of the Euclidean skeleton. Many researchers have developed surgical simulators, but one of the most difficult underlying problems is that of organ-instrument collision detection followed by the deformation of the tissue caused by the instrument. Much of the difficulty is due to the vast number of polygons in high resolution complex organ models. A high resolution gall bladder model for instance can number in the tens of thousands of polygons. Our methodology utilizes the reduction power of the skeleton to reduce computations. First, we recursively compute approximations to the Euclidean skeleton to generate a set of skeletal points for the organ. Then we pre-compute for each vertex in each polygon the associated skeleton point (minimal distance discs). A spring is then connected from each vertex to its associated skeleton point to be used in the deformation algorithm. The data structure for the organ thus stores for each skeletal point its maximum and minimum distances and the list of associated vertices. A heuristic algorithm using the skeleton structure of the instrument and the skeleton of the organ is used to determine instrument collisions with the organ.

Computer Simulation↗

GiPSi: an open source/open architecture software development framework for surgical simulation.

In this paper we propose an open source/open architecture framework for developing organ level surgical simulations. Our goal is to facilitate shared development of reusable models, to accommodate heterogeneous models of computation, and to provide a framework for interfacing multiple heterogeneous models. The framework provides an intuitive API for interfacing models with spatial relationships. It is specifically designed to be independent of the specifics of the modeling methods used and therefore facilitates seamless integration of heterogeneous models and processes. Furthermore, each model has separate geometries for visualization, simulation, and interfacing, allowing the modeler choose the most natural geometric representation for each case.

Computer Simulation↗

Sensible human projects: haptic modeling and surgical simulation based on measurements of practical patients with MR elastography--measurement of elastic modulus.

To provide realistic surgical simulation, 3D visualization and haptic feedback are important. In the existing surgical simulators, the fidelity of the deformation and haptic feedback is limited because they are based on the subjective evaluation of the expert-user and not on an objective model-based evaluation. To obtain accurate elastic modulus of whole human tissues, we have started a new project called the Sensible Human Project (SHP). This paper deals with establishing the measurement of elastic modulus by the magnetic resonance elastography (MRE) technique, as a first step of the SHP Project.

Computer Simulation↗

Feature preserving refinement of surfaces for web-based surgical simulation.

In plastic surgery, 3D models of the affected part are often used for the purpose of visualizations and surgical simulations. The optimal models for web-based surgical simulations keep high accuracy in affected parts and keep low accuracy in other parts. Consequently, the data size becomes small. In this research, we propose a method to generate free-form surfaces based on Lattice Structure from polygonal meshes. The polygonal meshes are generated automatically from CT and MRI data using Marching Cubes. By changing the resolution of input images, the accuracy of output meshes is controlled. Free-form surfaces based on Lattice Structure are fitted to polygonal meshes. Lattice Structure is a method to manage a free-form surface with a simple base polygonal mesh. The data size is quite small because surface shape is converted and saved as a simple polygon. A free-form surface is quickly generated and high accuracy is maintained. Moreover, users can input character lines and they are reflected as boundaries of patches. The models generated with this method are partly accurate and compact. These data make it possible to simulate surgery on the WWW, because they can be quickly transferred

Computer Graphics↗

Computer-assisted geometric design of cerebral aneurysms for surgical simulation.

This report presents conceptual aspects and the clinical implications of a computer-assisted geometric design of a cerebral aneurysm and surrounding structures. The technique is based on the approximation power of the parametric spline function, which achieves interpolation and surface fitting of the arterial information obtained by conventional angiography. Computer graphic transformations including shifting, scaling, rotation, and putting different colors in different intensities make it possible to obtain the surgical simulation of a cerebral aneurysm. To our knowledge, this is the first report in which the computer graphic simulation of the surgical view of a cerebral aneurysm is made with a personal computer. Using our method, it may be possible to obtain the surgical simulation of a more complicated view by introducing a navigation system of a new style for conventional open neurosurgery. Concepts and the technical details of the method are described.

