Patient-specific Surgical Simulation Research Articles

Patient-specific simulation for tracheobronchial reconstruction procedures using 3-dimensional operable models: A proof-of-concept study.

Patient-specific simulation for tracheobronchial reconstruction procedures using 3-dimensional operable models: A proof-of-concept study.

Revue compréhensive de l’apport de l’impression 3D en médecine : mise en perspective des différentes applications en urologie

Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Development and evaluation of a patient-specific surgical simulator for endoscopic colloid cyst resection.

Endoscopic resection of third-ventricle colloid cysts is technically challenging due to the limited dexterity and visualization provided by neuroendoscopic instruments. Extensive training and experience are required to master the learning curve. To improve the education of neurosurgical trainees in this procedure, a synthetic surgical simulator was developed and its realism, procedural content, and utility as a training instrument were evaluated. The simulator was developed based on the neuroimaging (axial noncontrast CT and T1-weighted gadolinium-enhanced MRI) of an 8-year-old patient with a colloid cyst and hydrocephalus. Image segmentation, computer-aided design, rapid prototyping (3D printing), and silicone molding techniques were used to produce models of the skull, brain, ventricles, and colloid cyst. The cyst was filled with a viscous fluid and secured to the roof of the third ventricle. The choroid plexus and intraventricular veins were also included. Twenty-four neurosurgical trainees performed a simulated colloid cyst resection using a 30° angled endoscope, neuroendoscopic instruments, and image guidance. Using a 19-item feedback survey (5-point Likert scales), participants evaluated the simulator across 5 domains: anatomy, instrument handling, procedural content, perceived realism, and confidence and comfort level. Participants found the simulator's anatomy to be highly realistic (mean 4.34 ± 0.63 [SD]) and appreciated the use of actual instruments (mean 4.38 ± 0.58). The procedural content was also rated highly (mean 4.28 ± 0.77); however, the perceived realism was rated slightly lower (mean 4.08 ± 0.63). Participants reported greater confidence in their ability to perform an endoscopic colloid cyst resection after using the simulator (mean 4.45 ± 0.68). Twenty-three participants (95.8%) indicated that they would use the simulator for additional training. Recommendations were made to develop complex case scenarios for experienced trainees (normal-sized ventricles, choroid plexus adherent to cyst wall, bleeding scenarios) and incorporate advanced instrumentation such as side-cutting aspiration devices. A patient-specific synthetic surgical simulator for training residents and fellows in endoscopic colloid cyst resection was successfully developed. The simulator's anatomy, instrument handling, and procedural content were found to be realistic. The simulator may serve as a valuable educational tool to learn the critical steps of endoscopic colloid cyst resection, develop a detailed understanding of intraventricular anatomy, and gain proficiency with bimanual neuroendoscopic techniques.

Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy

ObjectiveWe sought to develop a 3-D printing-based simulator for teaching extended septal myectomy to trainees in cardiothoracic surgery (clinical postgraduate year 4-7). This procedure is difficult to teach because of generally unfamiliar and highly variable anatomy, limited visibility for the assistant, and significant potential complications. MethodsA curriculum using multimedia didactics and 3-D print-based patient-specific surgical simulation was implemented. Six identical 3-D prints were constructed for each of 5 consecutive patients. Preoperative septal myectomy was performed on each printed heart by an attending surgeon and 5 residents. Model myectomy specimen volumes were measured according to liquid displacement. All print resections were videotaped and blindly evaluated by 3 attending surgeons. Pre- and post-test evaluations, and a survey tool were also used to evaluate the curriculum. ResultsBaseline myectomy resection volumes differed significantly (attending 15 cm3 vs resident 3.1 cm3; P < .05). Residents resected increasingly larger volumes of tissue over the course of the study. Initial resection volume (compared with faculty) increased by 0.82 cm3 per resection (95% confidence interval, 0.37-1.3 cm3; P < .0001). Total resection volume (compared with faculty) increased by 3.6 cm3 per resection (95% confidence interval, 2.4-4.9 cm3; P < .0001). The residents’ survey assessment of the simulator was favorable. ConclusionsA patient-specific 3-D printing-based simulation module shows promise as a tool to augment and improve cardiothoracic resident training in septal myectomy. The residents were quickly able to perform resections on par with the attending. Residents rated the simulator favorably. Each resident benefited by experiencing the variable anatomy of 5 separate patient-specific models.

Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education

Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills.

MaterialCloning: Acquiring Elasticity Parameters from Images for Medical Applications.

We present a practical approach for automatically estimating the material properties of soft bodies from two sets of images, taken before and after deformation. We reconstruct 3D geometry from the given sets of multiple-view images; we use a coupled simulation-optimization-identification framework to deform one soft body at its original, non-deformed state to match the deformed geometry of the same object in its deformed state. For shape correspondence, we use a distance-based error metric to compare the estimated deformation fields against the actual deformation field from the reconstructed geometry. The optimal set of material parameters is thereby determined by minimizing the error metric function. This method can simultaneously recover the elasticity parameters of multiple types of soft bodies using Finite Element Method-based simulation (of either linear or nonlinear materials undergoing large deformation) and particle-swarm optimization methods. We demonstrate this approach on real-time interaction with virtual organs in patient-specific surgical simulation, using parameters acquired from low-resolution medical images. We also highlight the results on physics-based animation of virtual objects using sketches from an artist's conception.

