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PubMed2005

An interactive simulation environment for craniofacial surgical procedures.

Recent advances in medical imaging and surgical techniques have made possible the correction of severe facial deformities and fractures. Surgical correction techniques often involve the direct manipulation - both relocation and surgical fracture - of the underlying facial bone. The work presented here introduces an environment for interactive, visuohaptic simulation of craniofacial surgical procedures, with an emphasis on both mandibular distraction procedures and traditional orthognathic surgeries. The simulator is intended both for instruction and for procedure-specific rehearsal, and can thus load canonical training cases or patient-specific image data into the interactive environment. A network module allows remote demonstration of procedure technique, a form of 'haptic tutoring'. This paper discusses the simulation, haptic feedback, and graphic rendering techniques used to drive the environment. Particular emphasis is placed on techniques for fracture and subsequent rigid manipulation of bone structures, a key component of the relevant procedures.

Computer Simulation↗
PubMed1999

Three-dimensional computer-assisted simulation combining facial skeleton with facial morphology for orthognathic surgery.

The purpose of this study was to use a 3-dimensional (3D) computer-aided design (CAD) simulation system to plan surgical procedures and predict postoperative changes in orthognathic surgery patients. A computer-generated imaging model was developed by combining a 3D reconstructed cephalometric skeletal image and a laser-scanned facial surface image. Moreover, postoperative data were studied and linked to the simulator model for programming and executing simulated surgical procedures. Interactive editing capabilities allow surgeons to operate CAD surgical simulation, and predicted results can be presented graphically and numerically. The results indicate that the integration of 3D images and CAD techniques have a potential for simulating surgery and providing graphic information to patients in obtaining an informed consent.

Adult↗
PubMed2005

Finite element simulation of spinal deformities correction by in situ contouring technique.

Biomechanical models have been proposed in order to simulate the surgical correction of spinal deformities. With these models, different surgical correction techniques have been examined: distraction and rod rotation. The purpose of this study was to simulate another surgical correction technique: the in situ contouring technique. In this way, a comprehensive three-dimensional Finite Element (FE) model with patient-specific geometry and patient-specific mechanical properties was used. The simulation of the surgery took into account elasto-plastic behavior of the rod and multiple moments loading and unloading representing the surgical maneuvers. The simulations of two clinical cases of hyperkyphosis and scoliosis were coherent with the surgeon's experience. Moreover, the results of simulation were compared to post-operative 3D measurements. The mean differences were under 5 degrees for vertebral rotations and 5 mm for spinal lines. These simulations open the way for future predictive tools for surgical planning.

Adult↗
PubMed2005

FEM-based soft tissue destruction model for ablation simulator.

In surgical procedures, ablation is one of the most difficult skills to train and acquire. For the risk of ablation failure, ablation training environments are desired. This paper proposes FEM-based deformation and destruction soft tissue model for ablation training simulator. The proposed model employs shearing stress hypothesis. The result of simulation experiments shows that the model can express different destruction progression by manipulation.

Catheter Ablation↗
PubMed2004

Two-handed next generation suturing simulator.

A realistic two-handed surgical suturing simulation would have a broad impact on the way doctors are trained in the field of surgery. Current state-of-the-art in suturing simulators do not accurately represent realistic suturing conditions, leaving many necessary components, i.e. two-handed interaction, skin undermining, skin repositioning etc., out of the model completely. The goal of this research is to develop a next generation immersive suturing simulator that uses an integrated two-handed tension based haptic device for tactile feedback, a hi-fidelity finite element model for more accurate skin, tissue and needle modeling and stereoscopic vision for depth-of-field.

Computer Simulation↗
PubMed2006

Simulators and virtual reality in surgical education.

This article explores the pros and cons of virtual reality simulators, their abilities to train and assess surgical skills, and their potential future applications. Computer-based virtual reality simulators and more conventional box trainers are compared and contrasted. The virtual reality simulator provides objective assessment of surgical skills and immediate feedback further to enhance training. With this ability to provide standardized, unbiased assessment of surgical skills, the virtual reality trainer has the potential to be a tool for selecting, instructing, certifying, and recertifying gynecologists.

Clinical Competence↗
PubMed2000

Evaluation of 3D imaging.

Interactive computer-based simulation is gaining acceptance for craniofacial surgical planning. Subjective visualization without objective measurement capability, however, severely limits the value of simulation since spatial accuracy must be maintained. This study investigated the error sources involved in one method of surgical simulation evaluation. Linear and angular measurement errors were found to be within +/- 1 mm and 1 degree. Surface match of scanned objects was slightly less accurate, with errors up to 3 voxels and 4 degrees, and Boolean subtraction methods were 93 to 99% accurate. Once validated, these testing methods were applied to objectively compare craniofacial surgical simulations to post-operative outcomes, and verified that the form of simulation used in this study yields accurate depictions of surgical outcome. However, to fully evaluate surgical simulation, future work is still required to test the new methods in sufficient numbers of patients to achieve statistically significant results. Once completely validated, simulation cannot only be used in pre-operative surgical planning, but also as a post-operative descriptor of surgical and traumatic physical changes. Validated image comparison methods can also show discrepancy of surgical outcome to surgical plan, thus allowing evaluation of surgical technique.

