Author reply

Adding Safety Rules to Surgeon-Authored Virtual Reality Training

“…The design adds dynamic, customizable, or entirely new safety rules via the instantaneous authoring process rather than via standard hard-coded rules. An accompanying video 23 demonstrates that and how the implementation achieves this objective.…”

“…Each respondent completed a simulated cholecystectomy module, that is, a complex sequence of surgical steps where only the goal, complete mobilization of the organ, and safe preparation of the remainder, were prescribed. That is, individual motions were not prescribed or measured, allowing for multiple correct choices of tools and sequence, for example, of applying clips to the cystic duct and blood vessels; however, the number of clips on the part of the duct and vessel remaining in the body (and no clip lost) were tracked as a safety measure (see minute 1:10 to 1:20 23 , show clip application). After completing the simulated cholecystectomy training module, the 64 respondents rated TIPS across several usability items on a Likert scale from 1 to 7 (7 = strongly agree, see the study by Black et al 35 ).…”

“…See for example cholecystectomy ensemble in Figure 3: a gall bladder, cystic duct, cystic artery, and the fatty tissue covering them (each with their unique Young's modulus, etc) combine via constraints to form a cholecystectomy simlet that is selected via TIPS-author. In our implementation, the web-based TIPS-author interface autocompletes typed items, once they are recognized to be in the database and thereby steers the author toward existing individual or compound simlets 23 . Both the listing of steps and the resulting simulation is peer reviewed for completeness and relevance before rollout to the trainees.…”

“…Four types of common surgical errors in laparoscopic cholecystectomy reported by TIPS-simulator. For immediate feedback, the tool tip becomes red (see ⇓) and the scene briefly freezes 23 . A, Wrong incision on common bile duct.…”