Aportable apparatus is being developed as a means of training surgeons in robot-assisted surgery, including laparoscopic and other forms of minimally invasive surgery. The apparatus can be characterized as a virtual reality system that includes not only a computer and a visual display subsystem, but also an electromechanical subsystem with which a surgeon in training can interact as though interacting with a console of the type used to control a laparoscopic, endoscopic, or other surgical robot.

The use of virtual reality in surgical training was proposed more than a decade ago. Heretofore, training in laparoscopic surgery has involved the use of mechanical models, followed by the use of animals as surgical subjects, and/or supervised participation in surgery on human patients. Unfortunately, the use of mechanical models is time-consuming and does not enable automated measurement of surgical performance. The use of virtual reality in surgical training offers potential for reducing the need for mechanical models, animals, and operating-room equipment while improving the quality of training.

A master/slave robot of the type used in minimally invasive surgery typically includes a surgeon console (the master), which exerts control over three or four robot arms (collectively, the slave) that manipulate the surgical instrument(s). The robotic system transforms the surgeon's hand movements into fine, precise instrument maneuvers in an elegant, intuitive way. To satisfy requirements for clinical use, the mechanical subsystem of the console is rather large and complex.

The design of the present system reflects the following considerations:

  • A console suitable for training could include a modern surgeon's- hand-motion-tracking subsystem similar to that of a surgeon robot console.
  • Because a training console is not subject to the full set of requirements and constraints pertinent to real surgery, a training console could, potentially, be less complex and less expensive, relative to a surgeon robot console.

The system includes both hardware and software components that emulate a laparoscopic situation. The system can be made to generate displays that resemble various body surfaces with various port placements and enables anatomical explorations specific to surgical procedures. The simulation software runs on a standard personal computer and offers a wide range of skill training. The simulation can include displays of abstract scenes and of realistic scenes like those encountered in surgical procedures. (Many basic skills can be learned in abstract environments; more advanced skills can be learned in procedure- realistic environments).

The system is equipped to compute validated metrics for assessment of a user's competence level. The software of this system includes an administrative application program and software tools through which this program can gain access to other modular software that generates educational multimedia displays. The educational modules can easily be added or updated. The software also includes application programs for training in a roaming mode (free selection of exercises) and training in a session mode (that is, according to a predefined curriculum). In the session mode, it is possible to require that the user perform in excess of a specified competence level before progressing to the next set of training exercises.

The development effort thus far has been focused on design, construction, and testing of a small demonstration version of the system for training in such basic skills as manipulation of surgical instruments, dissection, and suturing. From results of tests of 21 laparoscopic simulation exercises, it was concluded that the simulation software must be modified to render it capable of managing and recording collisions between instruments. It is planned that in the next phase, the effort will be focused on development of a specific robot-assisted procedure.

This work was done by Jan Sigurd Rotnes of SimSurgery AS for the Army Research Laboratory. For more information, download the Technical Support Package (free white paper) at www.defensetechbriefs.com/tsp  under the Bio-Medical category. ARL-0014



This Brief includes a Technical Support Package (TSP).
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Portable Simulator for Training in Robot-Assisted Surgery

(reference ARL-0014) is currently available for download from the TSP library.

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Defense Tech Briefs Magazine

This article first appeared in the August, 2007 issue of Defense Tech Briefs Magazine (Vol. 1 No. 4).

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Overview

The document is a final report on the project titled "Development of a Portable Simulator for Training Robot Assisted Surgery," led by Dr. Jan Sigurd Rotnes, M.D., Ph.D., from SimSurgery AS. The report was prepared for the U.S. Army Medical Research and Materiel Command and is dated December 2006. The project aimed to explore the use of virtual reality simulators in surgical training, a concept proposed over a decade prior to the report.

The report outlines the significance of using virtual reality in surgical education, emphasizing its potential to reduce reliance on mechanical models and live animals for training without compromising surgical outcomes. Traditional mechanical trainers, while useful for teaching laparoscopic skills, are noted to be time-consuming in assembly compared to virtual reality simulators. The vision of SimSurgery is to enhance clinical performance and lower healthcare costs by providing advanced training solutions and computer-assisted tools for surgery.

The document includes various sections, such as an introduction, body, and conclusions, detailing the project's objectives, methods, and key research accomplishments. It discusses the uniqueness of the effort, the hypothesis guiding the research, and the military significance of improved surgical training methods. The report also highlights the technical objectives and methodologies employed during the project, which spanned from November 10, 2005, to November 9, 2006.

The findings suggest that virtual reality simulators can significantly improve the training process for surgical procedures, offering a more efficient and effective alternative to traditional training methods. The report concludes with a summary of reportable outcomes and references, although it does not include appendices.

Overall, the document serves as a comprehensive overview of the project's goals, methodologies, and implications for the future of surgical training, particularly in military contexts. It underscores the importance of innovation in medical training and the potential benefits of integrating technology into surgical education. The report is approved for public release, indicating its relevance and contribution to the field of medical research and training.