Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill
Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill
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开发和验证带有触觉反馈的手术训练模拟器，用于学习锯骨技能
DOI：
10.1016/j.jbi.2013.12.010
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发表时间：
2014-04-01
影响因子：
4.5
通讯作者：
Shen Guofang
中科院分区：
文献类型：
--
作者：
Lin Yanping;Wang Xudong;Shen Guofang
目的：骨锯或骨切割广泛用于骨外科中的骨去除过程。这是一项基本技能，外科医生应执行高水平的经验和敏感的力量感知。具有虚拟和触觉反馈功能的手术训练模拟器可以为传统手术提供安全，可重复和具有成本效益的替代方案。在本研究中，我们开发了一个手术训练模拟器与虚拟和触觉力反馈的颌面外科手术，我们验证了骨锯技能的学习效果，通过实证evaluation.Methods：欧米茄。6从力的维度作为触觉设备，和Display300从SenseGraphices作为三维立体显示。利用计算机断层扫描（CT）图像构建了基于体素的模型，并通过逆向工程构建了虚拟刀具。多点碰撞检测方法被应用于触觉渲染，以测试虚拟工具和骨骼体素之间的3D关系。利用虚拟环境和实时力觉反馈技术对颌面外科锯骨手术进行了仿真。共25名参与者（16名新手和9名经验丰富的外科医生）被分为两组，进行骨锯模拟评估的结构效度。每个参与者在预定义的上颌区域完成相同的锯骨手术六次。记录每次试验的锯切操作时间、最大加速度和触觉力超过阈值的百分比，并进行分析以评估有效性。经过六次试验，所有参与者在安全力学习，稳定的手控制和整体性能方面对模拟器进行评分，以确认表面有效性。结果：结构效度分析结果表明，两组实验组在6次实验后，锯切手术次数均显著减少，且两组实验组的结构效度较对照组有显著性差异。关于最大加速度，曲线显著下降，并在第五次重复（新手）或第三次重复（外科医生）后达到平台。在安全触觉力方面，新手明显降低了触觉力超过阈值的百分比，经过4次试验后具有统计学意义，但外科医生没有表现出显著差异。此外，主观评分的结果表明，所提出的模拟器是更有帮助的新手比有经验的外科医生，得分为8.31和7.22，分别为他们的整体性能。技能迁移实验结果表明，实验组在锯骨操作时最大加速度低于对照组，差异有显著性（p < 0.05）。这些结果表明，模拟器训练对真实的锯切有积极的影响。结论：评价结果证明了模拟器的结构效度、表面效度和迁移效度。实验结果表明，该模拟器能够产生学习锯骨技能的效果，为初学者提供了一种训练选择。(C)2013 Elsevier Inc. All rights reserved.
Objective: Bone sawing or cutting is widely used for bone removal processes in bone surgery. It is an essential skill that surgeons should execute with a high level of experience and sensitive force perception. Surgical training simulators, with virtual and haptic feedback functions, can offer a safe, repeatable and cost-effective alternative to traditional surgeries. In this research, we developed a surgical training simulator with virtual and haptic force feedback for maxillofacial surgery, and we validated the effects on the learning of bone-sawing skills through empirical evaluation.Methods: Omega.6 from Force Dimension was employed as the haptic device, and Display300 from SenseGraphices was used as the 3D stereo display. The voxel-based model was constructed using computed tomography (CT) images, and the virtual tools were built through reverse engineering. The multi-point collision detection method was applied for haptic rendering to test the 3D relationship between the virtual tool and the bone voxels. Bone-sawing procedures in maxillofacial surgery were simulated with a virtual environment and real-time haptic feedback. A total of 25 participants (16 novices and 9 experienced surgeons) were included in 2 groups to perform the bone-sawing simulation for assessing the construct validity. Each of the participants completed the same bone-sawing procedure at the predefined maxillary region six times. For each trial, the sawing operative time, the maximal acceleration, and the percentage of the haptic force exceeding the threshold were recorded and analysed to evaluate the validity. After six trials, all of the participants scored the simulator in terms of safe force learning, stable hand control and overall performance to confirm the face validity. Moreover, 10 novices in 2 groups indentified the transfer validity on rapid prototype skull models by comparing the operative time and the maximal acceleration.Results: The analysed results of construct validity showed that the two groups significantly reduced their sawing operative times after six trials. Regarding maximal acceleration, the curve significantly descended and reached a plateau after the fifth repetition (novices) or third repetition (surgeons). Regarding safe haptic force, the novices obviously reduced the percentage of the haptic force exceeding the threshold, with statistical significance after four trials, but the surgeons did not show a significant difference. Moreover, the subjectively scored results demonstrated that the proposed simulator was more helpful for the novices than for the experienced surgeons, with scores of 8.31 and 7.22, respectively, for their overall performance. The experimental results on skill transference showed that the experimental group performed bone-sawing operation in lower maximal acceleration than control group with a significant difference (p < 0.05). These findings suggested that the simulator training had positive effects on real sawing.Conclusions: The evaluation results proved the construct validity, face validity and the transfer validity of the simulator. These results indicated that this simulator was able to produce the effect of learning bone-sawing skill, and it could provide a training alternative for novices. (C) 2013 Elsevier Inc. All rights reserved.