Enhancing robotic head and neck surgical skills using stimulated simulation

利用模拟仿真提高机器人头颈手术技能 摘要 我们建议将模拟模拟作为加速基于模拟器的培训的下一个范例 使用非侵入性脑刺激的经口腔机器人手术(TORS)。TORS是一种微创的 耳鼻喉科领域正在迅速采用的技术--头颈部手术切除 治疗咽喉部的良、恶性肿瘤以及治疗阻塞性睡眠呼吸暂停。作为一种相对的 新的和复杂的程序，外科医生正在学习在他们的实习结束后进行Tors手术，主要是在 团契之年。然而，Tors有一个陡峭的学习曲线，至少需要20-35个案例来 达到基本的熟练程度。没有系统的课程或有效的模拟平台，大多数新手 外科医生目前在为活体患者进行手术时达到了20-35例的基准。因此，积极的 低体积中心的口咽癌的切缘(即肿瘤未完全切除)比率为 在大容量设施中，这一数字是这一数字的两倍。用于机器人的商用任务训练器和虚拟现实模拟器 外科手术有四个主要缺陷：(I)它们没有为受训人员做好准备，以便在医院的有限空间内手术 口咽和不提供Tors所需的特定程序技能，如组织处理， 回缩，或使用电灼术进行解剖；(Ii)它们依赖于平台-培训基本的机器人技能 达芬奇平台(Intuitive Surgical，加利福尼亚州桑尼维尔)，尽管目前有两个平台获得FDA批准 TORS，第三个正在等待批准，(Iii)它们很昂贵，仅限于最富裕的中心使用 以及(Iv)除了暴力反复练习之外，它们没有提供任何加速技能获得的机制。 为了解决这些限制，我们将设计、开发和验证第一个虚拟口腔机器人 手术(VTORS)模拟器，用于培训TRS程序和使用经颅直流电 刺激(TDC)，一种安全有效、成熟、商用、可穿戴的非侵入性脑 一种刺激技术，使用施加在头皮上的极低直流电流(&lt；4 mA)来调节皮质 兴奋性，加速手术技能的获得。我们已经组建了一支高度跨学科的团队 研究人员要实现该项目的两个目标：(SA1)设计、开发和验证高分辨率， 超低成本、多功能且与平台无关的虚拟口腔手术机器人(VTORS)模拟器 TORS舌根切除术；和(SA2)经颅直流电显示训练效率 刺激(TDCs)(即刺激模拟)与假刺激的比较。 基于现成的虚拟现实(VR)和tDCS技术的最新发展，以及开放的 源码仿真软件，模拟仿真有潜力成为培训首选 范式-同时提高技能和加速技能获得-对于复杂的精神运动技能， 包括外科手术、航空、驾驶、体育和音乐。

Enhancing robotic head and neck surgical skills using stimulated simulation Abstract We propose stimulated simulation as the next paradigm for accelerating simulator-based training of transoral robotic surgery (TORS) using noninvasive brain stimulation. TORS is a minimally invasive technology that is seeing rapid adoption in the field of otolaryngology - head and neck surgery to resect benign and malignant tumors of the pharynx and larynx as well as treat obstructive sleep apnea. As a relatively novel and complex procedure, surgeons are learning to perform TORS after their residency, mostly during a fellowship year. However, TORS has a steep learning curve, with a minimum of 20-35 cases needed to achieve basic proficiency. Without a structured curriculum or effective simulation platform, most novice surgeons currently reach the 20-35 case benchmark while operating on live patients. Consequently, positive margin (i.e., the tumor is not entirely removed) rates for oropharyngeal cancers in low-volume centers are twice that in high-volume facilities. Commercially available task trainers and virtual reality simulators for robotic surgery have four major deficiencies: (i) they do not prepare trainees to operate in the confined space of the oropharynx and do not provide the procedure-specific skills necessary for TORS, such as tissue manipulation, retraction, or dissection using electrocautery; (ii) they are platform-dependent – training basic robotic skills for the da Vinci platform (Intuitive Surgical, Sunnyvale, CA), though two platforms are currently FDA approved for TORS, and a third one is waiting for approval, (iii) they are costly, limiting their use to the most affluent centers and (iv) they offer no mechanism to accelerate skill acquisition beyond brute-force repeated practice. To address these limitations, we will design, develop, and validate the first Virtual Transoral Robotic Surgical (VTORS) simulator for training TORS procedures and use transcranial direct current stimulation (tDCS), a safe and effective, well-established, commercially available, wearable noninvasive brain stimulation technique that uses very low direct current (<4mA) applied to the scalp to modulate cortical excitability, to accelerate the surgical skill acquisition. We have assembled a highly interdisciplinary team of researchers to accomplish the two aims of the project: (SA1) Design, develop and validate a high-resolution, ultra-low-cost, versatile, and platform-independent Virtual Transoral Robotic Surgical (VTORS) simulator for TORS tongue base resection; and (SA2) Demonstrate the training efficiency with transcranial direct current stimulation (tDCS) (i.e., stimulated simulation) compared with sham stimulation. Based on the latest developments in off-the-shelf virtual reality (VR) and tDCS technology and open- source simulation software, stimulated simulation has the potential to become the preferred training paradigm – simultaneously improving skills and accelerating skill acquisition - for complex psychomotor skills, including surgery, aviation, driving, sports, and music.