Basilar Artery↗

Correlation between perceptual, visuo-spatial, and psychomotor aptitude to duration of training required to reach performance goals on the MIST-VR surgical simulator.

Given the dynamic nature of modern surgical education, determining factors that may improve the efficiency of laparoscopic training is warranted. The objective of this study was to analyze whether perceptual, visuo-spatial, or psychomotor aptitude are related to the amount of training required to reach specific performance-based goals on a virtual reality surgical simulator. Sixteen MS4 medical students participated in an elective skills course intended to train laparoscopic skills. All were tested for perceptual, visuo-spatial, and psychomotor aptitude using previously validated psychological tests. Training involved as many instructor-guided 1-hour sessions as needed to reach performance goals on a custom designed MIST-VR manipulation-diathermy task (Mentice AB, Gothenberg, Sweden). Thirteen subjects reached performance goals by the end of the course. Two were excluded from analysis due to previous experience with the MIST-VR (total n = 11). Perceptual ability (r = -0.76, P = 0.007) and psychomotor skills (r = 0.62, P = 0.04) significantly correlated with the number of trials required. Visuo-spatial ability did not significantly correlate with training duration. The number of trials required to train subjects to performance goals on the MIST-VR manipulation diathermy task is significantly related to perceptual and psychomotor aptitude.

Adult↗

A GPU accelerated spring mass system for surgical simulation.

There is a growing demand for surgical simulators to do fast and precise calculations of tissue deformation to simulate increasingly complex morphology in real-time. Unfortunately, even fast spring-mass based systems have slow convergence rates for large models. This paper presents a method to accelerate computation of a spring-mass system in order to simulate a complex organ such as the heart. This acceleration is achieved by taking advantage of modern graphics processing units (GPU).

Computer Simulation↗

Craniofacial surgical simulation: application of three-dimensional medical imaging and rapid prototyping models.

BACKGROUND: Adequate assessment of the deformity, formulation of good treatment planning, and sufficient rehearsal of procedures before actually performing surgery ensure successful craniofacial surgery. Three-dimensional computed tomography (CT) imaging and facsimile models were used in combination to evaluate their function in craniofacial surgery. METHODS: Three-dimensional imaging and facsimile models were used for reconstruction of craniofacial deformity. CT data were acquired, processed, and reconstructed to display 3-dimensional images. The images were used for evaluation of the deformity. The images were then manipulated to create multiple osseous objects. Surgical simulation was performed by moving the computer images. The image processing and manipulation were achieved using the AnalyzePC program. The raw CT data were transformed into a readable format and transferred to produce facsimile models using rapid prototyping technology. The skull models were used for evaluation and surgical simulation. Both methods were compared and used to assist in surgery, which was performed according to the simulations. RESULTS: Three-dimensional CT imaging and facsimile models were helpful for simulation of craniofacial surgery. The actual surgery results were satisfactory without complications. Particular advantages were the unlimited trials with the imaging method, and the feeling of reality with the model method. CONCLUSIONS: Craniofacial surgery is facilitated by preoperative simulation of procedures. Both 3-dimensional CT imaging and facsimile models are helpful for craniofacial surgical simulation.

Craniofacial Abnormalities↗

Anatomical and physiological models for surgical simulation.

A considerable amount of effort has been aimed towards developing real-time deformable objects for surgical simulation, but very little work has been aimed towards including physiology within the soft tissue models. A simulator that links the structural and functional aspects of the human body would allow the user to develop a better understanding of the intrinsic link between anatomy and physiology. This positional paper discusses the challenges facing the creation of and the development of an integrated physiological and anatomical soft tissue model for use in surgical simulators. It explores the artificial dichotomy between anatomy and physiology and the issues it raises, by considering a suturing simulator capable of modelling ischaemia.

Animals↗

A web-based repository of surgical simulator projects.

