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< Contents ERCIM News No. 62, July 2005

Haptic Training Systems in Virtual Surgery

by José San Martín, David Miraut, Carolina Gómez and Sofía Bayona

In the near future, the learning process of different surgery techniques is going to be based on surgical simulators. On the one hand, emerging Minimal Invasive Surgery (MIS) means minimum patient trauma. On the other hand, the only surgeon assistance is an indirect visualization of the operation, via a video monitor. In this situation, the sense of touch has become a key feature in the training of surgeons. Consequently, there is a need for the development of virtual reality haptic training systems.

Virtual Reality is acquiring increasing importance due to its potential in many areas of science and technology. Its aim is the manipulation of human senses through computer-generated virtual scenes such that users can interact with the virtual environment intuitively and in real time, without realising it is not real. In order to achieve these goals, virtual reality hardware (eg head-mounted displays, data gloves, tracking systems and haptic devices) is being used.

Thanks to this potential, virtual reality has been applied to education, military training, architectural design, psychology (for phobia therapy) and medicine, in particular for anatomical teaching and surgical training systems such as Minimal Invasive Surgery (MIS).

Typically, most efforts have been focused on composing and recreating synthetic images and sounds. However, this kind of virtual environment, which involves only visual and auditory sensations, is very limited in its ability to interact with users. A growing research community has realized the necessity of the sense of touch in performing precise tasks like surgical simulations and the remote operation of robotics in hazardous environments. During these procedures, the handling of assorted objects is critical, and haptic assistance clearly improves performance.

A training session with Laparoscopy Impulse Engine.
A training session with Laparoscopy Impulse Engine.

Recent advances in computing and haptic devices now allow the pressure and temperature sensory receptors in human skin to be ‘cheated’. In order to create the sensation of touching and manipulating virtual objects in real time, we need to generate the reaction force over them. These receptors are spread over a large area and are extremely fast, so the reflecting force must be recalculated over 1000 times per second. This is a complex challenge when we deal with deformable bodies as in MIS.

MIS techniques offer important advantages, such as decreasing patient trauma and reducing costs, but they also have an important drawback: they are complex procedures and difficult to master. Traditional learning methods, assuming the importance of force feedback, use real surgical instruments with phantoms (plastic models) for training. However this set of instruments is expensive and delicate; moreover, the plastic models degrade due to the incisions until they become unusable.

Here virtual reality and haptics have come up with the solution. Our team, in cooperation with the company GMV, is developing a successful advanced arthroscopy training simulator, based on virtual reality. Using this simulator, the practitioner learns to handle the surgical instruments and to recognize pathologies. The incorporation of a haptic device facilitates triangulation and navigation learning, making it possible to feel and distinguish between different tissues.

Current haptic MIS training systems can be classified as either general purpose devices (eg from SensAble PHANToM) or brand new devices dedicated to surgical simulation (eg Immersion’s Laparoscopy Impulse Engine, Virtual Laparoscopic Interface-VLI without force-feedback, and Laparoscopic Surgical Workstation with force-feedback). We have designed a dedicated system, but there remain some limitations that we want to solve.

Shoulder arthroscopy requires a very flexible working area, especially regarding inter-trocar distance (this is fixed in current devices at 135mm). Human body dimensions differ from one patient to another, and this technique necessitates the simultaneous positioning of each trocar on every side of the patient’s shoulder.

We need both surgical instruments to face on, one trocar against the other: this is not normally possible because of the main stand structure. It is therefore necessary to include this additional degree of freedom.

It is crucial to ensure that even if the instruments face each other, and the minimum lateral distance between them has been established, they do not touch one another.

The suggested design, the Laparoscopy Training System, provides the usual five degrees of freedom (including a scissors handle option in order to simulate grasping forces), plus two additional degrees. These are a lateral displacement of every actuator set (adaptive inter-trocar distance) and a rotation of these sets around the device symmetry axis. Moreover, the design allows an ergonomic positioning of the surgical instruments depending on the preference of the trainee.

Our work is focused on designing an MIS training system to simulate specific laparoscopy techniques that are not generally considered. Having finished the design stage, a prototype is under construction, and a working device should be achieved by summer 2005.

Nowadays, the features of physical devices restrict programmers due to limitations in the number of degrees of freedom. We think that this design will help to solve these constraints


Please Contact:
José San Martín, Universidad Rey Juan Carlos/SpaRCIM, Spain