Surgery simulator

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A surgery simulator is computer technology developed to simulate surgical procedures for the purpose of training medical professionals, without the need of a patient, cadaver or animal. The concept goes back to the 1980s with video games, but only in the 1990s with three-dimensional graphics and the 2000s with the use of motion sensors for realistic movements (motion control) has the technology been able to simulate the real situation. The most common type of surgery taught through this method is laparoscopic surgery, although it has also been used to do a trial run before other kinds of procedures. Cataract surgery and other ophthalmic procedures are also widely taught using surgical simulators.

Contents

Uses

Surgery simulators are generally used to train medical students and surgeons in specific types of procedures without the use of animals or cadavers before working with live patients. They are best suited for two types of skills needed for surgery, eye–hand coordination and the ability to perform three-dimensional actions using a two-dimensional screen as a guide. Eye-hand coordination is improved because the simulation can give both visual feedback, by way of a screen, as well as tactile feedback that simulates the manipulation of organs and tissue. [1]

This kind of virtual reality is most often used in the training of surgeons in laparoscopic procedures, as in reality it is not possible to see the operation being performed. The simulator uses a computer screen displaying a three-dimensional graphic of the organs being operated on. Various surgical tools or gloves are connected to motion sensors and haptic or tactile feedback mechanisms where the user can physically feel the difference in simulated tissue and organs. The user can "perform surgery" upon the virtual organs by manipulating the tools, which are also displayed on the screen as the user moves them, and the tools also provide force-feedback and collision detection to indicate to the user when they are pushing on or moving some organs or tissue. By inputting data from computerized tomography (CT) and magnetic resonance imaging (MRI) scans the patient can be replicated in the virtual environment. The simulations can also provide more intensive training activity with the introduction of rare pathological cases and complications. [1]

However, the use of these simulators has its limitations. While significant gains have been seen with their use in novices, their effectiveness diminishes as the procedure is repeated with students reaching a plateau. For more experienced surgeons, the use of these simulators have had very limited use. [2]

Development of the technology

Virtual surgery as a means to simulate procedures and train surgeons grew out of the video game industry. Video games for entertainment has been one of the largest industries in the world for some time. [3] However, as early as the 1980s, companies such as Atari began working on ideas of how to use these video environments for training people in different tasks and different professions. Younger trainees in the medical field showed greater eye–hand coordination and quick thinking abilities over those who had never played. Although graphics were extremely limited, Atari began developing several types of simulators related to health care. [3] This type of training met with strong skepticism until studies in the mid-1980s began to show that the concept had promise. [3] [4]

However, the graphic and interactive limitations of video games hindered their development and usefulness until the 1990s, when companies such as Nintendo and Sony began to produce three dimensional polygon graphics to produce the concept of "virtual reality." This improved more with the introduction of Wii systems what allowed more realistic manipulation of the virtual reality through motion sensors.[ citation needed ] Studies at this time showed that the new interaction method improved coordination and space perception. The advances also allowed the technology to move from "game" to "simulator." [3] DaVinci Surgical System programmed their first simulator for laparoscopic surgery in 2005, and its accuracy and design made it quickly accepted by surgeons. [5] While most of this technology has been used for general surgical training, it has also been used to plan specific surgeries as well. The first virtual surgery (where actual surgery followed the virtual practice) was performed on 17 August 2009 when Dr. David Clarke in Halifax, Nova Scotia removed a brain tumour 24 hours after removing a simulated tumour. [6] By 2010, numerous hospitals had some kind of simulation technology available for medical professionals, especially for the training of laparoscopic procedures. [3]

The use of this kind of simulation technology continues to be important, especially with younger generations of medical students. These students have grown up with both entertainment video games and serious games, those developed for educational purposes, making the use of simulators both more acceptable and effective. [7] These students have been shown to more readily benefit from this kind of training, especially in areas of laproscopic procedures and suturing. [8]

Examples

The most widely used simulator for laparoscopic surgery today is the da Vinci Surgery Simulator. It is the newest way to practice these procedures that involves the surgeon in the surgery and control of the device. The simulator is a tutorial that prepares a surgeon for the real surgery at the da Vinci Surgical System. It contains real time images, identical controls of the original device and potential problems that may occur during a real surgery. [9]

In a study of another program, the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), participants were tested on 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator. [2]

One of the more popular games/simulators has been Trauma Center, a game based around solving puzzles and problems that might occur during surgery. The objective of the game is attending to patients that have sustained accidents, broken bones, internal bleeding and trauma, as well as responding to various diagnoses and performing various surgical procedures. The objective of the game is to make the user think faster and increase their ability to solve problems at the surgical table. Surgeons and health experts say that the game is perfect to accelerate the time of decision making at the surgical desk because it is a game based on placing pressure on the user by giving the user a time limit. [1] [7]

The EyeSi is a virtual reality simulator for intraocular surgery training. [10] The HelpMeSee Eye Surgery simulator is another virtual reality simulator with realtime haptic feedback, that is used to train trainees for Manual Small Incision Cataract Surgery. [11]

Related Research Articles

<span class="mw-page-title-main">Virtual reality</span> Computer-simulated experience

Virtual reality (VR) is a simulated experience that employs pose tracking and 3D near-eye displays to give the user an immersive feel of a virtual world. Applications of virtual reality include entertainment, education and business. Other distinct types of VR-style technology include augmented reality and mixed reality, sometimes referred to as extended reality or XR, although definitions are currently changing due to the nascence of the industry.

