Haptic Feedback for VR-Based Minimally Invasive Surgical (MIS) Training

Vol 37/6 July 2004 www.instmc.org.uk 174 The treatment of medical problems through the removal or repair of malfunctioning or abnormal parts has traditionally required that large incisions are made in and around the body part that needs the attention. However, the incision, and subsequent dissection needed to allow the surgeon to visualise the field, are the procedures that cause most of the pain and contribute to delays in patient recovery1. Minimally Invasive Surgery (MIS) is a relatively new approach to this surgical problem, first used less than 15 years ago. With a MIS procedure, essentially the same operations are performed as in open surgery; however, specialised instruments are used that are designed to fit into the body through several tiny punctures (canula) instead of one large incision. Rather than looking directly at the part of the body being treated, the physician monitors the procedure via a Laparoscope inserted through one of the small punctures. By eliminating the large incision and extensive dissections, the benefits are substantial: minimising surgical trauma and damage to healthy tissue, resulting in lower cost, shorter hospital stays, much quicker recovery, less infection, and less cosmetic damage1,2. Since its introduction in the 1980s, the growth in the use of this technique has been staggering and it is estimated that by the year 2000 from 60 to 80% of abdominal surgeries are performed laparoscopically3. Unfortunately, the procedures do have some potential disadvantages, primarily for the surgeon, due to the reduced dexterity, workspace, and sensory (visual and tactile) input and feedback. In addition, learning laparoscopic techniques can be much more difficult than learning open surgery procedures, particularly in operations requiring the use and co-ordination of multiple instruments4. The co-ordination and dexterity problems associated with learning the new MIS techniques have prompted studies of different approaches to the training of clinicians, with a greater appreciation of the potential benefits of computerbased simulations. This increased recognition of the prospects for realism in computer simulation has been due to recent developments in computer graphics, Virtual Reality and robotic systems. It is now possible to produce images of surgical procedures that are beginning to emulate many of the features of the real experience, and in so doing a channel has been opened for improving the training procedures for new or inexperienced laparoscopic surgeons1. This paper will present work on the development of hardware and software systems that will contribute to the user experience of virtual training for MIS procedures. In particular the work will look at the development of haptic feedback to augment the simulated experience and improve the level of fidelity, and realism and permit improved skills acquisition in situations involving dexterity and co-ordination. The paper will initially consider some of the background needs of MIS and virtual training. This will be followed by a study of the hardware and software system contained with the Virtual Haptic Training environment. Experiments will be presented representing three procedures: (i) a whole torso to show the gross simulation of forces (ii) a simulation of clamping and cutting a vein/artery/tendon (iii) an arthroscopic procedure (knee surgery). The paper will draw conclusions with regard to the results obtained and future directions for this and VR haptic training in general. Initially the paper will consider the current status and potential of computer-based surgical simulation and will outline the current limitations with regard to tactile fidelity. The design of the system hardware and software will be considered in the next two sections followed by experiments on the performance of the systems and appraisal by the users. The paper will conclude by looking at future work and the potential for technology of this type.

[1]  T. Hsia,et al.  A literature review: robots in medicine , 1991, IEEE Engineering in Medicine and Biology Magazine.

[2]  Antonio Bicchi,et al.  A sensor-based minimally invasive surgery tool for detecting tissutal elastic properties(003) 5323219 , 1996, Proceedings of IEEE International Conference on Robotics and Automation.

[3]  J. Bowersox Telepresence surgery , 1996, The British journal of surgery.

[4]  Lynda Chin,et al.  Guest Editor , 2003, Oncogene.

[5]  Richard A. Robb,et al.  VR assisted surgery planning , 1996 .

[6]  W. J. Greenleaf,et al.  Developing the tools for practical VR applications [Medicine] , 1996 .

[7]  W. J. Greenleaf,et al.  DEVELOPING THE TOOLS FOR PRACTICAL VR APPLICATIONS , 1996 .

[8]  Stephane Cotin,et al.  Real-time surgery simulation with haptic feedback using finite elements , 1998, Proceedings. 1998 IEEE International Conference on Robotics and Automation (Cat. No.98CH36146).

[9]  M. Akay The VRT revolution [Medicine] , 1996 .

[10]  A. Gallagher,et al.  Virtual reality training in laparoscopic surgery: a preliminary assessment of minimally invasive surgical trainer virtual reality (MIST VR). , 1999, Endoscopy.

[11]  M Smithwick Network options for wide-area telesurgery. , 1995, Journal of telemedicine and telecare.

[12]  Russell H. Taylor,et al.  A telerobotic assistant for laparoscopic surgery , 1995 .

[13]  F. Paolucci,et al.  Teleoperation using computer networks: prototype realization and performance analysis , 1996, Proceedings of 8th Mediterranean Electrotechnical Conference on Industrial Applications in Power Systems, Computer Science and Telecommunications (MELECON 96).