Graphic and haptic simulation for transvaginal cholecystectomy training in NOTES.
Graphic and haptic simulation for transvaginal cholecystectomy training in NOTES.
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DOI：
10.1016/j.jbi.2016.03.005
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发表时间：
2016-04
影响因子：
4.5
通讯作者：
De S
中科院分区：
文献类型：
--
作者：
Pan JJ;Ahn W;Dargar S;Halic T;Li BC;Sankaranarayanan G;Roberts K;Schwaitzberg S;De S
自然孔腔内内窥镜手术（NOTES）提供了一种新兴的外科技术，通常需要外科医生很长的学习曲线。具有视觉和触觉反馈的虚拟现实（VR）医疗模拟器通常可以提供一种高效且具有成本效益的替代方案，而不会对传统的培训方法造成风险。在此背景下，我们开发了NOTES中的第一个经阴道胆囊切除术虚拟现实模拟器（VTEST™）。基于VR的手术模拟器旨在模拟胆囊切除术的混合NOTES。我们使用一个六自由度触觉装置和一个跟踪传感器来构建模拟器的核心硬件组件。在软件方面，提出了一种基于内球体的器官真实的实时变形方法。针对软组织与手术器械频繁碰撞的问题，设计并实现了一种基于GPU的自适应碰撞检测方法。为了使电灼钩切除胆囊脂肪组织的过程具有逼真的视觉效果，提出了一种多层六面体模型来模拟电灼钩切除胆囊脂肪组织的过程。从实验结果来看，受训者可以在真实的时间内操作，具有高度的稳定性和逼真度。还进行了初步研究，以评估这种混合NOTES模拟器的真实性和实用性。该原型模拟系统已被外科医生通过试点研究进行了验证。在测试过程中，参与者对其视觉性能和实用性的一些项目进行了相当高的评价。它显示出提高受训者手术技能的潜力，并有效地缩短了他们的学习曲线。
Natural Orifice Transluminal Endoscopic Surgery (NOTES) provides an emerging surgical technique which usually needs a long learning curve for surgeons. Virtual reality (VR) medical simulators with vision and haptic feedback can usually offer an efficient and cost-effective alternative without risk to the traditional training approaches. Under this motivation, we developed the first virtual reality simulator for transvaginal cholecystectomy in NOTES (VTEST™). This VR-based surgical simulator aims to simulate the hybrid NOTES of cholecystectomy. We use a 6DOF haptic device and a tracking sensor to construct the core hardware component of simulator. For software, an innovative approach based on the inner-spheres is presented to deform the organs in real time. To handle the frequent collision between soft tissue and surgical instruments, an adaptive collision detection method based on GPU is designed and implemented. To give a realistic visual performance of gallbladder fat tissue removal by cautery hook, a multi-layer hexahedral model is presented to simulate the electric dissection of fat tissue. From the experimental results, trainees can operate in real time with high degree of stability and fidelity. A preliminary study was also performed to evaluate the realism and the usefulness of this hybrid NOTES simulator. This prototyped simulation system has been verified by surgeons through a pilot study. Some items of its visual performance and the utility were rated fairly high by the participants during testing. It exhibits the potential to improve the surgical skills of trainee and effectively shorten their learning curve.