Aportable apparatus is being developed as a means of training surgeons in robot-assisted surgery, including laparoscopic and other forms of minimally invasive surgery. The apparatus can be characterized as a virtual reality system that includes not only a computer and a visual display subsystem, but also an electromechanical subsystem with which a surgeon in training can interact as though interacting with a console of the type used to control a laparoscopic, endoscopic, or other surgical robot.

The use of virtual reality in surgical training was proposed more than a decade ago. Heretofore, training in laparoscopic surgery has involved the use of mechanical models, followed by the use of animals as surgical subjects, and/or supervised participation in surgery on human patients. Unfortunately, the use of mechanical models is time-consuming and does not enable automated measurement of surgical performance. The use of virtual reality in surgical training offers potential for reducing the need for mechanical models, animals, and operating-room equipment while improving the quality of training.

A master/slave robot of the type used in minimally invasive surgery typically includes a surgeon console (the master), which exerts control over three or four robot arms (collectively, the slave) that manipulate the surgical instrument(s). The robotic system transforms the surgeon's hand movements into fine, precise instrument maneuvers in an elegant, intuitive way. To satisfy requirements for clinical use, the mechanical subsystem of the console is rather large and complex.

The design of the present system reflects the following considerations:

  • A console suitable for training could include a modern surgeon's- hand-motion-tracking subsystem similar to that of a surgeon robot console.
  • Because a training console is not subject to the full set of requirements and constraints pertinent to real surgery, a training console could, potentially, be less complex and less expensive, relative to a surgeon robot console.

The system includes both hardware and software components that emulate a laparoscopic situation. The system can be made to generate displays that resemble various body surfaces with various port placements and enables anatomical explorations specific to surgical procedures. The simulation software runs on a standard personal computer and offers a wide range of skill training. The simulation can include displays of abstract scenes and of realistic scenes like those encountered in surgical procedures. (Many basic skills can be learned in abstract environments; more advanced skills can be learned in procedure- realistic environments).

The system is equipped to compute validated metrics for assessment of a user's competence level. The software of this system includes an administrative application program and software tools through which this program can gain access to other modular software that generates educational multimedia displays. The educational modules can easily be added or updated. The software also includes application programs for training in a roaming mode (free selection of exercises) and training in a session mode (that is, according to a predefined curriculum). In the session mode, it is possible to require that the user perform in excess of a specified competence level before progressing to the next set of training exercises.

The development effort thus far has been focused on design, construction, and testing of a small demonstration version of the system for training in such basic skills as manipulation of surgical instruments, dissection, and suturing. From results of tests of 21 laparoscopic simulation exercises, it was concluded that the simulation software must be modified to render it capable of managing and recording collisions between instruments. It is planned that in the next phase, the effort will be focused on development of a specific robot-assisted procedure.

This work was done by Jan Sigurd Rotnes of SimSurgery AS for the Army Research Laboratory. For more information, download the Technical Support Package (free white paper) at www.defensetechbriefs.com/tsp  under the Bio-Medical category. ARL-0014

This Brief includes a Technical Support Package (TSP).
Portable Simulator for Training in Robot-Assisted Surgery

(reference ARL-0014) is currently available for download from the TSP library.

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