Physically Realistic Virtual Surgery

物理上真实的虚拟手术 摘要 虽然基于虚拟现实（VR）的手术模拟技术正在发展，以提高腹腔镜手术的成功率， 在手术室（OR）外的手术培训中，现有的模拟器主要集中在以下方面的技术技能（TS）： 手眼协调能力在孤立的任务中，很少与两者相关的非技术技能（NTS） 决策的认知技能，以及沟通，团队合作和冲突的人际交往技能 分辨率为了使基于虚拟现实的手术模拟器也能训练认知技能，在上一个资助期内， 我们成功地开发了下一代（Gen 2）腹腔镜手术模拟器， 使用头戴式显示器（HMD）系统在虚拟OR中训练受训者，并引入分心、中断 和其他压力源来捕捉真实的OR的高压力环境。然而，为了我们最好的 知识，目前还没有基于VR的模拟器来训练所需的人际交往技能， 手术室团队的多学科整合，包括外科医生、麻醉师和 围手术期护士在其他学科的不良事件显著减少之后，例如 航空，通过引入强制性的基于模拟的团队培训（例如，机组资源 管理），美国外科医师学会制定的国家外科技能课程 (ACS)和外科项目主任协会（APDS）规定了10项基于团队的培训， 将在仿真设施中执行的模块（例如，一个或endosuite），并在高- 逼真的人体模型模拟器。然而，这种基于设施的团队培训极其昂贵， 繁琐，需要专门的设施和教师的时间，并需要大量的规划和时间表 学员、技术人员和教员之间的协调。克服基于设施的手术室的挑战 团队培训，该项目的目标是扩展沉浸式VR技术（Gen 2）， 我们之前为整个OR团队提供单个用户的授权，并利用云计算的最新进展， 基于移动的设备的VR和人工智能以及机器学习来设计、开发和 评估虚拟手术室团队体验（VORTex）模拟系统。漩涡将允许 OR团队以分布式方式一起训练（即，不在同一个房间或模拟中 设施）佩戴基于移动的设备的HMD系统，以基于计算机生成的 模拟场景取代物理场景。将对模拟情景进行评估 由专家团队根据行动后回放异步进行。我们将实施VORTex， 腹腔镜胆囊切除术危机情景，由我们的Co-I Dan Jones博士在BIDMC开发和验证 并作为ACS/APDS国家外科技能课程的团队培训模块之一。我们 我假设VORTex至少与传统的基于设施的系统一样好，甚至更好 模拟为手术室团队提供非技术技能培训。

Physically Realistic Virtual Surgery Abstract While virtual reality (VR)-based surgical simulation technology is being developed to improve laparoscopic surgical training outside the operating room (OR), existing simulators focus mostly on technical skills (TS) of hand-eye coordination for isolated tasks and seldom on non-technical skills (NTS) associated with both cognitive skills of decision making, as well as interpersonal skills of communication, team-work and conflict resolution. To enable VR-based surgical simulators to also train for cognitive skills, in the previous grant period we successfully developed the next generation (Gen2) of laparoscopic surgical simulators that immerse the trainee in a virtual OR using a head-mounted display (HMD) system, and introduce distractions, interruptions and other stressors to capture the high-stress environment of the real OR. However, to the best of our knowledge, there exists no VR-based simulator for training interpersonal skills needed for the multidisciplinary integration of OR teams, which consist of surgeons, anesthesiologists, and perioperative nurses. Following the significant reduction of adverse events in other disciplines, such as aviation, by the introduction of mandatory simulation-based team training (e.g., crew resource management), the National Surgical Skills Curriculum developed by the American College of Surgeons (ACS) and Association of Program Directors in Surgery (APDS) has prescribed ten team-based training modules to be performed in a simulation facility (e.g., an OR endosuite) with scenario-based training on high- fidelity manikin simulators. However, such facility-based team training is extremely expensive and cumbersome, requires dedicated facility and faculty time, and entails significant planning and schedule coordination between trainees, technicians, and faculty. To overcome the challenges of facility-based OR team training, the goal of this project is to extend the immersive VR technology (Gen2) developed as part of our prior grant for a single user to the entire OR team, and harness recent advances in cloud computing, mobile device-based VR and artificial intelligence and machine learning to design, develop and evaluate a Virtual Operating Room Team Experience (VORTeX) simulation system. The VORTeX will allow the OR team to train together in a distributed fashion (i.e., not co-located in the same room or simulation facility) wearing mobile device-based HMD systems to develop further their NTS based on computer-generated simulation scenarios replacing the physical ones. Evaluation of the simulation scenarios will be performed asynchronously by a team of experts based on post-action replays. We will implement the VORTeX for a laparoscopic cholecystectomy crisis scenario, developed and validated by our Co-I Dr. Dan Jones at BIDMC and adopted as one of the team training modules of the ACS/APDS national surgical skills curriculum. We hypothesize that the VORTeX will be at least as good as or better than traditional facility-based simulation in providing non-technical skills training to OR teams.