共查询到20条相似文献,搜索用时 15 毫秒
1.
Background To prevent unnecessary errors and adverse results of laparoscopic surgery, proper training is of paramount importance. A safe
way to train surgeons for laparoscopic skills is simulation. For this purpose traditional box trainers are often used, however
they lack objective assessment of performance. Virtual reality laparoscopic simulators assess performance, but lack realistic
haptic feedback. Augmented reality (AR) combines a virtual reality (VR) setting with real physical materials, instruments,
and feedback. This article presents the current developments in augmented reality laparoscopic simulation.
Methods Pubmed searches were performed to identify articles regarding surgical simulation and augmented reality. Identified companies
manufacturing an AR laparoscopic simulator received the same questionnaire referring to the features of the simulator.
Results Seven simulators that fitted the definition of augmented reality were identified during the literature search. Five of the
approached manufacturers returned a completed questionnaire, of which one simulator appeared to be VR and was therefore not
applicable for this review.
Conclusion Several augmented reality simulators have been developed over the past few years and they are improving rapidly. We recommend
the development of AR laparoscopic simulators for component tasks of procedural training. AR simulators should be implemented
in current laparoscopic training curricula, in particular for laparoscopic suturing training. 相似文献
2.
Thomas S. Lendvay Pasquale Casale Robert Sweet Craig Peters 《Journal of robotic surgery》2008,2(3):145-149
Robotic surgery is an accepted adjunct to minimally invasive surgery, but training is restricted to console time. Virtual-reality
(VR) simulation has been shown to be effective for laparoscopic training and so we seek to validate a novel VR robotic simulator.
The American Urological Association (AUA) Office of Education approved this study. Subjects enrolled in a robotics training
course at the 2007 AUA annual meeting underwent skills training in a da Vinci dry-lab module and a virtual-reality robotics
module which included a three-dimensional (3D) VR robotic simulator. Demographic and acceptability data were obtained, and
performance metrics from the simulator were compared between experienced and nonexperienced roboticists for a ring transfer
task. Fifteen subjects—four with previous robotic surgery experience and 11 without—participated. Nine subjects were still
in urology training and nearly half of the group had reported playing video games. Overall performance of the da Vinci system
and the simulator were deemed acceptable by a Likert scale (0–6) rating of 5.23 versus 4.69, respectively. Experienced subjects
outperformed nonexperienced subjects on the simulator on three metrics: total task time (96 s versus 159 s, P < 0.02), economy of motion (1,301 mm versus 2,095 mm, P < 0.04), and time the telemanipulators spent outside of the center of the platform’s workspace (4 s versus 35 s, P < 0.02). This is the first demonstration of face and construct validity of a virtual-reality robotic simulator. Further studies
assessing predictive validity are ultimately required to support incorporation of VR robotic simulation into training curricula. 相似文献
3.
《Journal of Clinical Orthopaedics and Trauma》2020,11(3):348-356
BackgroundNumerous publications of the late 20th century have presented the radiological outcome of open technique for distal metatarsal osteotomy for mild to moderate hallux valgus and the clinical outcomes by means of well-established scoring systems which have been published and make these open techniques today’s benchmark and gold standard. Minimally invasive procedures reduce surgical trauma because they are performed without large incisions, and injury to the soft tissues is limited. This has the theoretical advantages of improved recovery and decreased rehabilitation times. There is however limited literature to prove the same for minimally invasive surgery for hallux valgus.Our aim was thus to pool all available comparative literature on minimally invasive hallux valgus surgery done for mild to moderate hallux valgus versus open surgical approaches.MethodsA PubMed, Embase and Scopus search was performed using the keywords (‘hallux valgus’ OR bunion) AND (‘minimally invasive’ OR percutaneous) AND osteotomy. A total of 473 records were identified and out of which nine studies were included in the final review.ResultsMost available studies are either randomized control trials, or prospective cohort studies providing good level of evidence. Radiological analysis showed similar correction with both MIS and open osteotomies. In functional analysis results were different with open techniques providing better results in terms of AOFAS score. (p < 0.0001). VAS score and complication rate were similar in both groups.Discussion/conclusionWe conclude that based on available literature MIS provides equivalent radiological outcomes with respect to open surgery but functionally despite the promising results (good to excellent in most series), the outcomes in terms of function are not as good as open surgery. MIS techniques provide satisfactory outcomes for mild-to-moderate severity of hallux valgus though not as good as open surgery. There is evolving literature for this relatively new procedure. Longer duration of follow up and bigger numbers would allow for more meaningful data analysis and conclusions to be drawn as more studies come forward. 相似文献
4.
BackgroundVirtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism.PurposeTo assess the difference in face validity between two high fidelity VR simulators employing passive and active haptic feedback technology respectively.Method38 participants were recruited and divided into intermediate and expert groups based on orthopaedic training grade. Each participant completed a 12-point diagnostic knee arthroscopy VR module using the active haptic Simbionix ARTHRO Mentor and passive haptic VirtaMed ArthroS simulators. Subsequently, each participant completed a validated simulator face validity questionnaire.ResultsThe ARTHRO Mentor active haptic system failed to achieve face validity with mean scores for external appearance (6.61), intra-articular appearance (4.78) and instrumentation (4.36) falling below the acceptable threshold (≥7.0). The ArthroS passive haptic simulator demonstrated satisfactory scores in all domains: external appearance (8.42), intra-articular appearance (7.65), instrumentation (7.21) and was significantly (p < 0.001) more realistic than ARTHRO Mentor for all metrics. 61% of participants gave scores ≥7.0 for questions pertaining to haptic feedback realism from intra-articular structures such as menisci and ACL/PCL for the ArthroS vs. 12% for ARTHRO Mentor. There was no difference in face-validity perception between intermediate and expert groups for either simulator (p > 0.05).ConclusionCurrent active haptic technology which employs motors to simulate tactile feedback fails to demonstrate sufficient face-validity or match the sophistication of passive haptic systems in high fidelity arthroscopy simulators. Textured rubber phantoms that mirror the anatomy and haptic properties of the knee joint provide a significantly more realistic training experience for both intermediate and expert arthroscopists. 相似文献
5.
Seongmin Kim Kyung Jin Min Sanghoon Lee Jin Hwa Hong Jae Yun Song Jae Kwan Lee Nak Woo Lee 《Asian journal of surgery / Asian Surgical Association》2021,44(1):174-180
Background/ObjectiveRecent prospective studies have shown poorer oncologic outcomes following minimally invasive surgery, which has led many surgeons to deeply inspect their practices. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer.MethodsThis retrospective study included patients with early stage cervical cancer (Ia1 - IIa1) who were treated with radical hysterectomy from May 2006 to Dec 2016. Patients were divided into three groups according to the surgical approach: radical abdominal hysterectomy (RAH), laparoscopic radical hysterectomy (LRH), and robot-assisted radical hysterectomy (RRH).ResultsLearning curves of each type of surgery were obtained using the cumulative sum method. Survival rates were compared using Kaplan–Meier curves. To analyze the learning curve of a single surgeon, 89 patients were selected from the whole population. Learning curves of each group showed two distinct phases. The minimum number of cases required to achieve surgical improvement were 16 in RAH, 13 in LRH, and 21 in RRH. Progression-free survival (PFS) and overall survival did not vary between RAH and minimally invasive surgery (MIS) (p = .828 and p = .757, respectively). However, when stratified by the phases of the learning curves, patients included in the early phase of MIS showed a poorer PFS (p = .014).ConclusionsSurgical proficiency could significantly affect the oncologic outcome in MIS. A prospective study regarding sufficient surgical competence is necessary for elaborate analysis of the feasibility of minimally invasive radical hysterectomy. 相似文献
6.
Snyder CW Vandromme MJ Tyra SL Porterfield JR Clements RH Hawn MT 《World journal of surgery》2011,35(2):245-252
Background
Virtual reality (VR) simulators and Web-based instructional videos are valuable supplemental training resources in surgical programs, but it is unclear how to optimally integrate them into minimally invasive surgical training. 相似文献7.