A patient-specific surgical simulator using preoperative imaging data: an interactive simulator using a three-dimensional tactile mouse

Preoperative simulation can greatly facilitate the safe and effective conduct of surgical procedures, especially for difficult and complex operations such as hepatectomy and pancreatectomy. A computer simulation system may greatly assist surgeons to preoperatively evaluate an operation and facilitate sharing of information among the operative staff. However, there are several problems with existing simulation systems. We have developed a new surgical simulation system using a patient’s own imaging data, which has some advantages over existing systems. Individual anatomical information obtained through an imaging study is used in this system. In addition it allows interactive control, similar to what a surgeon does in a real operation. Furthermore, a surgeon can control the system intuitively using a three dimensional tactile mouse. Changing the translucency of objects makes it easy to understand complex anatomical relationships. In conclusion, this new system is a patient-specific surgical simulator and can be applied to navigation surgery, medical education and patient communication.

Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots

Introduction: The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise.Materials and Methods: This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery.Results: The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system.Discussion: The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

Tissue Modeling in a Patient‐Specific Skull Base Surgical Simulator

Objective: Patient-specific surgical simulation is a new frontier that promises great benefits for surgical planning and rehearsal. However, it requires an efficient means of generating virtual anatomic models. Our objective is to develop a workflow to convert clinical imaging data into computational representations that support real-time simulation and haptic interaction. Method: Standard computed tomography was obtained from 3 otologic patients. Key anatomy was segmented, cleaned by morphological operations, and converted into 3D polygonal meshes. These were reduced to the desired complexity and converted to solid tetrahedral meshes. Results were imported into the Simulation Open Framework Architecture (SOFA) for interactive simulation. Results: Using the workflow developed, we were able to create accurate patient-specific virtual models of surgically relevant otologic anatomy. The resulting structures can be deformed and manipulated interactively through a haptic interface. Although still labor-intensive, the workflow promises considerable time-saving over purely manual segmentation and model creation. The resulting models are amenable to derivation and application of physical properties of specific tissues to improve behavioral realism. Conclusion: Our prototype is an effective means of converting preoperative imaging into patient-specific 3D models suitable for interactive physical simulation. We continue to make model creation more automated. The potential for adding tissue-specific physical properties will augment realism and increase the utility of the simulation for surgical rehearsal.

Patient specific surgical simulator for the evaluation of the movability of bimanual robotic arms.

This work presents a simulator based on patient specific data for bimanual surgical robots. Given a bimanual robot with a particular geometry and kinematics, and a patient specific virtual anatomy, the aim of this simulator was to evaluate if a dexterous movability was obtainable to avoid collisions with the surrounding virtual anatomy in order to prevent potential damages to the tissues during the real surgical procedure. In addition, it could help surgeons to find the optimal positioning of the robot before entering the operative room. This application was tested using a haptic device to reproduce the interactions of the robot with deformable organs. The results showed good performances in terms of frame rate for the graphic, haptic, and dynamic processes.

Background-incorporated volumetric model for patient-specific surgical simulation: a segmentation-free, modeling-free framework

Patient-specific surgical simulation imposes both practical and technical challenges. We propose a segmentation-free, modeling-free framework that creates medical volumetric models for intuitive volume deformation and manipulation in patient-specific surgical simulation. The proposed framework creates a volumetric model based upon a new form of mesh structure, a Volume Proxy Mesh (VPM). The model can be generated in two phases: the vertex placement phase and mesh improvement phase. Vertices of a VPM are assigned to an initial location by curvature-based vertex placement method, and followed by mesh improvement performed by Particle Swarm Optimization (PSO). The framework is applied to several kidney CT volume data. Using the framework, the resulting models are closely tailored to the detailed features of the datasets. Moreover, the resulting VPM meshes can support broader spectrum deformation between the manipulated organ and its surrounding tissues. Progress in the mesh quality of the final mesh also shows that PSO is feasible for mesh improvement. The framework was applied to several kidney CT volume datasets. Using the framework, the resulting models are closely tailored to the detailed features of the datasets. Moreover, the resulting VPM meshes can support broader spectrum deformation between the manipulated organ and its surrounding tissues. Evaluation of final mesh quality shows that PSO is feasible for mesh improvement.

A Patient-Specific Surgical Simulation System for Spinal Screw Insertion Composed of Virtual Roentgenogram, Virtual C-Arm, and Rapid Prototyping

A Patient-Specific Surgical Simulation System for Spinal Screw Insertion Composed of Virtual Roentgenogram, Virtual C-Arm, and Rapid Prototyping