The use of computer-based surgical simulators for training of prospective surgeons has been a topic of research for more than a decade. As a result, a large number of academic projects have been carried out, and a growing number of commercial products are available on the market. Keeping track of all these endeavors for established groups as well as for newly started projects can be quite arduous. Gathering information on existing methods, already traveled research paths, and problems encountered is a time consuming task. To alleviate this situation, we have established a modifiable online repository of existing projects. It contains detailed information about a large number of simulator projects gathered from web pages, papers and personal communication. The database is modifiable (with password protected sections) and also allows for a simple statistical analysis of the collected data. For further information, the surgical repository web page can be found at www.virtualsurgery.vision.ee.ethz.ch.

Computer Simulation↗

Morphologic evaluation and surgical simulation of ossification of the posterior longitudinal ligament using helical computed tomography with three-dimensional and multiplanar reconstruction.

STUDY DESIGN: Using helical computed tomography with three-dimensional and multiplanar reconstruction, ossification of the posterior longitudinal ligament in the cervical and thoracic region was observed. Preoperative simulation also was performed, and the availability of these methods was evaluated. OBJECTIVE: To use preoperative evaluation and simulation with helical computed tomography to enhance the accuracy of excision of ossification of the posterior longitudinal ligament lesion. SUMMARY OF BACKGROUND DATA: Ossification of the posterior longitudinal ligament lesion is sometimes so complicated that preoperative morphologic evaluation and excision of the lesion are difficult when using only conventional imaging techniques. METHODS: Seven cases of cervical and two cases of thoracic ossification of the posterior longitudinal ligament were scanned using helical computed tomography at 2-mm or 5-mm slice thickness. Three-dimensional and multiplanar reconstruction were performed at 0.7-mm or 2-mm intervals in the bone window. Surgical simulation of the anterior approach for cervical lesion and posterior approaches for thoracic lesion was performed. RESULTS: Preoperative direct observation of the ossification of the posterior longitudinal ligament lesion was possible, and the complicated structures could be understood more easily than with other conventional methods. When surgical simulation was performed in the workstation, the ossification of the posterior longitudinal ligament lesion was removed sufficiently on arbitrarily reconstructed view in the spinal canal. When the viewpoint then was changed to the approaching side, the location and dimension of the removed area were determined. In all cases, surgical approach and excision of the ossification of the posterior longitudinal ligament lesion were performed more easily and more precisely than in the surgery with no three-dimensional images. CONCLUSION: Helical computed tomography with three-dimensional, multiplanar reconstruction would be a valuable tool for evaluation and surgical simulation of ossification of the posterior longitudinal ligament lesion by enhancing the accuracy of the surgical procedure.

Adult↗

Validation of soft tissue properties in surgical simulation with haptic feedback.

Numerous experiments are being conducted to extract soft tissue values for their integration into VR surgical simulations with haptic feedback. Haptic feedback has been shown to be relevant in laparoscopic surgery, however to date no experiments have been conducted to test user sensitivity to changes in soft tissue values in surgical simulations, and how users perception of 'reality' differs from experimentally determined soft tissue values. In this study we conduct a series of experiments investigating haptic sensitivity, haptic differentiation and comparing experimental and empirical values.

Connective Tissue↗

Virtual reality surgical simulation for lower urinary tract endoscopy and procedures.

BACKGROUND AND PURPOSE: To provide a realistic experience of lower urinary tract endoscopic procedures, we have developed and continue to expand a computer-based surgical simulator that incorporates a surgical tool interface with anatomic detail and haptic feedback. METHODS: Surface-based geometric data for the lower urinary tract were generated from the National Library of Medicine Visible Human dataset. The three-dimensional texture map of the surface geometry was developed from recorded endoscopic video procedures. Geometry and associated texture maps were rendered in real time using the Silicon Graphics Extreme Impacts program. The surgical interface device incorporated all normal ranges of motion and resistance that occur within an actual operative environment. The hands-on endoscopic device attached to the interface device was provided by Circon-ACMI, Inc. Urologic residents evaluated the program for correlation with actual endoscopic procedures. RESULTS: Texture-mapped digitized images provided a close anatomic similarity to actual videoendoscopic images. Virtual endoscopy of the lower urinary tract was reproducible and closely simulated actual visual and tactile endoscopic experience. CONCLUSIONS: Virtual reality surgical simulation is feasible for a variety of lower urinary tract procedures. This system coordinates visual perception with appropriate haptic feedback in both longitudinal and rotational axes. These types of procedures may be incorporated into future educational experiences for urologists to introduce new techniques and to provide documentation of surgical experience.

