Recent Advancements in Simulators for Surgical Robotics

Transcription

1 Recent Advancements in Simulators for Surgical Robotics Andrea Moglia, Giuseppe Turini, Vincenzo Ferrari, Mauro Ferrari, Franco Mosca EndoCAS, Center for Computer Assisted Surgery, University of Pisa (Italy) La Medicina Incontra la Realtà Virtuale 14 Dicembre 2010, Pisa (Italia)

2 Outline of the talk The Scientific Problem Surgical Simulators Simulators for Surgical Robotics Preoperative Planning for Surgical Robotics Conclusions

3 The Scientific Problem Reducing Medical Errors Over half of all medical adverse events are surgical in nature and 75% of these happen in the operating room. Many of them may be errors caused by physicians in the process of the learning curve. The Bristol Case in the U.K. and the Err is Human report published by the Institute of Medicine in the United States suggested that better training and objective assessment would be key strategies in attaining the goal of reduced medical errors. Drawing on the successful paradigm of flight simulation, Satava first proposed training surgical skills in virtual reality (VR) nearly a decade ago. Source: Seymour NE et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236:

4 Surgical Simulators Satava Insight Requirements Accurate Detail Highly Interactive A Realistic Simulation Fidelity Object Properties Interactivity Sensory Input Reactivity Source: Satava RM. Virtual reality surgical simulator. The first steps. Surg Endosc 1993; 7:

5 Manufacturers of Surgical Simulators Mimic SimSurgery Surgical Science SimuLab CAE Mentice Simbionix Virtamed SimSurgSys Haptica Immersion METI

6 Surgical Simulators Roadmap for Future Simulators Patient Specific Data for Surgical Planning and Rehearsal Judgement Assessment Intelligent tutors Virtual Mentors DaVinci Incorporation Haptics Integration Source: Satava RM. The future of sugical simulation and surgical robotics. Bull Am Coll Surg 2007; 92: 13-9.

7 Surgical Simulators The Value of Haptic Feedback A potential major drawback, comparing robotic assisted surgery (RAS) to conventional endoscopic surgery (CES), is the absence of haptic feedback in RAS. In CES force feedback is experienced by the surgeon through the laparoscopic instrument handles, resulting from the interaction of the laparoscopic instruments tips with the tissue. In RAS, lack of force feedback may prolongue operative times and learning curves, and increase the risk of surgical errors. Even experienced surgeons training with RAS often tear apart sutures and damage delicate tissues. The loss of force feedback in RAS compared with CES may be balanced partly by the restoration of three-dimensional vision. Source van der Meijden OA et al. The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training. Surg Endosc 2009; 23:

8 Simulators for Surgical Robotics Motivations Most robotic training occurs during live surgery or during robotic courses on animal models or inanimate objects. Source: Rashid HH, Leung YY, Rashid MJ, et al. Robotic surgical education: A systematic approach to training urology resi- dents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 2006; 68: The cost of the da Vinci Si System is approximately $1.7 million maintenance fee running between $125,000 and $150,000 per year. Adding a second console for training purposes would bring the cost to approximately $2.25 million.

9 Manufacturers of Surgical Simulators Mimic SimSurgery Surgical Science SimuLab CAE Mentice Simbionix Virtamed SimSurgSys Haptica Immersion METI

10 Simulators for Surgical Robotics RoSS by Simulated Surgical Systems Developed in collaboration between Roswell Park Cancer Institute and the University at Buffalo. RoSS (Robotic Surgical Simulator) to simulate the master console of da Vinci Surgical System. Two 6 d.o.f. input devices, stereo head mounted display, pedals for clutch and camera controls. Unveiled in late February Price: about 100,000 $.

11 Simulators for Surgical Robotics RoSS by Simulated Surgical Systems Basic skills module: tissue cutting, knot tying, needle driving, needle manipulation, suturing, fourth arm manipulation, and vessel clipping. To improve hand eye coordination and teach basic robotic surgical skills. Basic orientation module: camera navigation, robotic arm control and orientation, safe synchronous camera and arm movement, use and maneuverability of a fourth arm, and clutch and wristed instrumentation. To improve: the use and maneuvering of camera, the recognition of visual and depth perception, and the safe use of robotic surgical instruments. Surgical modules: Radical Prostatectomy, Hysterectomy, Cystectomy. To develop necessary technical and cognitive skills for specific steps during robot-assisted surgeries.

