Purpose: Within a scope of a cooperative project called “HapticIO” (funded by the German Ministry of Education and Research (BMBF)), a completely new force feedback device “IOMaster 7D” was intended to be developed for simulation of endoscopic ventriculo-cisternostomy (VCS). Methods: A VR model for endoscopic ventriculostomy was generated based on a MRI data set of a real hydrocephalic brain. Different software modules were used for segmentation (VESUV), modelling (KisMo) and visualization (KISMET). The software modules were implemented on a WIN32 platform and are running on Windows-NT, Win2000 or WinXP. A force feedback system for capturing of the position of both the trocar and the acting instrument was developed. Large arms are counterbalanced to reduce gravitational forces and torques. The position and orientation of the input handle is determined by taking the joint angles of the linkages and using the forward kinematics calculation. Force data returned by the simulation is mapped to a set of torques to be produced by the motors by using a so-called Jacobian transformation. Real microsurgical instruments (MINOP, Aesculap, Germany) were used and adapted to the simulator to provide for a design and haptic properties close to real situation in the OR. The system was evaluated in a pilot series. Results: The force feedback system IOMaster 7D offers 7 degrees of freedom and consists of two coupled force feedback elements. Both the trocar and the acting instruments (scissor, bipolar coagulation, forceps, inflatable balloon catheter) are captured separately. In this way, the trocar's position determines the view of the endoscopic 30° lens camera, the access to the target and the possible operating range of the instruments. A complex elastodynamic hydrocephalic configured ventricular system with realistic proportions and anatomical structures could be modelled. An interactive virtual preparation with force feedback was implemented coupling real surgical instruments (MINOP) with the force feedback system. The VR system provides different interactions like axial movement or rotation of the instruments, cutting, grasping as well as realistic elastodynamic deformations of the ventricle wall. First evaluations proved a reduction of the median failure rate and a reduction of the median required time to reach the target. Analysis of the total distance of instruments movement also showed a reduction. Conclusion: VR systems can simulate realistic and real-time surgical procedures and may open new perspectives for the neurosurgical training. The training of potentially hazardous procedures can be uncoupled from the patient resulting in a reduction of surgical morbidity. The integration of haptic information increases the quality of these training systems. The definition of no-touch areas and targets and the possibility of automatic registration of both kinetic parameters, failure rate and the time course of the procedure provide objective criteria for the appreciation of a learning effect.
"realistic milling properties of the bone, the detection of damaging structures at risk during the simulation, different pathology, the realistic operating room environment and the use of the surgical instrument being also used during the real surgery with a single system , , . Virtual simulators need complex computer models to simulate the above mentioned properties . It is easier to implement this with physical phantoms, since polyurethane infiltrated plaster has realistic properties for milling applications on bone structures. "
[Show abstract][Hide abstract] ABSTRACT: This paper describes the ElePhant (Electronic Phantom)-an anatomical correct simulation system based on 3D rapid prototyping models for the otologic intervention "Mastoidectomy". The anatomical structures of the head are created with plaster as base material using 3D-printing as rapid prototyping technology (RPT). Structures at risk, represented by electrically conductible material and fiber optics, are realized as an electric circuit and can be detected during the simulation of the surgical procedure. An accuracy study of 15 identical RPT-models compared to the 3D reconstructed CT-dataset of the patient showed that the mean accuracy is lower than the reconstructed CT layer thickness of 0.5 mm. An evaluation study of the ElePhant-system for "Mastoidectomy" was performed by 7 ENT-surgeons. The mean value of the study questionnaire (evaluation range from -2 (not at all) to +2 (very good)) was +1.2. The results showed that the ElePhant can simulate "Mastoidectomy" realistically. It is especially suitable for the simulation of the correct representation and position of the anatomical structures, realistic operation setting, and realistic milling properties of the bone structure. Furthermore it is applicable for training of surgeons.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2006; DOI:10.1109/IEMBS.2006.260542
[Show abstract][Hide abstract] ABSTRACT: The introduction of robot-assisted surgery into the operating room has revolutionized the medical field. These systems not only have the advantages of traditional minimally invasive surgery (MIS), such as reduced patient trauma and recovery time, lower morbidity, and lower health care costs, but they also eliminate surgeon tremor, reduce the effects of surgeon fatigue, and incorporate the ability to perform remote surgical procedures. However, current robotic surgical systems, such as the Da Vinci™ Surgical System, lack the capability of providing force feedback to the surgeon that is present in conventional surgery. Therefore, this lack of force feedback presents excellent developmental opportunities for surgeons and engineers to create novel surgical tools and methods to incorporate force feedback capabilities into these robotic surgical systems. The goal of this research is to restore force feedback capability to the surgeon in robot-assisted surgery through a haptic interaction experience involving force feedback from the surgical site using our novel teleoperation platform. This dissertation will summarize our research including: 1) the development of an automated laparoscopic grasper with force sensing capabilities, 2) a novel seven degree-of-freedom (DOF) haptic device with 4 degrees of force feedback with direct applications to robot-assisted surgery, 3) human subject studies to evaluate the addition of force feedback to robotic soft tissue characterization, 4) integration of the Mitsubishi PA-10 robot arm and laparoscopic grasper with a seven degree-of-freedom haptic device as a teleoperation platform, and 5) preliminary teleoperation experiments to evaluate the force feedback capabilities of the platform. Our results show the addition of force feedback to robot assisted surgery leads to better tissue characterization than using only vision feedback. In addition, providing force feedback in our teleoperation platform lowers the peak forces in surgical knot tying tasks.
[Show abstract][Hide abstract] ABSTRACT: Functional endoscopic sinus surgery is a minimally invasive technique that is carried out in high numbers. It combines an excellent outcome with minimal patient discomfort. Due to the anatomy, the procedure implies a high risk for the patient concerning the orbita and skull base. This problem and the level of costs in surgical training prompted us to develop a virtual training system coupled with a force feedback device for endoscopic sinus surgery. A pilot series with 10 inexperienced surgeons showed that the simulation is close to reality in parameters like aspect, anatomy, property of tissue and perceived resistance. The system opens up new perspectives in surgical training.
International Congress Series 05/2005; 1281:527-530. DOI:10.1016/j.ics.2005.03.184
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