<span class="mw-page-title-main">Simulation</span> Imitation of the operation of a real-world process or system over time

A simulation is an imitative representation of a process or system that could exist in the real world. In this broad sense, simulation can often be used interchangeably with model. Sometimes a clear distinction between the two terms is made, in which simulations require the use of models; the model represents the key characteristics or behaviors of the selected system or process, whereas the simulation represents the evolution of the model over time. Another way to distinguish between the terms is to define simulation as experimentation with the help of a model. This definition includes time-independent simulations. Often, computers are used to execute the simulation.

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Haptic technology</span> Any form of interaction involving touch

Haptic technology is technology that can create an experience of touch by applying forces, vibrations, or motions to the user. These technologies can be used to create virtual objects in a computer simulation, to control virtual objects, and to enhance remote control of machines and devices (telerobotics). Haptic devices may incorporate tactile sensors that measure forces exerted by the user on the interface. The word haptic, from the Greek: ἁπτικός (haptikos), means "tactile, pertaining to the sense of touch". Simple haptic devices are common in the form of game controllers, joysticks, and steering wheels.

Remote surgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms, a master controller (console), and a sensory system giving feedback to the user. Remote surgery combines elements of robotics, telecommunications such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

<span class="mw-page-title-main">Computer-mediated reality</span> Ability to manipulate ones perception of reality through the use of a computer

Computer-mediated reality refers to the ability to add to, subtract information from, or otherwise manipulate one's perception of reality through the use of a wearable computer or hand-held device such as a smartphone.

<span class="mw-page-title-main">Motion simulator</span> Type of mechanism

A motion simulator or motion platform is a mechanism that creates the feelings of being in a real motion environment. In a simulator, the movement is synchronised with a visual display of the outside world (OTW) scene. Motion platforms can provide movement in all of the six degrees of freedom (DOF) that can be experienced by an object that is free to move, such as an aircraft or spacecraft:. These are the three rotational degrees of freedom and three translational or linear degrees of freedom.

<span class="mw-page-title-main">Robot-assisted surgery</span> Surgical procedure

Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.

<span class="mw-page-title-main">Immersion (virtual reality)</span> Perception of being physically present in a non-physical world

Immersion into virtual reality (VR) is a perception of being physically present in a non-physical world. The perception is created by surrounding the user of the VR system in images, sound or other stimuli that provide an engrossing total environment.

da Vinci Surgical System Robotic surgical system

The da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, increasingly for cardiac valve repair and for renal and gynecologic surgical procedures.

A serious game or applied game is a game designed for a primary purpose other than pure entertainment. The "serious" adjective is generally prepended to refer to video games used by industries like defense, education, scientific exploration, health care, emergency management, city planning, engineering, politics and art. Serious games are a subgenre of serious storytelling, where storytelling is applied "outside the context of entertainment, where the narration progresses as a sequence of patterns impressive in quality ... and is part of a thoughtful progress". The idea shares aspects with simulation generally, including flight simulation and medical simulation, but explicitly emphasizes the added pedagogical value of fun and competition.

An instructional simulation, also called an educational simulation, is a simulation of some type of reality but which also includes instructional elements that help a learner explore, navigate or obtain more information about that system or environment that cannot generally be acquired from mere experimentation. Instructional simulations are typically goal oriented and focus learners on specific facts, concepts, or applications of the system or environment. Today, most universities make lifelong learning possible by offering a virtual learning environment (VLE). Not only can users access learning at different times in their lives, but they can also immerse themselves in learning without physically moving to a learning facility, or interact face to face with an instructor in real time. Such VLEs vary widely in interactivity and scope. For example, there are virtual classes, virtual labs, virtual programs, virtual library, virtual training, etc. Researchers have classified VLE in 4 types:

<span class="mw-page-title-main">Flight simulation video game</span> Video game genre

A flight simulation video game refers to the simulation of various aspects of flight or the flight environment for purposes other than flight training or aircraft development. A significant community of simulation enthusiasts is supported by several commercial software packages, as well as commercial and homebuilt hardware. Open-source software that is used by the aerospace industry like FlightGear, whose flight dynamics engine (JSBSim) is used in a 2015 NASA benchmark to judge new simulation code to space industry standards, is also available for private use. A popular type of flight simulators video games are combat flight simulators, which simulate combat air operations from the pilot and crew's point of view. Combat flight simulation titles are more numerous than civilian flight simulators due to variety of subject matter available and market demand.

The Dextroscope is a medical equipment system that creates a virtual reality (VR) environment in which surgeons can plan neurosurgical and other surgical procedures.

