R01EB025247: Development and Validation of a Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS)

项目摘要 胃食管反流病（GERD）在美国流行，影响约20%的美国人。 人口，导致生活质量下降。如果不治疗，GERD可能导致并发症 如食管炎、Barrett食管和食管腺癌。食管裂孔疝是一种 疝，疝：腹腔的内容物，主要是胃，通过 横膈膜上的食管孔，进入胸腔。一个强有力的联系一直是 食管裂孔疝和胃食管反流病之间的关系此外， 疝气会使食道癌的风险加倍。85%的食管裂孔疝病例为I型和5- 15%的病例是食管旁II-IV型疝，如果不进行治疗， 诱发GERD，也可导致疝出内容物的局部缺血或扭转。腹腔镜 食管裂孔疝手术是一种微创手术，使用专门的工具进行， 腹部有五个小切口它是一种先进的普通外科手术， 学习曲线约50例，达到低复发率。目前正在为此进行培训 程序是通过有限的奖学金，不存在动物，尸体或虚拟现实 模拟器来训练这个特定的程序。虚拟现实模拟器提供标准化的 培训环境，可以反复练习程序以获得熟练程度。他们 还可以自动评估性能，而不受任何主观影响。解决 在腹腔镜食管裂孔疝手术培训的差距，我们建议开发虚拟 腹腔镜食管裂孔疝模拟器（VLaHHS），具有逼真的建模技术和功能 模拟III型食管裂孔疝，自定义双手力反馈（触觉）界面。的 在这个项目中开发的VLaHHS也将有助于培训外科医生进行抗反流手术， 治疗GERD。我们提出了三个具体目标，以实现和证明我们的有效性， 模拟器在aim 1中，我们将开发使用组织特性和实时的模拟器。 变形以模拟该过程。我们将开发定制的触觉设备， 反馈在目标2中，我们将开发，模拟场景和指标，并集成到VLaHHS中。 在目标3中，我们将进行验证研究，以证明VLaHHS培训将导致改善 性能这项研究最终将减少手术错误，并改善 患者安全。

Project Summary Gastroesophageal reflux disease (GERD) is prevalent in USA and affects about 20% of the population and leads to decreased quality of life. If untreated, GERD can lead to complications such as esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. Hiatal hernia is a condition in which the contents of the abdominal cavity, mainly the stomach, herniate through the hole meant for esophagus in the diaphragm and into the chest cavity. A strong link has been established between the presence of hiatal hernias and GERD. Moreover, presence of hiatal hernia doubles the risk of esophageal cancer. 85% of the hiatal hernia cases are of Type I and 5- 15% of the cases are of paraesophageal Type II-IV hernias, which when left untreated, apart from inducing GERD, can also result in ischemia or volvulus of the herniated contents. Laparoscopic hiatal hernia surgery is a minimally invasive procedure performed with specialized tools through five small incisions on the abdomen. It is an advanced general surgery procedure that has a learning curve of about 50 cases to achieve a low recurrent rate. Currently training for this procedure is through limited fellowships and there exists no animal, cadaver or virtual reality simulator to train in this specific procedure. Virtual reality simulators provide a standardized training environment where, a procedure can be practiced repeatedly to gain proficiency. They can also automatically assess the performance without any subjective influence. To address the gap in training for laparascopic hiatal hernia surgery, we propose to develop the Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS) with realistic modeling techniques, capabilities to simulate types III hiatal hernia, custom bimanual force feedback (haptic) interface. The VLaHHS developed in this project will also be useful to train surgeons in anti-reflux surgeries to treat GERD. We propose three specific aims to achieve and prove the effectiveness of our simulator. In aim1 we will develop the simulator that uses tissue properties and real-time deformation to simulate the procedure. We will develop custom haptic device to provide force feedback. In aim 2, we will develop, simulation scenario and metrics, and integrate into VLaHHS. In aim 3, we will conduct validation studies to prove that training on VLaHHS will lead to improved performance. The research will eventually lead to fewer surgical errors and improvement to patient safety.