Development and validation of a Virtual Colorectal Surgical Trainer (VCoST)

虚拟结直肠外科训练器(VCoST)的开发与验证 摘要 在外科历史上第一次，亲自动手的外科技能考试-结直肠 客观结构化技能评估(COSATS)，由美国职业技能学会开发 结肠和直肠外科医生(ASCR)-已在美国结肠和直肠委员会推出 外科医生(ABCRS)考试，从2014年开始。COSATS需要一个复杂的设置，有八个 不同的站，居民必须通过这些站进行五个开放的外科手术(直肠脱垂， 盆腔出血、回肠袋肛门吻合术、结肠肛门吻合术、手工缝合吻合术)，两例 腹腔镜术和结肠镜检查。预计基于计算机生成的虚拟现实(VR) 具有视觉和触觉(触觉)反馈的模拟器可以提供集成的培训和评估 为结直肠居民提供不会对实际患者构成风险的环境，使其能够攀登他们的“学习曲线”，标准化 技能培训和资格认证的过程，并允许对业绩进行客观量化，而无需 需要人类监督员。虽然VR模拟技术正在开发用于结肠镜检查和 腹腔镜手术过程中的三大技术障碍阻碍了基于VR的发展 开放式外科手术的模拟，如COSATS中的模拟：(1)完全沉浸式3D可视化 允许外科医生用手直接与病人的解剖结构互动，以及操纵 无系带手术工具；(2)接触检测、响应和物理的高保真稳定计算 模拟；以及(3)与虚拟解剖和自由手术的全手双手触觉交互 工具。在本提案中，我们的目标是克服这些挑战，并设计、开发和 首次评估虚拟结直肠外科训练器(VCoST)用于五项开放式外科任务 在COSATS中。为了实现我们的目标，我们已经组建了一个多学科的研究团队，以实现 具体目标如下：(SA1)开发VCoST平台。具体来说，我们将发展：(1)高度实事求是 在沉浸式3D高清(HD)头盔显示器中模拟五个开放的COSATS任务 (2)基于活体实验研究的物理模拟；(3)新型触觉界面 设备(具有触觉和力反馈)，允许与虚拟解剖进行逼真的全手交互 以及(4)实时评估和反馈。(Sa2)确定以下各项的有效性 VCoST作为培训工具。对自愿入学的受试者进行实验，建立面子和 VCoST的结构效度。我们假设VCoST任务，就像COSATS任务一样，将能够 区分普通外科和结直肠外科毕业实习医生的技能水平。(SA3)评估 VCoST作为培训工具的有用性。我们将进行学习、保持和迁移 关于VCoST的研究。我们假设，接受VCoST培训的住院医生将展示学习和 转移到临床环境中，会比对照组表现得更好。

Development and validation of a Virtual Colorectal Surgical Trainer (VCoST) Abstract For the first time in the history of surgery, a hands-on surgical technical skills examination – the Colorectal Objective Structured Assessment of Technical Skills (COSATS), developed by the American Society of Colon and Rectal Surgeons (ASCRS) – has been introduced in the American Board of Colon and Rectal Surgeons (ABCRS) examination, starting in 2014. The COSATS requires an elaborate setup with eight different stations through which residents must circulate to perform five open surgical tasks (rectal prolapse, pelvic bleeding, ileal pouch anal anastomosis, coloanal anastomosis, handsewn anastomosis), two laparoscopic and a colonoscopic task. It is anticipated that a computer generated virtual reality (VR)-based simulator with both visual and haptic (touch) feedback could provide an integrated training and evaluation environment for colorectal residents to climb their "learning curves" without risk to actual patients, standardize the process of skill training and credentialing and allow objective quantification of performance, without the need for human proctors. While VR simulation technology is being developed for colonoscopy and laparoscopic surgical procedures, three major technical hurdles have thwarted the development of VR-based simulation of open surgical procedures, such as the ones in COSATS: (1) fully immersive 3D visualization to allow surgeons to interact with the patient’s anatomy directly using their hands as well as manipulate untethered surgical tools; (2) high fidelity stable computations for contact detection, response and physical simulations; and (3) full-hand bi-manual haptic interactions with the virtual anatomy and untethered surgical tools. Our aim, in this present proposal, is to overcome these challenges and design, develop, and evaluate, for the first time, a Virtual Colorectal Surgical Trainer (VCoST) for the five open surgical tasks in the COSATS. To achieve our goal, a multidisciplinary research team has been assembled to achieve the following specific aims: (SA1) Develop a VCoST platform. Specifically, we will develop: (1) highly realistic simulation of the five open COSATS tasks within an immersive 3D high definition (HD) head mounted display (HMD) system; (2) physics-based simulations based on in vivo experimental studies; (3) novel haptic interface devices (with both tactile and force feedback) that allow realistic full-hand interactions with the virtual anatomy and untethered surgical tools; and (4) real time assessment and feedback. (SA2) Establish the validity of the VCoST as a training tool. We will conduct experiments on voluntarily enrolled subjects to establish face and construct validity of the VCoST. We hypothesize that the VCoST tasks, like the COSATS tasks, will be capable of distinguishing the skill levels of graduating general surgery and colorectal surgery residents.(SA3) Evaluate the usefulness of the VCoST as a training tool. We will perform learning, retention, and transfer-of-learning studies on the VCoST. We hypothesize that residents who trained with VCoST will demonstrate learning and transfer in the clinical environment, and will perform better than a control group.