Touch Surgery is a London, New York City, Sydney and Auckland-based health technology app and trading name for the company Digital Surgery LTD. Digital Surgery is a health tech company shaping the future of surgery through the convergence of surgical expertise and technology. The app was first discussed in 2010. The Touch Surgery mobile app is a mobile surgical training platform designed to simulate surgical procedures. As of October 2019, The Touch Surgery mobile app included surgical instructions for about 200 surgical procedures in 17 different specialties.

<span class="mw-page-title-main">AdventHealth Nicholson Center</span>

The AdventHealth Nicholson Center is a medical research and training center with locations in Celebration and Orlando, Florida. Founded in 2001, it operates within the AdventHealth network and trains physicians on foundational surgical techniques, including robotic surgery and laparoscopic surgery, using tools like robotic simulators, wet and dry labs. Using emerging robotic, laparoscopic and orthopedic surgical techniques, the Nicholson Center is researching to develop modified ways to operate.

<span class="mw-page-title-main">Virtual reality applications</span> Overview of the various applications that make use of virtual reality

Virtual reality applications are applications that make use of virtual reality (VR), an immersive sensory experience that digitally simulates a virtual environment. Applications have been developed in a variety of domains, such as education, architectural and urban design, digital marketing and activism, engineering and robotics, entertainment, virtual communities, fine arts, healthcare and clinical therapies, heritage and archaeology, occupational safety, social science and psychology.

Simbionix is a line of surgical simulators that are used in medical schools to simulate surgical procedures.

VirtaMed is a Zurich, Switzerland-based company that develops virtual reality simulators for post-graduate medical education. The company was founded in 2007 as a spin-off of ETH Zurich by Gabor Székely, Co-Head of the Computer Vision Laboratory at ETH Zurich and Director of the Swiss National Centre of Competence in Research (NCCR) for Computer-Aided and Image-Guided Medical Interventions (CO-ME). Co-founders were Stefan Tuchschmid, Daniel Bachofen, Matthias Harders, Michael Bajka and Raimundo Sierra.

<span class="mw-page-title-main">Rolando Del Maestro</span> Italian-born Canadian neurosurgeon

Rolando Fausto Del Maestro is an Italian-born Canadian neurosurgeon, the William Feindel Professor Emeritus in neuro-oncology and director of the Neurosurgical Simulation Research Center at the Montreal Neurological Institute and Hospital, where he has been involved in simulating real brain surgery by creating virtual setting scenarios, founded upon the principles of flight simulation.

References

  1. 1 2 3 Bradley H (2005). "Can video games be used to predict or improve laparoscopic skills?". Journal of Endourology. 19 (3): 372–376. doi:10.1089/end.2005.19.372. PMID   15865530.
  2. 1 2 Grantcharov, Teodor P; Bardram, Linda; Funch-Jensen, Peter; Rosenberg, Jacob (February 2003). "Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills". The American Journal of Surgery. 185 (2): 146–149. doi:10.1016/S0002-9610(02)01213-8. PMID   12559445.
  3. 1 2 3 4 5 Derryberry, A. (2010). "Serious Games: Online Games for Learning" (PDF) (White Paper). pp. 1–15. Archived from the original on 2016-07-21.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  4. ↑ Giannotti, Domenico; Patrizi, Gregorio; Di Rocco, Giorgio; Vestri, Anna Rita; Semproni, Camilla Proietti; Fiengo, Leslie; Pontone, Stefano; Palazzini, Giorgio; Redler, Adriano; Mandell, Mercedes Susan (27 February 2013). "Play to Become a Surgeon: Impact of Nintendo WII Training on Laparoscopic Skills". PLOS ONE. 8 (2): e57372. Bibcode:2013PLoSO...857372G. doi: 10.1371/journal.pone.0057372 . PMC   3583870 . PMID   23460845.
  5. ↑ "Serious Game Types & Examples". Archived from the original on 22 December 2015. Retrieved 8 May 2013.
  6. ↑ Bouzane, Bradley (21 August 2009). "First-ever virtual surgery performed". Winnipeg Free Press . FP Canadian Newspapers. Retrieved 9 June 2010.
  7. 1 2 van Dongen, Koen W.; Verleisdonk, Egbert-Jan M. M.; Schijven, Marlies P.; Broeders, Ivo A. M. J. (17 March 2011). "Will the Playstation generation become better endoscopic surgeons?". Surgical Endoscopy. 25 (7): 2275–2280. doi:10.1007/s00464-010-1548-2. PMC   3116125 . PMID   21416186.
  8. ↑ Curet, Myriam J. (1 February 2007). "The Impact of Video Games on Training Surgeons in the 21st Century—Invited Critique". Archives of Surgery. 142 (2): 186. doi:10.1001/archsurg.142.2.186.
  9. ↑ "Skills simulator" . Retrieved 8 May 2013.
  10. ↑ "EyeSi Surgical" . Retrieved 3 July 2020.
  11. ↑ "HelpMeSee Eye Surgery Simulator" . Retrieved 3 July 2020.
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