Adult↗
PubMed2003

Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills.

BACKGROUND: The study was carried out to analyze the learning rate for laparoscopic skills on a virtual reality training system and to establish whether the simulator was able to differentiate between surgeons with different laparoscopic experience. METHODS: Forty-one surgeons were divided into three groups according to their experience in laparoscopic surgery: masters (group 1, performed more than 100 cholecystectomies), intermediates (group 2, between 15 and 80 cholecystectomies), and beginners (group 3, fewer than 10 cholecystectomies) were included in the study. The participants were tested on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator. RESULTS: The learning curves regarding time reached plateau after the second repetition for group 1, the fifth repetition for group 2, and the seventh repetition for group 3 (Friedman's tests P <0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman's tests, P >0.2) indicating the absence of a learning curve for these parameters. Group 2 error scores reached plateau after the first repetition, and group 3 after the fifth repetition. Group 2 improved their economy of movement score up to the third repetition and group 3 up to the sixth repetition (Friedman's tests, P <0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P <0.05). CONCLUSIONS: Different learning curves existed for surgeons with different laparoscopic background. The familiarization rate on the simulator was proportional to the operative experience of the surgeons. Experienced surgeons demonstrated best laparoscopic performance on the simulator, followed by those with intermediate experience and the beginners. These differences indicate that the scoring system of MIST-VR is sensitive and specific to measuring skills relevant for laparoscopic surgery.

Clinical Competence↗
PubMed2003

Computer-assisted simulations in orthodontic diagnosis and the application of a new cone beam X-ray computed tomography.

Computational simulations which include three-dimensional (3-D) image processing and biomechanical calculations should provide useful information to our research and orthodontic clinic as a clinical tool defined as 'thinking'. In this review, 1) biomechanical simulations applied to predict the mandibular growth; 2) mathematical models of virtual bone cells and 3) 3-D images and solid model simulations for surgical planning are introduced. In biomechanical simulation, biting force, electromyographic (EMG) activity and cephalograms of 32 subjects were applied. Computational results of mathematical model were compared with actual bone growth in a rat. Three-dimensional image and solid model of 14 patients were utilized for their treatment planning. From the results, several concepts of our simulations were confirmed: 1) reaction forces generated by masticatory muscles at the condyle control the direction of mandibular growth; 2) some mathematical models have the possibility to describe the process of bone growth; 3) 3-D image processing software and solid models are necessary for diagnosis and planning of orthognathic surgery. We also believe that the orthodontists can more accurately predict the affects of surgical procedures and orthodontic tooth movement using the new cone beam X-ray computed tomography (CT) (CB MercuRay; Hitachi Medico Technology, Tokyo, Japan) and its advanced application software.

Animals↗
PubMed2001

The effects of practice and instruction on speed and accuracy during resident acquisition of simulated laparoscopic skills.

To assess the effects of practice and dynamic instruction on changes in speed and accuracy during acquisition of simulated laparoscopic surgical skills.Fourteen PGY-1 general surgery residents were randomly assigned to 1 of 2 experimental conditions (n = 7 per group), either practice only or practice with instruction, and required to perform 10 trials of each of 2 laparoscopic surgical skills-cannulation and object passing. Practice only subjects were given verbal instructions for each task, and corrective feedback only after trial 1. Practice with instruction subjects were treated the same, but also saw a videotaped demonstration and received dynamic feedback during and between each trial. Performance speed was recorded for each trial and number of errors was recorded for trials 8 to 10 by videotape review.Mean speed for subjects in both groups increased significantly for both tasks (p < 0.01). Practice with instruction subjects committed significantly fewer errors on object passing (p < 0.04) and were less variable in the number of errors committed during the cannulation task (p < 0.01).Practice, with or without dynamic instruction, results in significant improvement in the speed of performance of simulated laparoscopic surgical skills. The addition of dynamic instruction to simulator-based practice improves the quality and consistency of resident acquisition of laparoscopic surgical skills.

Journal Article↗
PubMed1998

[Biomechanical modeling of instrumentation for the scoliotic spine using flexible elements: a feasibility study].

Surgical instrumentation of the scoliotic spine is a complex procedure with many parameters, such as the spinal segment to operate on, the number and position of the hooks and screws, etc. Biomechanical modeling is a tool which can be used to determine the influence of these parameters. However, technical difficulties due to the large stiffness range of involved components and the large deformations associated with surgical maneuvers are encountered when using the finite elements method. Thus, the objective of this study is to adapt a modeling approach using analysis of flexible mechanisms and evaluate its feasibility. The model combines rigid bodies for the vertebrae and flexible elements representing intervertebral structures. The mechanical properties were calculated from published data and the geometry was personalized with intraoperative measurements. Following the installation of the hooks and screws on the modeled spine, two steps were used to simulate the surgical maneuvers: 1) translation and attachment of the hooks/screws on the first rod; 2) rod rotation. The feasibility of this modeling approach was evaluated by simulating the surgical maneuvers on 2 cases: 1) a physical model; 2) a clinical case. The agreement between intraoperative measurements and simulation results (frontal curvatures are reproduced with over 80% accuracy) shows the feasibility of the modeling approach. This approach also reduces computational convergence problems because of its limited sensitivity to stiffness differences between elements, which demonstrates the advantage of flexible mechanism modeling relative to finite element modeling. Long term goals of subsequent refinements are the development of a tool for surgical correction predictions and for the design of more efficient instrumentation.

