Application Experience of Eyesi Operation Simulation Training System in the Teaching of Cataract Surgery for Ophthalmology Masters

Objective:To explore the application effect of the Eyesi surgical simulator in the teaching of cataract surgery for professional ophthalmology postgraduate students.Methods:The professional postgraduate students who were trained in the third year of ophthalmology at the First Affiliated Hospital of Xi’an Medical University were selected as the research objects.After passing the theoretical examination,they were randomly divided into the pig eyeball group,Eyesi group,and pig eye+Eyesi group,with 5 students in each group.The pig eyeball,Eyesi surgery simulator,and pig eye+Eyesi surgery simulator were used for microscopic technique operation and cataract surgery steps training,respectively.After the training,the overall training effects of the three groups of postgraduates were scored,and questionnaires were used to objectively evaluate the three training methods.Results:The scores of the students in the pig eye+Eyesi group were better than those in the Eyesi group,and the students in the Eyesi group were better than those in the pig eyeball group.Conclusion:The Eyesi surgical simulation training system can evaluate the microsurgical skills of professional masters and improve their surgical skills.This system is of great significance for the training of the cataract surgery skills of professional masters.

Three-dimensional visualization and virtual reality simulation role in hepatic surgery:Further research warranted

Artificial intelligence(AI)is the study of algorithms that enable machines to analyze and execute cognitive activities including problem solving,object and word recognition,reduce the inevitable errors to improve the diagnostic accuracy,and decision-making.Hepatobiliary procedures are technically complex and the use of AI in perioperative management can improve patient outcomes as discussed below.Three-dimensional(3D)reconstruction of images obtained via ultrasound,computed tomography scan or magnetic resonance imaging,can help surgeons better visualize the surgical sites with added depth perception.Preoperative 3D planning is associated with lesser operative time and intraoperative complications.Also,a more accurate assessment is noted,which leads to fewer operative complications.Images can be converted into physical models with 3D printing technology,which can be of educational value to students and trainees.3D images can be combined to provide 3D visualization,which is used for preoperative navigation,allowing for more precise localization of tumors and vessels.Nevertheless,AI enables surgeons to provide better,personalized care for each patient.

Virtual brain surgery simulation system based on haptic interaction

To improve the accuracy and interactivity of soft tissue deformation simulation,a new plate spring model based on physics is proposed.The model is parameterized and thus can be adapted to simulate different organs.Different soft tissues are modeled by changing the width,number of pieces,thickness,and length of a single plate spring.In this paper,the structural design,calculation of soft tissue deformation and real-time feedback operations of our system are also introduced.To evaluate the feasibility of the system and validate the model,an experimental system of haptic interaction,in which users can use virtual hands to pull virtual brain tissues,is built using PHANTOM OMNI devices.Experimental results show that the proposed system is stable,accurate and promising for modeling instantaneous soft tissue deformation.

Need for simulation in laparoscopic colorectal surgery training

The dissemination of laparoscopic colorectal surgery(LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal andhuman tissue and synthetic materials. Studies have even demonstrated an improvement in trainees' laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting.

3D Cohesive Finite Element Minimum Invasive Surgery Simulation Based on Kelvin‑Voigt Model

Minimally invasive surgery is an important technique used for cytopathological examination.Recently,multiple studies have been conducted on a three-dimensional(3D)puncture simulation model as it can reveal the internal deformation state of the tissue at the micro level.In this study,a viscoelastic constitutive equation suitable for muscle tissue was derived.Additionally,a method was developed to define the fracture characteristics of muscle tissue material during the simulation process.The fracture of the muscle tissue in contact with the puncture needle was simulated using the cohesive zone model and a 3D puncture finite element model was established to analyze the deformation of the muscle tissue.The stress nephogram and reaction force under different parameters were compared and analyzed to study the deformation of the biological soft tissue and guide the actual operation process and reduce pain.

A Novel Twist Deformation Model of Soft Tissue in Surgery Simulation

Real-time performance and accuracy are two most challenging requirements in virtual surgery training.These difficulties limit the promotion of advanced models in virtual surgery,including many geometric and physical models.This paper proposes a physical model of virtual soft tissue,which is a twist model based on the Kriging interpolation and membrane analogy.The proposed model can quickly locate spatial position through Kriging interpolation method and accurately compute the force change on the soft tissue through membrane analogy method.The virtual surgery simulation system is built with a PHANTOM OMNI haptic interaction device to simulate the torsion of virtual stomach and arm,and further verifies the real-time performance and simulation accuracy of the proposed model.The experimental results show that the proposed soft tissue model has high speed and accuracy,realistic deformation,and reliable haptic feedback.

Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation

AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions:viewing 3D models from arbitrary directions,changing the colors and opacities of the models,deforming the models based on user interaction,and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013,99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013,11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim wasused. Furthermore,medical students and surgical residents were asked to complete questionnaires regarding the new software.RESULTS:There were no obvious discrepancies(i.e.,the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min(range,110 to 846) in the VINCENT group and 397 min(range,232 to 497) in the Liversim group(P = 0.30). The median amount of intraoperative bleeding was 510 m L(range,18 to 5120) in the VINCENT group and 470 m L(range,130 to 1600) in the Liversim group(P = 0.44). The median postoperative stay was 12 d(range,6 to 100) in the VINCENT group and 13 d(range,9 to 21) in the Liversim group(P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that the Liversim image was almost the same as the actual hepatectomy.CONCLUSION:Virtual hepatectomy with real-time deformation of the liver using Liversim is useful for the safe performance of hepatectomies and for surgical education.

Patients' specific simulations of coronary fluxes in case of three-vessel disease

In this work, we propose a model of the coronary circulation based on hydraulic/electric analogy. This model aims to provide quantitative estimations of the distribution of flows and pressures across the coro-nary network for patients with stenoses of the left main coronary artery (LMCA), left anterior de-scending artery (LAD) and left circumflex branch (LCx), and chronic occlusion of the right coronary artery (RCA), undergoing off-pump coronary sur-gery. The results of the simulations are presented for 10 patients with various stenoses grades and collat-eral supply. For each patient, the four revasculariza-tion situations (no graft operating, pathological situa-tion (0G);right graft only (1G), left grafts only (2G), complete revascularization (3G)) are considered. It is shown that: 1) the complete revascularization is fully justified for these patients because neither the right graft alone, nor the left grafts alone can ensure a suf-ficient perfusion improvement for the heart;2) the capillary and collateral resistances (and the propor-tion between them) have a major impact on the flows and pressures everywhere in the network;3) in the presence of the left grafts, the flows in the native stenosed arteries become low and this could promote the development of the native disease in these branches.

Understanding the effects of structured self-assessment in directed,self-regulated simulation-based training of mastoidectomy:A mixed methods study

Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.Methods:A prospective,educational cohort study of a novice training program consisting of directed,self-regulated learning with distributed practice(5x3 procedures)in a virtual reality temporal bone simulator.The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos.Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants.Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’self-assessment scores.Results:Six major themes were identified in the interviews:goal-directed behaviour,use of learning supports for scaffolding of the training,cognitive engagement,motivation from self-assessment,selfassessment bias,and feedback on self-assessment(validation).Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure.They scaffolded their learning through the available learning supports.Finally,structured self-assessment was reported to increase the participants’cognitive engagement,which was further supported by a quantitative increase in cognitive load.Conclusions:Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.

Orthopaedic education in the era of surgical simulation: Still at the crawling stage

Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills. Although the need for a simulationbased curriculum in orthopaedic surgery is clear, several obstacles need to be overcome for a smooth transformation. The main issues to be addressed can be summarized as defining the skills and procedures so that simulation-based training will be most effective; choosing the right time period during the course of orthopaedic training for exposure to simulators; the right amount of such exposure; using objective, valid and reliable metrics to measure the impact of simulation-based training on the development and progress of surgical skills; and standardization of the simulation-based curriculum nationwide and internationally. In the new era of surgical education, successful integration of simulation-based surgical skills training into the orthopaedic curriculum will depend on efficacious solutions to these obstacles in moving forward.

Using simulation to train orthopaedic trainees in non-technical skills: A pilot study

AIM: To enhance non-technical skills and to analyse participant's experience of a course tailored for orth-opaedic surgeons.METHODS: A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents(six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire(strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself.RESULTS: Twenty-six orthopaedic residents participated(24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showedthat while the majority of candidates recognised the importance of non-technical(NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course(Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the course achieved its intended aims with realistic simulation scenarios. Participants believed patient care, patient safety and team working would all improve with further human factors training(4.4-4.6). and felt that NT skills learnt through simulation-based training should become an integral component of their training program.CONCLUSION: Participants demonstrated improved understanding of non-technical performance, recognised its relevance to patient safety and expressed a desire for its integration in training.

