Microsurgery simulators in virtual reality: review

Surgical training is undergoing a rapid transformation, which has been influenced by advances in computer modeling. Increased pressure to reduce the use of animals in technical training has led to a new approach in teaching microsurgery. This new technology may prove to be a cost-effective, portable, and nonhazardous way forward in microsurgical training. This paper reviews the current state of available technological models used in microsurgical training. In doing so, we review articles from the latest journals and authenticated Internet websites to compare and contrast these various methods. Finally, we look at the specific technique that has potential impact on the future modeling of microsurgical techniques.     

Consensus guidelines for validation of virtual reality surgical simulators

The Work Group for Evaluation and Implementation of Simulators and Skills Training Programmes is a newly formed sub-group of the European Association of Endoscopic Surgeons (EAES). This work group undertook a review of validation evidence for surgical simulators and the resulting consensus is presented in this article. Using clinical guidelines criteria, the evidence for validation for six different simulators was rated and subsequently translated to a level of recommendation for each system. The simulators could be divided into two basic types; systems for laparoscopic general surgery and flexible gastrointestinal endoscopy. Selection of simulators for inclusion in this consensus was based on their availability and relatively widespread usage as of July 2004. Whilst level 2 recommendations were achieved for a few systems, it was clear that there was an overall lack of published validation studies with rigorous experimental methodology. Since the consensus meeting, there have been a number of new articles, system upgrades and new devices available. The work group intends to update these consensus guidelines on a regular basis, with the resulting article available on the EAES website ( ). Sponsored by the EAES Work Group for Evaluation and Implementation of Simulators and Skills Training Programmes, residing under the European Association for Endoscopic Surgery     

The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation

Introduction Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic suturing training. Methods All participants of several European Association for Endoscopic Surgery (EAES)-approved laparoscopic skills courses (N = 45) filled out a questionnaire on their opinion on laparoscopic suturing training. Additionally, participants with little or no laparoscopic suturing experience were allotted to two groups: group A (N = 10), who started training on the box trainer and subsequently the VR simulator (SimSurgery), and group B (N = 10), who began on the VR simulator followed by the box. Finally, suturing and knot-tying skills were assessed by an expert observer, using a standard evaluation form (eight items on five-point-Likert scale). The same was done after the initial training on the box in group A, as a control. Significant differences were calculated with the independent-sample t-test and the paired t-test. Results The total score of group A was higher than both group B and control (means of 30.80, 27.60, 28.20, respectively), but not significantly. The only tendency to a significant difference between group A and B was found in ‘taking proper bites’ (mean 4.10 versus 3.60, p = 0.054). All the participants scored the features of the box trainer significantly higher than those of the VR simulator (p < 0.001), 46.7% was of the opinion that the box alone would be sufficient for laparoscopic suturing training. Conclusion From this study we can conclude that VR simulation does not have a significant additional value in laparoscopic suturing training, over traditional box trainers. One should consider that the future development in VR simulation should focus on basic skills and component tasks of procedural training in laparoscopic surgery, rather than laparoscopic suturing.     

Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback

OBJECT: The purpose of this study was to evaluate the accuracy of ventriculostomy catheter placement on a head- and hand-tracked high-resolution and high-performance virtual reality and haptic technology workstation. METHODS: Seventy-eight fellows and residents performed simulated ventriculostomy catheter placement on an ImmersiveTouch system. The virtual catheter was placed into a virtual patient's head derived from a computed tomography data set. Participants were allowed one attempt each. The distance from the tip of the catheter to the Monro foramen was measured. RESULTS: The mean distance (+/- standard deviation) from the final position of the catheter tip to the Monro foramen was 16.09 mm (+/- 7.85 mm). CONCLUSIONS: The accuracy of virtual ventriculostomy catheter placement achieved by participants using the simulator is comparable to the accuracy reported in a recent retrospective evaluation of free-hand ventriculostomy placements in which the mean distance from the catheter tip to the Monro foramen was 16 mm (+/- 9.6 mm).     

