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. 2016 Apr:60:410-21.
doi: 10.1016/j.jbi.2016.03.005. Epub 2016 Mar 12.

Graphic and haptic simulation for transvaginal cholecystectomy training in NOTES

Jun J Pan  1 , Woojin Ahn  2 , Saurabh Dargar  2 , Tansel Halic  3 , Bai C Li  2 , Ganesh Sankaranarayanan  2 , Kurt Roberts  4 , Steven Schwaitzberg  5 , Suvranu De  2
Affiliations

Graphic and haptic simulation for transvaginal cholecystectomy training in NOTES

Jun J Pan et al. J Biomed Inform. 2016 Apr.

Retraction in

Abstract

Background: Natural Orifice Transluminal Endoscopic Surgery (NOTES) provides an emerging surgical technique which usually needs a long learning curve for surgeons. Virtual reality (VR) medical simulators with vision and haptic feedback can usually offer an efficient and cost-effective alternative without risk to the traditional training approaches. Under this motivation, we developed the first virtual reality simulator for transvaginal cholecystectomy in NOTES (VTEST™).

Methods: This VR-based surgical simulator aims to simulate the hybrid NOTES of cholecystectomy. We use a 6DOF haptic device and a tracking sensor to construct the core hardware component of simulator. For software, an innovative approach based on the inner-spheres is presented to deform the organs in real time. To handle the frequent collision between soft tissue and surgical instruments, an adaptive collision detection method based on GPU is designed and implemented. To give a realistic visual performance of gallbladder fat tissue removal by cautery hook, a multi-layer hexahedral model is presented to simulate the electric dissection of fat tissue.

Results: From the experimental results, trainees can operate in real time with high degree of stability and fidelity. A preliminary study was also performed to evaluate the realism and the usefulness of this hybrid NOTES simulator.

Conclusions: This prototyped simulation system has been verified by surgeons through a pilot study. Some items of its visual performance and the utility were rated fairly high by the participants during testing. It exhibits the potential to improve the surgical skills of trainee and effectively shorten their learning curve.

Keywords: Dissection; GPU; Inner-sphere; NOTES; Transvaginal cholecystectomy; Virtual reality.

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Conflict of interest statement

Conflict of Interest Statement

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

Figures

Figure 1
Figure 1
Peritoneal cavity access via the cul de sac in hybrid NOTES.
Figure 2
Figure 2
Organs and tissues involved in the cholecystectomy.
Figure 3
Figure 3
Typical cholecystectomy procedures [23]. (a) Identification of the cystic duct and artery; (b) Clamping of cystic duct and artery; (c) Cutting of the cystic duct and artery; (d) Disconnect the liver and gallbladder.
Figure 4
Figure 4
The hardware and software interface of transvaginal cholecystectomy NOTES simulator. (a) The hardware interface of VR simulator; (b) Screenshot from the real surgery video; (b) The software interface of our VR simulator.
Figure 5
Figure 5
The software architecture of our VR-based NOTES simulator.
Figure 6
Figure 6
Construction of inner-spheres for liver model. (a) The original triangular mesh of liver; (b) Initial inner-spheres model of liver after spheres packing; (c) Liver model contained both mesh and inner-spheres; (d) Inner-spheres of liver after optimization. (e) Liver model contained both mesh and inner-spheres after optimization.
Figure 7
Figure 7
The illustration of vacant space filling.
Figure 8
Figure 8
The topology construction of the liver inner-spheres model. (a) The original inner-spheres model; (b) The inner-spheres model with connectivity.
Figure 9
Figure 9
The illustration of stretching constraint for two connected spheres.
Figure 10
Figure 10
The deformation of liver model by our inner-spheres based method. (a) The inner-spheres model; (b) The surface mesh with texture.
Figure 11
Figure 11
Illustration of collision handling for multiple organs.
Figure 12
Figure 12
The simplification of surgical instruments (cautery hook and grasper) with a set of cylinders.
Figure 13
Figure 13
The illustration of collision detection between a sphere and a cylinder.
Figure 14
Figure 14
The construction process of the multi-layer hexahedron model for fat tissue. (a) The exterior gallbladder and fat tissue model with texture; (b) Exterior and interior mesh (two layers) of gallbladder and fat tissue; (c) Exterior and interior mesh in the area of fat tissue; (d) Silhouettes for the exterior and interior mesh; (e) Silhouette and intermediate layers in one cross section; (f) Multi-layer hexahedral model.
Figure 15
Figure 15
The inner-spheres model and deformation result of different abdominal organs (From left to right: mesh and the inner-spheres model; the topology connection for the inner-spheres; deformation result 1; deformation result 2). (a) Gall-bladder, (b) Intestine, (c) Stomach.
Figure 16
Figure 16
The comparison between our method and three typical approaches in the liver deformation. (a) FEM based method; (b) Mass-spring method; (c) PBD based method; (d) Our method.
Figure 17
Figure 17
The comparison of computation efficiency for collision detection between soft tissue and surgical instrument among three different approaches.
Figure 18
Figure 18
Screenshots of the transvaginal cholecystectomy simulation. (a) Identification of the cystic duct and artery; (b) Clamping of cystic duct and artery; (c) Cutting of the cystic duct and artery; (d) Disconnect the liver and gallbladder.
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References

    1. Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ. A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery. Ann. Surg. 2008 Apr.247:583–602. - PubMed
    1. Giday SA, Kantsevoy SV, Kalloo AN. Principle and history of natural orifice translumenal endoscopic surgery (NOTES) Minim. Invasive Ther. Allied Technol. 2006 Jun.15:373–377. - PubMed
    1. Baron TH. Natural orifice translumenal endoscopic surgery. Br. J. Surg. 2007 Jan.94:1–2. - PubMed
    1. Coomber RS, Sodergren MH, Clark J, Teare J, Yang G-Z, Darzi A. Natural orifice translumenal endoscopic surgery applications in clinical practice. World journal of gastrointestinal endoscopy. 2012;4(3):65–74. - PMC - PubMed
    1. http://endosim.com/

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