Computer-Aided Simulation of Mastoidectomy

Objective To establish a three-dimensional model of the temporal bone using CT scan images for study of temporal bone structures and simulation of mastoidectomy procedures. Methods CT scan images from 6 individuals (12 temporal bones) were used to reconstruct the Fallopian canal, internal auditory canal, cochlea, semicircular canals, sigmoid sinus, posterior fossa floor and jugular bulb on a computer platform. Their anatomical relations within the temporal bone were restored in the computed model. The same model was used to simulate mastoidectomy procedures. Results The reconstructed computer model provided accurate and clear three-dimensional images of temporal bone structures. Simulation of mastoidectomy using these images provided procedural experiences closely mimicking the real surgical procedure. Conclusion Computer-aided three dimensional reconstruction of temporal bone structures using CT scan images is a useful tool in surgical simulation and can aid surgical procedure planning.

A Three-Stage Cutting Simulation System Based on Mass-Spring Model

The cutting simulation of soft tissue is important in virtual surgery.It includes three major challenges in computation:Soft tissue simulation,collision detection,and handling,as well as soft tissue models.In order to address the earlier challenges,we propose a virtual cutting system based on the mass-spring model.In this system,MSM is utilized to simulate the soft tissue model.Residual stress is introduced to the model for simulating the shrinking effect of soft tissue in cutting.Second,a cylinder-based collision detection method is used to supervise the collision between surgical tools and soft tissue.Third,we simulate the cutting operation with a three-stage cutting method with swept volume,B´ezier curve,and an algorithm named shortest distance nodes matching method.In order to verify the system performance,we carry out three validation experiments on the proposed system:Cutting accuracy experiment,collision detection validation,and practical cutting evaluation.Experiments indicate that our system can well perform the shrinking effect of soft tissue in cutting.The system has fast and accurate collision detection.Moreover,the system can reconstruct smooth incisions vividly.

Three-dimensional image simulation of primary diaphragmatic hemangioma: A case report

BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional(3D)simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.CASE SUMMARY A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.CONCLUSION In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.

Three-Dimensional Cerebral Aneurysm Models for Surgical Simulation and Education—Development of Aneurysm Models with Perforating Arteries and for Application of Fenestrated Clips

We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.

Vitreoretinal surgical training-assessment of simulation,models,and rubrics-a narrative review

Background and Objective:Vitreoretinal surgery requires fine micro-surgical training and handling of delicate tissue.To aid in the training of residents and fellows,unique educational modalities exist to help facilitate the development of these microsurgical skills.From virtual simulators to artificial eye models,simulation of the posterior segment has gained an increased focus in vitreoretinal surgical training programs.Development of surgical curricula for vitreoretinal training and attainment of surgical milestones has been a key component in integrating these educational training modalities.We will explore various simulators,eye models,and potential rubrics and discuss unique ways each may help and complement one another to train future vitreoretinal surgeons.Methods:We conducted a systematic PubMed search of various review studies(from publications in English ranging from January 1978 to December 2020)discussing surgical simulators,eye models,and surgical rubrics for vitreoretinal surgery and their potential impacts upon training.Key Contents and Findings:Our review assesses the benefits and applicability of various simulators,eye models,and surgical rubrics upon training.Conclusions:Utilization of vitreoretinal surgical training tools may aid in complementing the hands-on surgical training experience for vitreoretinal surgical fellows.By using simulators and rubrics,we may better be able to standardize training for reaching vitreoretinal surgical milestones and providing adequate feedback to improve surgical competency and ultimately patient outcomes.