12 Simulators for Surgical Robotics RoSS by Simulated Surgical Systems Clinical Studies Kesavadas T, Stegemann A, Sathyaseelan G, Chowriappa A, Srimathveeravalli G, Seixas-Mikelus S, Chandrasekhar R, Wilding G, Guru K. Validation of Robotic Surgery Simulator (RoSS). To be presented at the Medicine Meets Virtual Reality, February Seixas-Mikelus SA, Stegemann AP, Kesavadas T, Srimathveeravalli G, Sathyaseelan G, Chandrasekhar R, Wilding GE, Peabody JO, Guru KA. Content validation of a novel robotic surgical simulator. BJU Int Oct 4. Seixas-Mikelus SA, Kesavadas T, Srimathveeravalli G, Chandrasekhar R, Wilding GE, Guru KA. Face validation of a novel robotic surgical simulator. Urology 2010; 76: Seixas-Mikelus S, Adal A, Srimathveeravalli G, Kesavadas T, Baheti A, Chandrashekar R, Wilding G and Guru K. Can Image Based Virtual Reality Help Teach Anatomy? J Endourol 2010; 24:

13 Simulators for Surgical Robotics dv-trainer TM by Mimic Commissioned by the Departments of Urology at Indiana University and Mechanical Engineering at Purdue University. Accurate modeling of da Vinci kinematics and instruments. Simulation exercises were developed in close collaboration with Intuitive Surgical to achieve unparalleled realism. System training module: surgeon console awareness, endowrist manipulation, camera & clutching, trouble shooting. Skills training module: needle control, needle driving, energy & dissection, games. Price: 98,000 $.

14 Simulators for Surgical Robotics dv-trainer TM by Mimic Clinical Studies Lerner MA, Ayalew M, Peine WJ, Sundaram CP. Does training on a virtual reality robotic simulator improve performance on the da Vinci surgical system? J Endourol 2010; 24: Kenney PA, Wszolek MF, Gould JJ, Libertino JA, Moinzadeh A. Face, content, and construct validity of dv-trainer, a novel virtual reality simulator for robotic surgery. Urology 2009; 73: Sethi AS, Peine WJ, Mohammadi Y, Sundaram CP. Validation of a novel virtual reality robotic simulator. J Endourol 2009; 23: SEP by SimSurgery Clinical Study Lin DW, Romanelli JR, Kuhn JN, Thompson RE, Bush RW, Seymour NE. Computer-based laparoscopic and robotic surgical simulators: performance characteristics and perceptions of new users. Surg Endosc 2009 Jan; 23:

15 Preoperative Planning for Surgical Robotics Patient Specific Data for Surgical Planning and Rehearsal Judgement Assessment Intelligent tutors Virtual Mentors DaVinci Incorporation Haptics Integration Source: Satava RM. The future of sugical simulation and surgical robotics. Bull Am Coll Surg 2007; 92: 13-9.

16 Preoperative Planning for Surgical Robotics Benefits Integrating the geometrical structure of the individual patient and the surgical scene in virtual space, surgeons can confirm the movability of the robot in the operating room. Appropriate placement of the trocar ports maximizes the movable range of the robot, and significantly influences the success of the operation. If surgeons rehearse by using a virtual training system, they can develop an intuitively common perception about how to set up the robot in the operating room and the actual setup time in the operating room will be reduced. The planning system can be effective as an educational program for doctors who are inexperienced in robotic surgery. Source: Hayashibe M, Suzuki N, Hattori A, Suzuki S, Konishi K, Kakeji Y, Hashizume M. Surgical robot setup simulation with consistent kinematics and haptics for abdominal surgery. Stud Health Technol Inform 2005; 111:

17 Simulators for Surgical Robotics Judgement Assessment Intelligent tutors Virtual Mentors Any Robot Incorporation Haptics Integration Patient Specific Data for Surgical Planning and Rehearsal Source: Satava RM. The future of sugical simulation and surgical robotics. Bull Am Coll Surg 2007; 92: 13-9.

18 Preoperative Planning for Surgical Robotics The ARAKNES Simulator Moglia A, Turini G, Ferrari V, Ferrari M, Mosca F. Patient Specific Surgical Simulator for the Evaluation of the Movability of Bimanual Robotic Arms. To be presented at the Medicine Meets Virtual Reality, February 2011.

19 Conclusions The Scientific Problem Surgical Simulators Simulators for Surgical Robotics Preoperative Planning for Robotic Surgery