Women’s positive perception of transvaginal NOTES surgery 总被引:1,自引:0,他引:1
Carrie Y. Peterson Sonia Ramamoorthy Barbara Andrews Santiago Horgan Mark Talamini Alana Chock 《Surgical endoscopy》2009,23(8):1770-1774
8.
通过将力触觉反馈系统应用到现代数字化外科,为医用外科机器人、虚拟现实手术模拟系统及远程外科提供力触觉信息,可有效提高外科手术精确性和灵活性、增加手术安全性并缩短手术时间。本文对力触觉反馈系统在现代数字化外科的应用及研究进展进行综述。 相似文献
9.
van der Schatte Olivier RH Van't Hullenaar CD Ruurda JP Broeders IA 《Surgical endoscopy》2009,23(6):1365-1371
Background Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also
have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user’s
mental and physical comfort in performing standard laparoscopic and robot-assisted techniques. Surgical performance also was
analyzed.
Methods In this study, 16 surgically inexperienced participants performed three tasks using both a robotic system and standard laparoscopic
instrumentation. Distress was measured using questionnaires and an ambulatory monitoring system. Surgical performance was
analyzed with time-action analysis.
Results The physiologic parameters (p = 0.000), the questionnaires (p = 0.000), and the time-action analysis (p = 0.001) favored the robot-assisted group in terms of lower stress load and an increase in work efficiency.
Conclusion In this experimental setup, the use of a robot-assisted surgical system was of value in both cognitive and physical stress
reduction. Robotic assistance also demonstrated improvement in performance. 相似文献
10.
Adrian Park M.D. Donald Witzke Ph.D. Michael Donnelly Ph.D. 《Journal of gastrointestinal surgery》2002,6(3):501-509
Patient preference has driven the adoption of minimally invasive surgery (MIS) techniques and altered surgical practice. MIS
training in surgical residency programs must teach new skill sets with steep learning curves to enable residents to master
key procedures. Because no nationally recognized MIS curriculum exists, this study asked experts in MIS which laparoscopic
procedures should be taught and how many cases are required for competency. Expert recommendations were compared to the number
of cases actually performed by residents (Residency Review Committee [RRC] data). A detailed survey was sent nationwide to
all surgical residency programs (academic and private) known to offer training in MIS and/or have a leader in the field. The
response rate was approximately 52%. RRC data were obtained from the resident statistics summary report for 1998–1999. Experts
identified core procedures for MIS training and consistently voiced the opinion that to become competent, residents need to
perform these procedures many more times than the RRC data indicate they currently do. At present, American surgical residency
programs do not meet the suggested MIS case range or volume required for competency. Residency programs need to be restructured
to incorporate sufficient exposure to core MIS procedures. More expert faculty must be recruited to train residents to meet
the increasing demand for laparoscopy.
Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23,
2001 (oral presentation).
Supported in part by an educational grant from Tyco/U.S. Surgical Corporation. 相似文献
11.
Tavakoli M Patel RV Moallem M 《The international journal of medical robotics + computer assisted surgery : MRCAS》2005,1(2):53-63
Conventional endoscopic surgery has some drawbacks that can be addressed by using robots. The robotic systems used for surgery are still in their infancy. A major deficiency is the lack of haptic feedback to the surgeon. In this paper, the benefits of haptic feedback in robot-assisted surgery are discussed. A novel robotic end-effector is then described that meets the requirements of endoscopic surgery and is sensorized for force/ torque feedback. The endoscopic end-effector is capable of non-invasively measuring its interaction with tissue in all the degrees of freedom available during endoscopic manipulation. It is also capable of remotely actuating a tip and measuring its interaction with the environment without using any sensors on the jaws. The sensorized end-effector can be used as the last arm of a surgical robot to incorporate haptic feedback and/or to evaluate skills and learning curves of residents and surgeons in endoscopic surgery. 相似文献
12.
