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Sim Surgery is New Virutal Surgical Training

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Sim Surgery is New Virutal Surgical Training

Sim Surgery Training Medical Surgeons in the Virtual World

phantom.thumbnail Sim Surgery is New Virutal Surgical TrainingTraining surgeons in the virtual world is a realistic possibility. Medical students will be able to operate on very realistic computer generated organs that they can not only see but also feel!

Researcher Suvranu De and his team at Rensselaer Polytechnic Institute are developing a surgery simulator similar to the flight simulators used to train pilots. The medical training system would allow surgeons to manipulate virtual human organs in real time, learning and acquiring crucial skills without using cadavers or risking human life. De’s team is pursuing a grand vision of developing the holy grail of simulation technology: a “virtual human.”

glove.thumbnail Sim Surgery is New Virutal Surgical TrainingThis giant database of human anatomy would look and feel just like a flesh-and-blood person. Surgeons would be able to see a completely realistic virtual model of a human being, accurate down to the last detail, and touch and manipulate it using haptic interfaces such as a SensAble Technologies’ Phantom devices or Meta Motion’s CyberGlove.

“A virtual human can be pushed and prodded pretty much as you would a real human,” says De. “Surgeons would never have to go to cadavers for any of their training. One could use such a model to plan surgical processes even before such surgeries are performed.”

medical student.thumbnail Sim Surgery is New Virutal Surgical TrainingCurrently, surgeons in training learn by observing experienced doctors in action and by performing procedures under supervision, slowly expanding their surgical repertoires as their skill levels increase. The few surgical simulators on the market aren’t very popular with the medical community because of their lack of realism: They mostly rely on simplistic graphics to represent human tissue, and the haptics technology used to let surgeons “feel” their actions isn’t mature enough to simulate how soft biological tissue reacts when poked, cut or sliced.

Watch The Virtual Surgery Demo

surgery virtual.thumbnail Sim Surgery is New Virutal Surgical TrainingThe simulators do allow surgeons to interact with computer-generated models of tissue using the same tool handles used in real surgery, with haptic interfaces translating the motion of the surgeon’s hands into the movement of computer-generated tools that interact with virtual organs. The haptics then feed interaction information back to the student. The surgical scene is rendered entirely by computer monitors, and no existing simulator realistically mimics how soft tissues behave.

“If I’m learning to perform an operation and everything in the body is perfectly still, or looks like an animated cartoon, I’m unlikely to feel ‘immersed’ and won’t make the connection to real surgery,” says Dan Morris, a student at Stanford University’s Artificial Intelligence Laboratory. “More importantly, many of the motor skills you learn in surgery have a lot to do with how tissue behaves: How hard do I need to push on a blood vessel to move it out of the way or cut it? How hard is too hard? If these things aren’t represented accurately, I’m unlikely to learn many of the core skills that I need to learn.”

surgerysim1 f.thumbnail Sim Surgery is New Virutal Surgical TrainingTo be able to operate effectively, surgeons have to be able to feel how human tissue — which exhibits the characteristics of both solids and liquids, similar to chewing gum or putty — responds to direct touch and how it interacts with surgical instruments.

Creating this interaction in real time with three-dimensional graphical models that act and react like human tissue remains a major technological challenge for makers of surgical simulators.

But De and his team think they have developed a solution: a computational tool called the point-associated finite field approach that allows any kind of matter (solid, liquid or gas) to be simulated in real time. The software is complex enough to model tissue response accurately, allowing surgeons to touch and interact with virtual tissue realistically. It can even model blood flow.

To achieve this level of real-time touch feedback and interactivity, the program must perform at blinding speeds.

“Speed is everything in real-time simulation,” says De. “Real-time simulation is all about fooling the human sensory system,” he says. “If you present static images at 30 frames a second, it looks as if things are moving in real time (just as in movies and television). The haptic sense is not that easily fooled; the ‘haptic scene’ or force information must be updated 1,000 times a second for us to feel it as realistic — otherwise things will feel mushy or jerky.”

Currently working on improving its computer models, De’s team initially intends to develop training modules for specific tasks such as grasping, cauterizing and surgical cutting. The team hopes to piece together individual tasks later to generate complicated, multistep procedures. De says his team is getting closer to a viable prototype to use in tests with doctors.

No matter what, experts say such a virtual human is still decades away. Besides the technological challenges there are many unanswered questions about how biological tissues behave and the complexities of internal physiological interactions.

“It will be around 20 years until a realistic virtual human is created that looks and feels exactly like a real, live human,” says Allan J. Hamilton, executive director of the Arizona Simulation Technology and Education Center. “There is still a lot of work to be done.”

Some doctors argue that this kind of technology does hold some applications, but we should not rush to change what has been proven for years. They feel a student cannot adequately train yourself in a virtual environment because there are no virtual patients nor virtual diseases. There are certain things that cannot be learned in the virtual world. Human body and human organs manifest in different ways in disease and wellness, as the number of people on earth.

The basics of minimally invasive surgery skills could be learned in virtual environments (like learn for the first time the spatial skill in angle laparoscopes). From there to the point of learn certain procedure in a simulator, it’s a long way.

I think it’s a very positive step in the right direction. And not only does it allow training, some of them can track and record a student’s movements and accuracy, so that progress and level of skill can be objectively measured. It would really be something if such a thing were possible for open surgery.

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