Physically Realistic Virtual Surgery

描述（由申请人提供）：虽然预期具有视觉和触觉（触摸）反馈的计算机生成的基于虚拟现实（VR）的手术模拟器将显著改善微创手术（MIS）训练，从而导致手术室（OR）错误和患者发病率的大幅减少，但由于以下主要缺点，现有模拟器尚未在医学界被广泛接受：（1）它们缺乏真实的时间中的外科手术工具-软组织相互作用的基于物理学的仿真算法;（2）计算器官模型不是牢固地基于实验数据;以及（3）它们主要提供心理运动技能训练，即，手眼协调和运动技能方面的训练，这些技能是工具移动、切割、切割等任务所必需的，而与工作量管理、计划、沟通、决策和解决问题等高级心理功能相关的认知技能方面的训练很少。在上一个资助期，我们专注于问题（1）和（2），而在这个更新提案中，我们计划合理地扩展我们的工作，并主要集中在最后一个问题上。基于成人学习理论[LaWe 91]和飞行模拟技术文献[Le 05]，我们认为下一代（'Gen 2'）手术模拟器必须提供认知和心理运动技能训练。认知技能训练转化为以下两个基本要求：（1）认知保真度，即，模拟器环境应该尽可能接近地复制OR中的高压力环境，以及（2）认知反馈，即，它应该对每项任务的质量进行真实的评估，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（“Gen 2”）手术模拟器，该手术模拟器将提供认知和心理运动技能培训。为了实现该项目的目标，组建了一个多学科团队，以实现以下具体目标：SA 1）设计和开发Gen 2手术模拟器背后的基本技术。SA 2）基于新兴的单切口腹腔镜手术（锡尔斯）方法，开发第1代和第2代腹腔镜可调节胃束带（LAGB）手术模拟器。SA 3）通过在波士顿Beth Israel Deaconess Medical Center（BIDMC）的技能实验室进行实验，确定Gen 1和Gen 2锡尔斯LAGB模拟器作为培训工具的有效性，以确保在模拟器上测量的分数反映他们打算测量的技术技能。SA 4）通过跟踪受试者随时间的学习曲线，并在Gen 1和Gen 2锡尔斯LAGB模拟器上进行培训后测量其技能保持率和诊断判断质量，评价认知保真度和反馈对使用模拟器进行手术技能培训和学习的有效性。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，新手术工具和手术技术的设计。

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.