Physically Realistic Virtual Surgery

描述(申请人提供)：虽然预期具有视觉和触觉(触摸)反馈的基于计算机生成的虚拟现实(VR)的手术模拟器将显著改进微创手术(MIS)培训，导致大幅减少手术室(OR)错误和患者发病率，但现有的模拟器由于以下主要缺陷而没有在医学界被广泛接受：(1)它们缺乏实时的基于物理的手术工具-软组织相互作用的模拟算法；(2)计算器官模型没有牢固地基于实验数据；(3)它们主要提供心理-运动技能培训，即手眼协调和完成工具移动、切割、缝合等任务所需的运动技能的培训，很少有与工作量管理、规划、沟通、决策和解决问题有关的高级心理功能相关的认知技能培训。在上一个赠款期间，我们侧重于问题(1)和(2)，而在这次的延长提案中，我们计划合理地延长我们的工作，主要集中在最后一个问题上。基于成人学习理论[LaWe91]和飞行模拟技术文献[Le05]，我们认为下一代(‘Gen2’)手术模拟器必须同时提供认知和心理运动技能培训。认知技能训练有两个基本要求：(1)认知保真度，即模拟器环境应尽可能接近地复制OR中的高压力环境；(2)认知反馈，即应对所执行的每项任务的质量提供实时评估，并提出纠正措施和替代程序。该项目的目标是设计、开发和评估下一代(‘Gen2’)手术模拟器，它将提供认知和心理运动技能培训。为了实现该项目的目标，已经组建了一个多学科团队来实现以下具体目标：1)设计和开发第二代手术模拟器背后的基础技术。SA2)在新出现的单切口腹腔镜手术(SILS)方法的基础上，开发用于腹腔镜可调胃束带(LAGB)手术的Gen1和Gen2模拟器。SA3)在波士顿贝丝以色列女执事医疗中心(BIDMC)的技能实验室进行实验，确保模拟器上测量的分数反映它们打算测量的技术技能，以确定Gen1和Gen2 SILS LAGB模拟器作为培训工具的有效性。SA4)通过跟踪受试者随时间的学习曲线，并测量他们在Gen1和Gen2 SILS LAGB模拟器上训练后的技能保持和诊断判断质量，来评估使用模拟器进行手术技能训练和学习的认知保真度和反馈的有效性。我们研究的成功将使这项技术成为下一代手术模拟器的潜在标准，所开发的技术将在手术培训之外获得好处，例如，在设计新的手术工具和手术技术方面。 公共卫生相关性：这项研究的目标是开发和验证一种全面的基于计算机的技术，使外科实习生能够在基于计算机的模型上练习他们的外科技能。在应用于患者之前，以这种无风险的方式学习和完善手术程序和技术，将转化为更少的手术室错误、减少患者发病率和改善患者结果，从而更快地愈合、更短的住院时间以及减少手术后并发症和治疗成本。

DESCRIPTION (provided by applicant): While it is anticipated that computer generated virtual reality (VR)-based surgical simulators with both visual and haptic (touch) feedback will significantly improve minimally invasive surgical (MIS) training, leading to substantial reduction in operating room (OR) errors and patient morbidity, existing simulators have not been widely accepted in the medical community due to the following major drawbacks: (1) they lack realistic physics- based simulation algorithms of surgical tool-soft tissue interactions in real time; (2) the computational organ models are not firmly based on experimental data; and (3) they provide primarily psycho-motor skill training, i.e., training in hand-eye coordination and motor skills necessary for tasks such as tool movement, cutting, suturing, etc with little training in cognitive skills associated with higher level mental functions related to workload management, planning, communication, decision-making and problem-solving. In the previous grant period we focused on issues (1) & (2), while in this renewal proposal we plan a logical extension of our work and concentrate primarily on the last issue. Based on adult learning theories [LaWe91] and literature in flight simulation technology [Le05], we argue that the next generation ('Gen2') surgical simulators must provide both cognitive and psycho-motor skill training. Cognitive skill training translates to the following two fundamental requirements: (1) Cognitive fidelity, i.e., the simulator environment should, as closely as possible, replicate the high stress environment in the OR and (2) Cognitive feedback, i.e., it should provide real time assessment of the quality of each task performed, suggesting corrective measures and alternative procedures. The goal of this project is to design, develop and evaluate the next generation ('Gen2') surgical simulators that will provide both cognitive and psycho-motor skill training. To accomplish the goals of the project, a multidisciplinary team has been assembled to achieve the following Specific Aims: SA1) To design and develop the fundamental technology behind Gen2 surgical simulators. SA2) To develop Gen1 and Gen2 simulators for the laparoscopic adjustable gastric banding (LAGB) procedure based on the emerging single incision laparoscopic surgical (SILS) approach. SA3) Establish the validity of Gen1 and Gen2 SILS LAGB simulators, as training tools by conducting experiments at the Skills Lab at Beth Israel Deaconess Medical Center (BIDMC) in Boston to ensure that the scores measured on the simulators reflect the technical skills they intend to measure. SA4) Evaluate the effectiveness of cognitive fidelity and feedback on surgical skills training and learning using the simulators by following the learning curves of subjects over time and measuring their skill retention and quality of diagnostic judgment after training on Gen1 and Gen2 SILS LAGB simulators. Success in our research will establish this technology as a potential standard in next generation surgery simulators and the technology developed will accrue benefits outside of surgical training, e.g., in the design of new surgical tools and surgical techniques. PUBLIC HEALTH RELEVANCE: The goal of this research is to develop and validate a comprehensive computer-based technology that will allow surgical trainees to practice their surgical skills on computer-based models. Surgical procedures and techniques, learnt and perfected in this risk-free manner before application to patients, will translate to fewer operating room errors, reduced patient morbidity and improved patient outcomes resulting in faster healing, shorter hospital stay and reduced post surgical complications and treatment costs.