Peter Culmer Jenifer Barrie Rob Hewson Martin Levesley Mark Mon‐Williams David Jayne Anne Neville 《The international journal of medical robotics + computer assisted surgery : MRCAS》2012,8(2):146-159
Minimally invasive surgery (MIS) has heralded a revolution in surgical practice, with numerous advantages over open surgery. Nevertheless, it prevents the surgeon from directly touching and manipulating tissue and therefore severely restricts the use of valuable techniques such as palpation. Accordingly a key challenge in MIS is to restore haptic feedback to the surgeon. This paper reviews the state‐of‐the‐art in laparoscopic palpation devices (LPDs) with particular focus on device mechanisms, sensors and data analysis. It concludes by examining the challenges that must be overcome to create effective LPD systems that measure and display haptic information to the surgeon for improved intraoperative assessment. Copyright © 2012 John Wiley & Sons, Ltd. 相似文献
13.
Ström P Hedman L Särnå L Kjellin A Wredmark T Felländer-Tsai L 《Surgical endoscopy》2006,20(9):1383-1388
Background In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends
on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze
whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance.
Methods A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training
session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper
abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual–spatial
ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A).
Results After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better
(p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test).
Conclusion The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided
surgical simulator training. 相似文献
14.
Background With the expanding implementation of minimally invasive surgery, the operating team is confronted with challenges in the field
of ergonomics. Visual feedback is derived from a monitor placed outside the operating field. This crossover trial was conducted
to evaluate and compare neck posture in relation to monitor position in a dedicated minimally invasive surgery (MIS) suite
and a conventional operating room.
Methods Assessment of the neck was conducted for 16 surgeons, assisting surgeons, and scrub nurses performing a laparoscopic cholecystectomy
in both types of operating room. Flexion and rotation of the cervical spine were measured intraoperatively using a video analysis
system. A two-question visual analog scale (VAS) questionnaire was used to evaluate posture in relation to the monitor position.
Results Neck rotation was significantly reduced in the MIS suite for the surgeon (p = 0.018) and the assisting surgeon (p < 0.001). Neck flexion was significantly improved in the MIS suite for the surgeon (p < 0.001) and the scrub nurse (p = 0.018). On the questionnaire, the operating room team scored their posture significantly higher in the MIS suite and also
indicated fewer musculoskeletal complaints.
Conclusions The ergonomic quality of the neck posture is significantly improved in the MIS suite for the entire operating room team. 相似文献
15.
Application of haptic feedback to robotic surgery 总被引:2,自引:0,他引:2
Bethea BT Okamura AM Kitagawa M Fitton TP Cattaneo SM Gott VL Baumgartner WA Yuh DD 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2004,14(3):191-195
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. 相似文献
16.
Katsavelis D Siu KC Brown-Clerk B Lee IH Lee YK Oleynikov D Stergiou N 《Surgical endoscopy》2009,23(1):66-73
Background A robotic virtual-reality (VR) simulator has been developed to improve robot-assisted training for laparoscopic surgery and
to enhance surgical performance in laparoscopic skills. The simulated VR training environment provides an effective approach
to evaluate and improve surgical performance. This study presents our findings of the VR training environment for robotic
laparoscopy.
Methods Eight volunteers performed two inanimate tasks in both the VR and the actual training environment. The tasks were bimanual
carrying (BC) and needle passing (NP). For the BC task, the volunteers simultaneously transferred two plastic pieces in opposite
directions five times consecutively. The same volunteers passed a surgical needle through six pairs of holes in the NP task.
Both tasks require significant bimanual coordination that mimics actual laparoscopic skills. Data analysis included time to
task completion, speed and distance traveled of the instrument tip, as well as range of motion of the subject’s wrist and
elbow of the right arm. Electromyography of the right wrist flexor and extensor were also analyzed. Paired t-tests and Pearson’s r were used to explore the differences and correlations between the two environments.
Results There were no significant differences between the actual and the simulated VR environment with respect to the BC task, while
there were significant differences in almost all dependent parameters for the NP task. Moderate to high correlations for most
dependent parameters were revealed for both tasks.
