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

项目摘要 胃食道反流病(GERD)在美国很流行，大约20%的人会受到影响 并导致生活质量下降。如果不治疗，GERD可能会导致并发症 如食管炎、巴雷特氏食管炎和食管腺癌。裂孔疝气是一种 腹壁内容物，主要是胃，通过腹壁突出的状态 指的是横隔膜上的食道进入胸腔的孔。一种强有力的联系是 建立在裂孔疝气和胃肠道反流病之间。此外，裂孔的存在 疝气会使患食道癌的风险增加一倍。85%的裂孔疝气病例为I型和5型- 15%的病例是II-IV型食道旁疝气，如果不治疗，除了 诱发GERD，也可导致突出物缺血或扭转。腹腔镜术 裂孔疝气手术是一种微创手术，使用专门的工具通过 腹部有五个小伤口。这是一种先进的普通外科手术程序，具有 学习曲线者约50例，复发率低。目前正在为此进行培训 手术是通过有限的奖学金进行的，不存在动物、身体或虚拟现实 在此特定程序中进行培训的模拟器。虚拟现实模拟器提供了标准化的 在培训环境中，一个程序可以反复练习以获得熟练程度。他们 还可以在不受任何主观影响的情况下自动评估绩效。要解决这个问题 在培训中的差距，为腹腔镜裂孔疝气手术，我们建议开发虚拟 具有逼真建模技术、功能的腹腔镜裂孔疝模拟器(VLaHHS) 为了模拟III型裂孔疝气，定制了双手指力反馈(触觉)界面。这个 在该项目中开发的VLaHHS也将有助于培训外科医生进行抗反流手术 治疗胃肠道反流病。我们提出了三个具体目标来实现和证明我们的 模拟器。在AIM 1中，我们将开发使用组织属性和实时 模拟变形的过程。我们将开发定制的触觉设备来提供力量 反馈。在目标2中，我们将开发、模拟场景和度量，并集成到VLaHHS中。 在目标3中，我们将进行验证研究，以证明关于VLaHHS的培训将导致改善 性能。这项研究最终将减少手术错误并改善 病人安全。

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.