Robotic4all project:Results of a hands-on robotic surgery training program

Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and experience.Our aim was to study the impact of a robotic introduction training program on gesture performance,such as suturing,in robot-naive individuals.Methods Using the DaVinci robot,a 2-hour program was based on virtual reality and anatomical model exercises.All participants performed 3 repetitions of virtual reality exercises on the virtual simulator,and then performed and were assessed on 2 tests,ie robot and laparoscopic training box.After the course,the participants were surveyed for this training program.Results Twenty-seven residents and surgeons were enrolled in the training program.With only 2 hours of training,all of the participants were able to complete the training program,thus learning generic and specific skills in robotic surgery.In virtual reality exercise,the scores of the 3 exercises increased significantly with every repetition(p<0.001)and the size of the increase was large.The completion time on the robot platform was 2.6 times faster(169.33±28.28 s vs.447.96±156.55 s,p<0.001)than that in the laparoscopic box,and the difference between both types of tests was large(pη2=0.797).The centralization and passage of the needle were significantly better on the robot platform(5 vs.3,p<0.001,r=0.47;5 vs.4,p<0.001,r=0.59)than in the laparoscopic box.For the intracorporeal stitch+knot test,every participant was able to perform the exercise on the robot but only 85.2%(23/27)in the laparoscopic box.Twenty-one participants answered the survey,and 13(61.9%)of them considered robotic performance independent of laparoscopic experience.Conclusions Surgeons are interested and seek training in robotic surgery.We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose.All participants,even without robotic experience,learned quicker,performed better,faster and more precisely on the robot over laparoscopy.

Recent advances in computerized imaging and its vital roles in liverdisease diagnosis, preoperative planning, and interventional liversurgery: A review

The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes.In clinical settings,screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering approp-riate therapeutic procedures.Moreover,in a patient undergoing liver resection,a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments,making surgical decisions during the procedure,and anticipating postoperative results.Conventionally,various medical imaging modalities,e.g.,computed tomography,magnetic resonance imaging,and positron emission tomography,have been employed to assist in these tasks.In fact,several standardized procedures,such as lesion detection and liver segmentation,are also incorporated into prominent commercial software packages.Thus far,most integrated software as a medical device typically involves tedious interactions from the physician,such as manual delineation and empirical adjustments,as per a given patient.With the rapid progress in digital health approaches,especially medical image analysis,a wide range of computer algorithms have been proposed to facilitate those procedures.They include pattern recognition of a liver,its periphery,and lesion,as well as pre-and postoperative simulations.Prior to clinical adoption,however,software must conform to regulatory requirements set by the governing agency,for instance,valid clinical association and analytical and clinical validation.Therefore,this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses,visualization,and simulation in the literature.Emphasis is placed upon their concepts,algorithmic classifications,merits,limitations,clinical considerations,and future research trends.

Haptic Modeling and Rendering Based on Neurofuzzy Rules for Surgical Cutting Simulation

This paper combines image processing with 3D magnetic tracking method to develop a scalpel for haptic simulation in surgical cutting. First, a cutting parameter acquisition setup is presented and the performance is validated from soft tissue cutting. Then, based on the acquired input-output data pairs, a method for fuzzy system modeling is presented, that is, after partitioning each input space equally and giving the premises and the total number of fuzzy rules, the consequent parameters and the fuzzy membership functions (MF) of the input variables are learned and optimized via a neurofuzzy modeling technique. Finally, a haptic scalpel implemented with the established cutting model is described. Preliminary results show the feasibility of the haptic display system for real-time interaction.

数字化正颌外科技术在临床实践中面临的挑战

计算机辅助正颌外科经过多年的发展、完善,其优势已被广泛认可,但在临床实际应用中,这项技术仍面临着诸多挑战。从影像数据采集、数字化技术的辅助诊断、数据处理及计算机辅助手术设计,到最后将虚拟方案转移到实际手术中,计算机辅助正颌外科流程中的每一步都可能产生误差,诸多误差的累计、放大,将会影响到最终的手术效果。目前正在探索的误差控制的思路包括:使用数字化设备,例如口内扫描仪;使用自动化方法和算法;使用个性化的骨块定位方式等。同时,术后软组织的精准模拟、下颌骨功能性运动评估、可吸收内固定材料等难题尚未得到完善的解决。只有充分理解当下计算机辅助正颌外科存在的不足之处,才能为继续优化现有方法提供方向,同时在临床实际工作中规避潜在的风险,充分发挥其优势,得到最佳的治疗效果。个体化钛板、人工智能和手术机器人等新技术的应用与发展,将进一步推动本学科的发展,期待未来数字化正颌外科技术在自动化、智能化、个性化方面的革新。