Conclusions Our data shows that the VR environment adequately simulated the BC task. The significant differences found for the NP task
may be attributed to an oversimplification in the VR environment. However, they do point to the need for improvements in the
complexity of our VR simulation. Further research work is needed to develop effective and reliable VR environments for robotic
laparoscopic training. 相似文献
17.
Donias HW Karamanoukian RL Glick PL Bergsland J Karamanoukian HL 《The American surgeon》2002,68(2):177-181
Robotics has been recognized as a major driving force in the advancement of minimally invasive surgery. However, the extent to which General Surgery residents are being trained to use robotic technology has never been assessed. A survey was sent to program directors of accredited General Surgery training programs to determine the prevalence and application of robotics in surgical training programs. Responses were tabulated and analyzed. Thirty-three per cent indicated interest in minimally invasive surgery. Twelve per cent of responders have used robotics in their practice, and 65 per cent felt robotics will play an important role in the future of General Surgery. Currently residents from 14 per cent of the responding training programs have exposure to robotic technology, and residents from an additional 4 per cent of these programs have limited didactic exposure. Program directors from 23 per cent of responding programs identified plans to incorporate robotics into their program. Robotics have been shown to make standard endoscopic surgical procedures more efficient and cost-effective as well as allowing a variety of procedures that were only possible with conventional methods to be completed with minimally invasive techniques. This new technology promises to be a large part of the future of surgery and as such deserves more attention in the training of General Surgery residents. 相似文献
18.
BACKGROUND: Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic instruments are used within an hybrid mannequin on tissue or objects while using video tracking. This study was designed to assess the difference in realism, haptic feedback, and didactic value between AR and VR laparoscopic simulation. METHODS: The ProMIS AR and LapSim VR simulators were used in this study. The participants performed a basic skills task and a suturing task on both simulators, after which they filled out a questionnaire about their demographics and their opinion of both simulators scored on a 5-point Likert scale. The participants were allotted to 3 groups depending on their experience: experts, intermediates and novices. Significant differences were calculated with the paired t-test. RESULTS: There was general consensus in all groups that the ProMIS AR laparoscopic simulator is more realistic than the LapSim VR laparoscopic simulator in both the basic skills task (mean 4.22 resp. 2.18, P < 0.000) as well as the suturing task (mean 4.15 resp. 1.85, P < 0.000). The ProMIS is regarded as having better haptic feedback (mean 3.92 resp. 1.92, P < 0.000) and as being more useful for training surgical residents (mean 4.51 resp. 2.94, P < 0.000). CONCLUSIONS: In comparison with the VR simulator, the AR laparoscopic simulator was regarded by all participants as a better simulator for laparoscopic skills training on all tested features. 相似文献
19.
Objective Psychomotor Skills Assessment of Experienced, Junior,
and Novice Laparoscopists with Virtual Reality 总被引:22,自引:1,他引:21
Anthony G. Gallagher Ph.D. Karen Richie B.Sc. Neil McClure M.D. Jim McGuigan 《World journal of surgery》2001,25(11):1478-1483
Objective assessment of psychomotor
skills in surgery is now a priority; however, this assessment is
difficult to achieve because of measurement difficulties associated
with the reliability and validity of assessing surgical skills in vivo
and in the laboratory. In this study virtual reality (VR) was used to
overcome these problems in the objective psychomotor assessment of
senior, junior, and novice laparoscopists. Twelve experienced
laparoscopic surgeons (performed >50 Minimal Access Surgery (MAS)
procedures), 12 inexperienced laparoscopic surgeons (<10 MAS
procedures), and 12 laparoscopic novices (no MAS procedures)
participated in the study. Each subject completed all six tasks of the
Minimally Invasive Surgical Trainer; Virtual Reality (MIST VR). In
comparison to the other groups, experienced laparoscopic surgeons
performed the tasks significantly (p < 0.01) faster,
had a lower error rate, were more economic in their movement of
surgical instruments and in the use of diathermy. As a group they also
showed greater consistency in their performance. MIST VR distinguished
between the three groups of laparoscopists. VR provides a useful
objective assessment tool for evaluating psychomotor skills for
laparoscopic surgery. 相似文献
20.