In the course of developing a training simulator for puncture, a novel approach is proposed to render in realtime the ultrasound (US) image of any 3D model. It is combined with the deformation of the soft tissues (due to their interactions with a needle and a probe) according to their physical properties. Our solution reproduces the usual US artifacts at a low cost. It combines the use of textures and ray-tracing with a new way to efficiently render fibrous tissues. Deformations are handled in real-time on the GPU using displacement functions. Our approach goes beyond the usual bottleneck of real-time deformations of 3D models in interactive US simulation. The display of tissues deformation and the possibilities to tune the 3D morphotypes, tissue properties, needle shape, or even specific probe characteristics, is clearly an advantage in such a training environment.
Background There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. Methods Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups’ performance over two sessions. Results Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. Conclusion This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.
Background: General agreement exists upon the importance of acquiring laparoscopic skills outside the operation room. During the past two decades, simulation-based training and simulators have been more extensively used in surgeons’ training. Nevertheless learning through simulation-based systems is hindered by several flaws. High-fidelity simulators are cost-prohibitive which limits training opportunities. Their use also elicits a high cognitive load. Low-fidelity simulators lack in haptic, direct and summative feedback. Our goal is to develop a new low fidelity simulator integrating effective learning features as a new assessment variable while limiting the associated costs. We also aim at assessing its primary validity. Methods: We engineered a low fidelity simulator for teaching basic laparoscopic skills taking into account psychomotor skills, direct and summative feedback and engineering key features (haptic feedback and complementary assessment variables). Afterward, 77 participants with 4 different surgical skill levels (17 experts; 12 intermediates; 28 inexperienced interns and 20 novices) tested the simulator. We checked the content validity using a 10 point Likert scale. We also assessed the simulator discriminative power by comparing the 4 groups’ performance over two sessions. To do so, we used 3 variables: time, number of errors (collisions) and affine velocity. Results: The content validation mean value score was 7.57/10. The statistical analysis yielded performance discrepancies on the selected variables among the groups (p<0.001). Conclusion: We developed an affordable and validated simulator for testing and learning basic laparoscopic skills. The results exhibit three levels of performance on the selected variables. Experts and intermediates outperformed the inexperienced interns who in turn outperformed the novices. Results show that the embedded evaluation variables are complimentary and provide realistic results. The inclusion of a new variable and, meanwhile, haptic, direct and summative feedback is innovative regarding low-fidelity simulators. Limitations and implementation conditions of the simulator in the surgical curricula are discussed.
Articular and soft tissue punctions or injections are widely used for the diagnosis and the treatment of rheumatic disorders. Ultrasound is increasingly used to guide these interventions in order to correctly position the needle in the target area, and thereby improve the efficiency and safety of the procedure. During their learning, medical students need to practice in order to master the manipulation of the needle and the ultrasound probe at the same time and acquire enough skills before practicing in a real patient. To offer a risk-free training for apprentices, we present in this paper the design and development of a simulator based on Haptics and Virtual Reality. We described in particular two main aspects of our prototype: (i) the model of forces involved in the needle insertion and their haptic rendering; (ii) the 2D ultrasound image rendering of the virtual environment. Their combination provides the student with a realistic experience. An additional 3D view is also presented, that serves as pedagogical tool useful in the learning process. Experimental validation and preliminary evaluation by the medical partner show that our prototype exhibits sufficient stability and realism for a good immersion in the training scene.
This paper introduces the development of exercises to be embedded in a lightweight laparoscopic haptic simulator to help surgeons starting their training to Minimal Invasive Surgery (MIS) gestures. These exercises were created by observing professionals in operation rooms and by isolating key gestures, which have been combined to create desired trajectories with a slow learning curve. These exercises combine memory, new gestures, new environments and new visual feedback so that the trainees' cognitive load remains low. This favors an effective training. Hence, the simulator displays a simple 3D virtual environment in order to focus on the gestures and trajectories, performed on an haptic device by means of real MIS tool handles. Its ludic dimension, which make it a Serious Game, should help users to make progress in their first gesture training in order to continue on more evolved medical simulators. This paper introduces the software architecture analysis and the methods used for creating the exercises.
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