Recent Advancements in Simulators for Surgical Robotics › chirurgiavirtuale10 › 06_Moglia.pdf · clutch and wristed instrumentation. To improve: the use and maneuvering of camera,

Recent Advancements in Simulators for Surgical Robotics

Andrea Moglia, Giuseppe Turini, Vincenzo Ferrari, Mauro Ferrari, Franco Mosca

La Medicina Incontra la Realtà Virtuale

14 Dicembre 2010, Pisa (Italia)

EndoCAS – University of Pisa, Italy

EndoCAS, Center for Computer Assisted Surgery, University of Pisa (Italy)

Outline of the talk

The Scientific Problem

Surgical Simulators

Simulators for Surgical Robotics

Preoperative Planning for Surgical Robotics

Conclusions


Over half of all medical adverse events are surgical in nature and 75% of these happen in the operating room.

Many of them may be errors caused by physicians in the process of the learning curve.

The “Bristol Case” in the U.K. and the “Err is Human” report published by the Institute of Medicine in the United States suggested that better training and objective assessment would be key strategies in attaining the goal of reduced medical errors.


Drawing on the successful paradigm of flight simulation, Satava first proposed training surgical skills in virtual reality (VR) nearly a decade ago.

Source:Seymour NE et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236: 458-63.

Reducing Medical Errors


Surgical Simulators

Source:Satava RM. Virtual reality surgical simulator. The first steps. Surg Endosc 1993; 7: 203-5.

Requirements

A Realistic Simulation

Accurate Detail

Highly Interactive

Fidelity Object Properties

Interactivity Sensory Input

Reactivity

Satava Insight


Manufacturers of Surgical Simulators

Surgical Science

Mentice

SimSurgery

CAE

Virtamed

Immersion

Haptica

Mimic

SimSurgSys

SimuLab

METI

Simbionix


Roadmap for Future Simulators

Haptics Integration

DaVinci Incorporation

Intelligent tutors

Virtual Mentors

Judgement Assessment

Patient Specific Data for Surgical

Planning and Rehearsal

Source:Satava RM. The future of sugical simulation and surgical robotics. Bull Am Coll Surg 2007; 92: 13-9.

Surgical Simulators


The Value of Haptic Feedback

Sourcevan der Meijden OA et al. The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training. Surg Endosc 2009; 23:1180-90.

A potential major drawback, comparing robotic assisted surgery (RAS) to conventional endoscopic surgery (CES), is the absence of haptic feedback in RAS.

The loss of force feedback in RAS compared with CES may be balanced partly by the restoration of three-dimensional vision.

In CES force feedback is experienced by the surgeon through the laparoscopic instrument handles, resulting from the interaction of the laparoscopic instruments tips with the tissue.

In RAS, lack of force feedback may prolongue operative times and learning curves, and increase the risk of surgical errors.Even experienced surgeons training with RAS often tear apart sutures and damage delicate tissues.

Surgical Simulators


Source:Rashid HH, Leung YY, Rashid MJ, et al. Robotic surgical education: A systematic approach to training urology resi- dents to perform robotic-assisted laparoscopic radical pros-tatectomy. Urology 2006; 68:75-79.

Most robotic training occurs during live surgery or during robotic courses on animal models or inanimate objects.


The cost of the da Vinci Si System is approximately $1.7 million maintenance fee running between $125,000 and $150,000 per year.Adding a second console for training purposes would bring the cost to approximately $2.25 million.

Motivations


Manufacturers of Surgical Simulators

Surgical Science

Mentice

SimSurgery

CAE

Virtamed

Immersion

Haptica

Mimic

SimSurgSys

SimuLab

METI

Simbionix


RoSS by Simulated Surgical Systems

RoSS (Robotic Surgical Simulator) to simulate the master console of da Vinci®Surgical System.

Two 6 d.o.f. input devices, stereo head mounted display, pedals for clutch and camera controls.

Price: about 100,000 $.

Developed in collaboration between Roswell Park Cancer Institute and the University at Buffalo.

Unveiled in late February 2010.

http://www.simulatedsurgicals.com




Basic skills module: tissue cutting, knot tying, needle driving, needle manipulation, suturing, fourth arm manipulation, and vessel clipping.

To improve hand eye coordination and teach basic

robotic surgical skills.

Basic orientation module: camera navigation, robotic arm control and orientation, safe synchronous camera and arm movement, use and maneuverability of a fourth arm, and clutch and wristed instrumentation.

