A virtual reality based surgical skills training simulator for catheter ablation with real-time and robust interaction

Background Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia that can cause severe heart problems.Catheter ablation is one of the most ideal procedures for the treatment of AF.Physicians qualified to perform this procedure need to be highly skilled in manipulating the relevant surgical devices.This study proposes an interactive surgical simulator with high fidelity to facilitate efficient training and low-cost medical education.Methods We used a shared centerline model to simulate the interaction between multiple surgical devices.An improved adaptive deviation-feedback approach is proposed to accelerate the convergence of each iteration.The periodical beating of the human heart was also simulated in real time using the position-based dynamics(PBD)framework to achieve higher fidelity.We then present a novel method for handling the interaction between the devices and the beating heart mesh model.Experiments were conducted in a homemade simulator prototype to evaluate the robustness,performance,and flexibility of the proposed method.Preliminary evaluation of the simulator was performed by medical students,residents,and surgeons.Results The interaction between surgical devices,static vascular meshes,and beating heart mesh was stably simulated in a frame rate suitable for interaction.Conclusion Our simulator is capable of simulating the procedure of catheter ablation with high fidelity and provides immersive visual experiences and haptic feedback.

Hanging up the surgical cap:Assessing the competence of aging surgeons

BACKGROUND As the average age of surgeons continues to rise,determining when a surgeon should retire is an important public safety concern.AIM To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.METHODS We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety.The mandatory age and certification process,including cognitive and physical requirements,were reported for each profession.Methods for determining surgical competency currently in use,and those existing in the literature,were also identified.RESULTS Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified:Airline pilots,air traffic controllers,firefighters,and United States State Judges.Nine late career practitioner policies designed to evaluate the ageing physician,including surgeons,were described.Six of these policies included subjective performance testing,4 using peer assessment and 2 using dexterity testing.Six objective testing methods for evaluation of surgeon technical skill were identified in the literature.All were validated for surgical trainees.Only Objective Structured Assessment of Technical Skills(OSATS)was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.CONCLUSION A surgeon should not be forced to hang up his/her surgical cap at a predetermined age,but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency.The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’surgical competency,showing who may require remediation or retirement.

Virtual reality simulator for training urologists on transurethral prostatectomy

Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate （TURP） are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated. Methods Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSimTM system. Pre and post-training global rate scale （GRS） scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out. Results Compared with baseline levels, the GRS scores of trainees increased （18.0±4.0 vs. 12.4±4.2, P 〈0.001）, while the rate of capsule resection （26.3%±0.6% vs. 21.2%±0.4%, P 〈0.001）, amount of blood loss （（125.8±86.3） ml vs. （83.7±41.6） ml, P 〈0.001）, external sphincter injury （3.6±2.9 vs. 2.0±2.0, P 〈0.001 ） decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills. Conclusions As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSimTM system in education and training of urologic surgery is warranted.