Adult↗

Construct validity testing of a laparoscopic surgical simulator.

BACKGROUND: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator. STUDY DESIGN: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with < 30 laparoscopic cases per year (ES<30) and those with > 30 laparoscopic cases per year (ES>30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and object-translocation (SK9). RESULTS: Mean MS (n=23), R/F (n=24), ES<30 (n=26), and ES>30 (n=30) ages were 26 years (range 21 to 32 years), 31 years (range 27 to 39 years), 49 years (range 31 to 70 years) and 47 years (range 34 to 69 years), respectively. In the lower level skill tasks (SK3, SK4, SK5, and SK6) the ES>30, ES<30, and R/F had similar scores, but were all substantially better than the MS scores. In the higher level skill tasks (SK7, SK8, and SK9), the ES>30 scores tended to be better than the R/F and ES<30, which were similar, and these, in turn, were markedly better than the MS. The ES>30 had notably higher SK8 scores than the R/F and ES<30, who had similar scores, and these had notably better scores than the MS. CONCLUSIONS: The noncamera skills (SK3 to 9) of the LAPMentor surgical simulator can distinguish between laparoscopically naive and ES. SK8 showed the highest level of construct validity, by accurately differentiating among the MS, R/F, ES<30 and ES>30.

Adult↗

Incorporating the sense of smell into haptic surgical simulators.

It is widely recognized that the sense of smell plays an important role in the field of medicine. The sense of smell not only assists the physician in the diagnosis of certain disorders, but it also plays a surgical role as well. Historically, learning this skill was contingent upon some level of clinical exposure to medically related odors. The advent of computerized scent production devices could change this. This article proposes a hypothetical surgical simulation model that incorporates olfactory technologies into existing, haptic, surgical simulators. If incorporated into virtual educational settings such as these, computerized scent production devices could be used not only as a novel way to enhance the virtual experience, but also as a way for medical students to begin to recognize the important role that the sense of smell can play during surgery.

Clinical Competence↗

Incorporating the sense of smell into patient and haptic surgical simulators.

It is widely recognized that the sense of smell plays an important role in the field of medicine. The sense of smell not only assists the physician in the diagnosis of certain disorders, but it also plays a surgical role as well. Historically, learning this skill was mostly contingent upon some level of clinical exposure to medically related odors. The advent of computerized scent production devices could change this. This article proposes a surgical simulation model that incorporates olfactory technologies into existing patient and haptic surgical simulators. If incorporated into virtual educational settings such as these, computerized scent production devices could be used not only as a novel way to enhance the virtual experience, but also as a way for medical students to begin to recognize the important role that the sense of smell plays during both diagnosis and surgery.

Computer Simulation↗

Surgical simulators.

The use of emerging virtual reality technology for surgical skill training has recently attracted a lot of attention. Computerized surgical simulators offer a significant potential for providing a realistic and configurable training environment that bridges the gap between basic training and performing the actual interventions on patients. This paper summarizes the current state of this rapidly developing field and analyses the major problems to be addressed in order to make this technology an indispensable tool for routine clinical training and education.

Journal Article↗

Enhanced pre-computed finite element models for surgical simulation.

Soft tissue modeling is an important component in effective surgical simulation systems. A pre-computed finite element method based on elastic models is well suited to modeling soft tissue deformation. This paper addresses two principal issues: the flexibility of the pre-computed FE method and the approximation approach to non-linear elastic models. We describe a dynamic mechanism of the reconfiguration of the contacted nodes and the fixed boundary, without re-computing the inverse of the global stiffness matrix. The flexibility of the pre-computed models is described for both linear and non-linear elastic models.

Canada↗