To improve: the use and maneuvering of camera, the

recognition of visual and depth perception, and the safe

use of robotic surgical instruments.

Surgical modules: Radical Prostatectomy, Hysterectomy, Cystectomy.

To develop necessary technical and cognitive skills for specific

steps during robot-assisted surgeries.



Kesavadas T, Stegemann A, Sathyaseelan G, Chowriappa A, Srimathveeravalli G, Seixas-Mikelus S, Chandrasekhar R, Wilding G, Guru K. Validation of Robotic Surgery Simulator (RoSS). To be presented at the Medicine Meets Virtual Reality, February 2011.

Seixas-Mikelus SA, Stegemann AP, Kesavadas T, Srimathveeravalli G, Sathyaseelan G, Chandrasekhar R, Wilding GE, Peabody JO, Guru KA.Content validation of a novel robotic surgical simulator. BJU Int. 2010 Oct 4.

Seixas-Mikelus SA, Kesavadas T, Srimathveeravalli G, Chandrasekhar R, Wilding GE, Guru KA. Face validation of a novel robotic surgical simulator. Urology 2010; 76: 357-60.

Seixas-Mikelus S, Adal A, Srimathveeravalli G, Kesavadas T, Baheti A, Chandrashekar R, Wilding G and Guru K. Can Image Based Virtual Reality Help Teach Anatomy? J Endourol 2010; 24: 629-34.


Clinical Studies



Simulation exercises were developed in close collaboration with Intuitive Surgical to achieve unparalleled realism.

System training module: surgeon console awareness, endowrist manipulation, camera & clutching, trouble shooting.

Commissioned by the Departments of Urology at Indiana University and Mechanical Engineering at Purdue University.

dV-TrainerTM by Mimic

Skills training module: needle control, needle driving, energy & dissection, games.

Accurate modeling of da Vinci kinematics and instruments.

http://www.mimic.ws

Price: 98,000 $.



Lerner MA, Ayalew M, Peine WJ, Sundaram CP. Does training on a virtual reality robotic simulator improve performance on the da Vinci surgical system? J Endourol 2010; 24: 467-72.

Kenney PA, Wszolek MF, Gould JJ, Libertino JA, Moinzadeh A. Face, content, and construct validity of dV-trainer, a novel virtual reality simulator for robotic surgery. Urology 2009; 73: 1288-92

Sethi AS, Peine WJ, Mohammadi Y, Sundaram CP. Validation of a novel virtual reality robotic simulator. J Endourol 2009; 23: 503-8.

Clinical Studies

dV-TrainerTM by Mimic

SEP by SimSurgery

Clinical Study

Lin DW, Romanelli JR, Kuhn JN, Thompson RE, Bush RW, Seymour NE. Computer-based laparoscopic and robotic surgical simulators: performance characteristics and perceptions of new users. Surg Endosc 2009 Jan; 23: 209-14.



Haptics Integration

DaVinci Incorporation

Intelligent tutors

Virtual Mentors








Benefits

Source:Hayashibe M, Suzuki N, Hattori A, Suzuki S, Konishi K, Kakeji Y, Hashizume M. Surgical robot setup simulation with consistent kinematics and haptics for abdominal surgery. Stud Health Technol Inform 2005; 111: 164-6.

Integrating the geometrical structure of the individual patient and the surgical scene in virtual space, surgeons can confirm the movability of the robot in the operating room.

Appropriate placement of the trocar ports maximizes the movable range of the robot, and significantly influences the success of the operation.

If surgeons rehearse by using a virtual training system, they can develop an intuitively common perception about how to set up the robot in the operating room and the actual setup time in the operating room will be reduced.

The planning system can be effective as an educational program for doctors who are inexperienced in robotic surgery.


Haptics Integration

Any Robot Incorporation

Intelligent tutors

Virtual Mentors








Moglia A, Turini G, Ferrari V, Ferrari M, Mosca F. Patient Specific Surgical Simulator for the Evaluation of the Movability of Bimanual Robotic Arms. To be presented at the Medicine Meets Virtual Reality, February 2011.


The ARAKNES Simulator

Conclusions


Surgical Simulators


Preoperative Planning for Robotic Surgery


Documents

Recent Advancements in Simulators for Surgical Robotics › chirurgiavirtuale10 › 06_Moglia.pdf · clutch and wristed instrumentation. To improve: the use and maneuvering of camera,