Adolescent↗
PubMed2005

A vision-based surgical tool tracking approach for untethered surgery simulation and training.

This paper presents progress in the development of an untethered surgery simulation and training system. A surgical trainee interacts with the simulation in the most natural way possible-using standard, untethered surgical tools and hands. This natural interface requires innovations in tracking, haptic feedback, and visualization. This article describes the approach used for tool tracking with color cameras. A novel tracking algorithm is used to identify the type of tool, its position, and its orientation. Integration of the vision system with the tissue deformation and visualization modules is also discussed.

Algorithms↗
PubMed1999

Simulation and virtual reality in surgical education: real or unreal?

Rapid change is under way on several fronts in medicine and surgery. Advances in computing power have enabled continued growth in virtual reality, visualization, and simulation technologies. The ideal learning opportunities afforded by simulated and virtual environments have prompted their exploration as learning modalities for surgical education and training. Ongoing improvements in this technology suggest an important future role for virtual reality and simulation in surgical education and training.

Computer Simulation↗
PubMed1988

Surgery in space. Phase I: Basic surgical principles in a simulated space environment.

The venturing forth of man into space confronts the surgeon with a new weightless environment with which he will inevitably have to contend. In this study operative procedures were performed on 20 rats in a simulated space environment with use of neutral buoyancy in order to identify those factors that could actually or potentially affect operative technique. There are three general areas of difference from normal conditions in simulated microgravity: physical adaptation to gravity deprivation tissue behavior, including bleeding; and the conduct of surgery. Without gravity, the tactile "feel" of objects is changed ("heavy" and "light" are meaningless terms) and proprioception is confused so that there is past pointing and overreaching of movements. Tissue planes tend to separate, and organs float and bob in the operative field, which makes clamping, cutting, and suturing different. Bleeding is a major consideration; surface tension tends to keep venous blood oozing along surfaces, whereas pulsatile arterial blood forms droplets, streamers, and clouds, depending on the force of the bleeding. These factors and others interfere with surgical technique in a number of ways: dispersion of blood obscures the surgeon's vision, sutures become entangled, organs are not stabilized, and instruments float into the operative field. The limitations of comparing neutral buoyancy to the true zero gravity of space are addressed. There is a definite need for further investigation for development of new surgical techniques in preparation for experimental and clinical surgery in space.

Animals↗
PubMed2001

The fourth dimension in simulation surgery for craniofacial surgical procedures.

The intracranial volume was measured in all 18 cases of craniosynostosis and craniofacial synostosis with 3DCT using a modification of Miyake's formula, with a 6 years' follow-up. 1: There were no cases where the intracranial volume was less than the modified Miyake's formula. 2: Total cranial reshaping, compared to the local forehead advancement, was effective in increasing the intracranial cavity and growth postoperatively. 3: In cases of craniofacial synostosis, there is a possibility that mental retardation will develop if the intracranial volume tends to increase rapidly and more than expected.

Child Development↗
PubMed2006

Flow study of an extracardiac connection with persistent left superior vena cava.

BACKGROUND: Numerous studies have sought to optimize the design of total cavopulmonary connections with a single superior vena cava. This study was directed to the 2% to 4.5% of the population with dual superior venae cavae, investigating the flow fields associated with such total cavopulmonary connection anatomies. Additionally, it demonstrates the potential use of computational designs and simulations as surgical planning tools. METHODS: A 3-dimensional model of a total cavopulmonary connection with bilateral superior venae cavae was reconstructed from a patient's magnetic resonance images and investigated experimentally and numerically to assess the power losses and flow structures within the connection. On the basis of these results, a virtual operation was performed in the computer to improve the original connection design. The modified anatomy was studied numerically. RESULTS: Because of a smooth connection with an extracardiac conduit and no major dimension mismatch between the baffle and the connecting vessels, the original anatomy yielded smooth flow fields, low power losses, and few disturbances. However, a large offset between the inferior vena cava and the left superior vena cava resulted in flow stasis and unbalanced hepatic flow distribution. Shifting the inferior vena cava and positioning it between the 2 superior venae cavae resulted in a 7% decrease in power losses and eliminated the associated flow stasis regions in the main pulmonary artery segment. CONCLUSIONS: This study demonstrates the potential use of computer-aided design and numeric simulations for surgical planning. It shows that locating the inferior vena cava between the superior venae cavae may lead to better-balanced lung perfusion. This may require suturing the right and left superior venae cavae closer to each other during the hemi-Fontan or Glenn stage.

Anastomosis, Surgical↗