A comparative analysis and guide to virtual reality robotic surgical simulators

Background

Since the US Food and Drug Administration approved robotically assisted surgical devices for human surgery in 2000, the number of surgeries utilizing this innovative technology has risen. In 2015, approximately 650 000 robot‐assisted procedures were performed worldwide. Surgeons must be properly trained to safely transition to using such innovative technology. Multiple virtual reality robotic simulators are now commercially available for educational and training purposes. There is a need for comparative evaluations of these simulators to aid users in selecting an appropriate device for their purposes.

Methods

We conducted a comparison of the design and capabilities of all dedicated simulators of the da Vinci robot – the da Vinci Skills Simulator (dVSS), dV‐Trainer (dVT), Robotic Skills Simulators (RoSS) and the RobotiX Mentor. This paper provides the base specifications of the hardware and software, with an emphasis on the training capabilities of each system.

Results

Each simulator contains a large number of training exercises for skills development: dVSS n = 40, dVT n = 65, RoSS n = 52, RobotiX Mentor n = 31. All four offer 3D visual images but use different display technologies. The dVSS leverages the real robotic surgical console to provide visualization, hand controls and foot pedals. The dVT, RoSS and RobotiX Mentor created simulated versions of all of these control systems. Each includes systems management services that allow instructors to collect, export and analyze the scores of students using the simulators.

Conclusions

This study provides comparative information on the four simulators' functional capabilities. Each device offers unique advantages and capabilities for training robotic surgeons. Each has been the subject of validation experiments, which have been published in the literature. But those do not provide specific details on the capabilities of the simulators, which are necessary for an understanding sufficient to select the one best suited for an organization's needs. This article provides comparative information to assist with that type of selection.     

The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review

Background  Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic (VR training) platforms are unknown. Many questions about haptic feedback in the different areas of surgical skills (training) need to be answered before adding costly haptic feedback in VR simulation for MIS training. This study was designed to review the current status and value of haptic feedback in conventional and robot-assisted MIS and training by using virtual reality simulation. Methods  A systematic review of the literature was undertaken using PubMed and MEDLINE. The following search terms were used: Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/Education. Results  The results were assessed according to level of evidence as reflected by the Oxford Centre of Evidence-based Medicine Levels of Evidence. Conclusions  In the current literature, no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery. Although the majority of the results show positive assessment of the benefits of force feedback, results are ambivalent and not unanimous on the subject. Benefits are least disputed when related to surgery using robotics, because there is no haptic feedback in currently used robotics. The addition of haptics is believed to reduce surgical errors resulting from a lack of it, especially in knot tying. Little research has been performed in the area of robot-assisted endoscopic surgical training, but results seem promising. Concerning VR training, results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition.     

The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training

Objective

The use of simulators has shown a profound impact on the development of both training and assessment of endovascular skills. Furthermore, there is evidence that simulator training is of great benefit for novice trainees. However, there are only a few simulators available geared specifically toward novice learners. Whereas research suggests that low-fidelity simulators could fill this gap, there are insufficient data available to determine the role of low-fidelity simulators in the training of endovascular skills.

Laparoscopic surgery training in pelvitrainer and virtual simulators

Over the last few decades, there has been a rise in the number of minimally invasive techniques, such as arthroscopy, vascular radiology and our speciality, laparoscopy. Laparoscopy has resulted in a reduction in the damage caused during intervention, with the subsequent reduction in hospital stay, postoperative pain and infections. However, one disadvantage of these techniques is that they require a large investment in instruments and a long and costly training period. In the following chapter, we describe the laparoscopic training process of the medical residents from our Urology Service in the pelvitrainer and virtual simulator.     

Application of haptic feedback to robotic surgery

Robotic surgical systems have greatly contributed to the advancement of minimally invasive endoscopic surgery. However, current robotic systems do not provide tactile or haptic feedback to the operating surgeon. Under certain circumstances, particularly with the manipulation of delicate tissues and suture materials, this may prove to be a significant irritation. We hypothesize that haptic feedback, in the form of sensory substitution, facilitates the performance of surgical knot tying. This preliminary study describes evidence that visual sensory substitution permits the surgeon to apply more consistent, precise, and greater tensions to fine suture materials without breakage during robot-assisted knot tying.