A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery

Abstract

PurposeSmaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors.MethodsFace and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario.ResultsThe trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill.ConclusionThe developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.

From a Disposable Ureteroscope to an Active Lightweight Fetoscope—Characterization and Usability Evaluation

“…A mixed-reality simulator was used to simulate a realistic TTTS treatment [20]. The trainer is composed of physical and virtual components.…”

“…They were asked to compare two instruments : 1) an original LithoVue of which the proximal part was shortened and made stiffer by adding a rigid shaft and 2) the proposed active LithoVue fetoscope. The surgeons were asked to test both instruments in virtual reality, using a validated simulator [20]. Then, they were asked to fill in a questionnaire to evaluate the ergonomics and the ease of manipulation of these instruments.…”

“…User experiments with shortened rigidified LithoVue and active LithoVue fetoscope using virtual reality simulator[20]. 1) Simulator box with integrated force sensor and electromagnetic tracking system; 2) Instrument with integrated electromagnetic sensor; 3) Screen displaying the artificially generated images of the placenta.…”

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“…47 This raises questions about the viability of smaller programmes, and emphasises the need for appropriate high-fidelity training models for this (and other) fetal procedures. 48,49 Imaging, and increasingly MRI, is key in selecting cases suitable for fetal therapy as it is used for planning, simulating, and optimising fetal surgery. An early application is likely to be in the treatment of twin-to-twin transfusion syndrome where a combination of Doppler and MRI are used to determine placenta and vascular structure, 50 and, using computer vision and deep learning techniques, the ideal entry point and the laser trajectory can be determined.…”

Application of Mixed Reality Technology in Visualization of Medical Operations

“…In the past two years, with the development of France presented a live webcast of shoulder prosthesis implantation through a mixed reality device. Javaux A et al 13 from University of Leuven in Belgium developed a mixed realistic surgical trainer for minimally invasive fetal laser surgery, which had been used to train surgeons for the purpose of improving their surgical skills.…”