Suturing Simulator Research Articles

Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery.

Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model. A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity. Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014-2016. All face and content validity measures achieved a median score greater than 4 (range 4.0-5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477s and transverse closure: 79 vs. 192s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons). Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

Characterizing the learning curve of a virtual intracorporeal suturing simulator VBLaST-SS©.

The virtual basic laparoscopic skill trainer suturing simulator (VBLaST-SS©) was developed to simulate the intracorporeal suturing task in the FLS program. The purpose of this study was to evaluate the training effectiveness and participants' learning curves on the VBLaST-SS© and to assess whether the skills were retained after 2weeks without training. Fourteen medical students participated in the study. Participants were randomly assigned to two training groups (7 per group): VBLaST-SS© or FLS, based on the modality of training. Participants practiced on their assigned system for one session (30min or up to ten repetitions) a day, 5days a week for three consecutive weeks. Their baseline, post-test, and retention (after 2weeks) performance were also analyzed. Participants' performance scores were calculated based on the original FLS scoring system. The cumulative summation (CUSUM) method was used to evaluate learning. Two-way mixed factorial ANOVA was used to compare the effects of group, time point (baseline, post-test, and retention), and their interaction on performance. Six outof seven participants in each group reached the predefined proficiency level after 7days of training. Participants' performance improved significantly (p < 0.001) after training within their assigned group. The CUSUM learning curve shows that one participant in each group achieved 5% failure rate by the end of the training period. Twelve out of fourteen participants' CUSUM curves showed a negative trend toward achieving the 5% failure rate after further training. The VBLaST-SS© is effective in training laparoscopic suturing skill. Participants' performance of intracorporeal suturing was significantly improved after training on both systems and was retained after 2 weeks of no training.

An Integrated Suture Simulation System with Deformation Constraint Under A Suture Control Strategy

Current research on suture simulation mainly focus on the construction of suture line, and existing suture simulation systems still need to be improved in terms of diversity, soft tissue effects, and stability. This paper presents an integrated liver suture surgery system composed of three consecutive suture circumstances, which is conducive to liver suture surgery training. The physically-based models used in this simulation are based on different mass-spring models regulated by a special constrained algorithm, which can improve the model accuracy, and stability by appropriately restraining the activity sphere of the surrounding mass nodes around the suture points. We also studied the kinematic model to update the status of suture points in real time, according to an external force exerted by the operators, which can sense synchronous force feedback in return as well. Moreover, in case that the sutured wounds tear open again, a suture control strategy is designed to ensure the stability of the whole suturing procedure. Several experiments are carried out to validate the model performance in terms of model accuracy, suture control effects, and comprehensive training effects. The experiment results show that the proposed models have realistic visual and haptic feedback, stable control on the suture, as well as good training effects as an integrated liver suture surgery system compared to other suture simulation systems which only simulate suture on a single kind of soft tissue.

The alternative model of silicone for experimental simulation of suture of living tissue in the teaching of surgical technique.

Purpose: To develop a silicone alternative model of tissue suture simulation to be used in the teaching of surgical technique. Methods: Twelve alternative models of silicone for tissue suture simulation were manufactured and implemented as a tool for suture pattern training of undergraduate medical students of Universidade Federal do Amazonas. Forty-eight students participated in the research. The evaluation of the proposed model was done through a questionnaire using the Likert scale, in order to verify the student satisfaction index of the alternative resource and its performance as opposed to the model historically used in the discipline, which is to suture in cloths. Results: The alternative model showed satisfactory results, especially with respect to the structural aspect, such as, better perception of anatomical planes, handling and transport. About 89.58% of positive concordant responses demonstrating expressive approval for incorporation of a complementary form of the alternative methodological proposal of the discipline of surgical technique. Conclusions: The model developed for experimental simulation of tissue sutures has proved to be a fully feasible alternative method for the training of this surgical skill. It is a simple, reproducible and low-cost model.

Investigating the Efficacy of Anatomical Silicone Models Developed from a 3D Printed Mold for Perineal Repair Suturing Simulation.

There is a scarcity of affordable, validated, standardized and anatomically correct silicone perineum models for the rehearsal of postpartum laceration repair. The purpose of this technical report is to describe and validate evidence for a silicone, perineal repair model created from a 3D printed mold for medical resident training and clinical skills maintenance.A pre-existing model from an open-source royalty-free website was purchased and converted using Fusion360TM (Autodesk Inc., San Rafael, CA, USA) into a stereolithography (.stl) file and altered to produce a negative mold. Using a spatula, a fine silicone layer was first applied inside the mold, followed by a small piece of flesh-colored mesh netting material within the perineal surface area, fitting the width of the mold. The mesh was pressed into the thin layer of silicone, which was meant to provide anatomical structure to prevent the sutures from tearing through the silicone. The remainder of the silicone mix was then poured into the mold, which required three hours to fully set before being removed from the mold. Twelve silicone models were produced and used during a one-hour workshop at the Rural and Remote Conference by 16 obstetrics and gynecology residents and practicing rural physicians, and four facilitators. At the end of the workshop, the participants were provided with a qualitative survey and asked to rate the perceived realism and educational effectiveness of the silicone perineum model as compared to pre-existing simulation models that they have used previously. The overall workshop participant feedback was positive, noting that the models provided more realistic visualization for the suturing simulation of first- and second-degree perineal injuries.The silicone models were considered to be useful in simulation training when attempting first- and second-degreeperineum suturing techniques within a confined space. The overall feedback was positive, noting that they provided more realistic visualization experience compared to pre-existing simulation models, such as beef tongues and synthetic sponges. The feedback from the participants and facilitators included thoughts about how to add additional mesh to the silicone model so the subcutaneous and vaginal plane sutures would hold, as well as increase the size of the vaginal canal size to more accurately represent a postpartum repair. There were also suggestions to alter the colour of the model to be flesh-toned as opposed to pink, to more accurately simulate human tissue.Silicone perineum models, created from a 3D printed mold, are an economical training tool as compared to commercially available, cost prohibitive models. They also provide anatomically accurate simulation training opportunities for residents to learn and maintain clinical skills in perineal repair, as compared to beef tongues and synthetic sponges, which have previously been used in obstetrics and gynecology simulation-based medical education.

Mo1976 Development and Initial Validation of a Fully Synthetic and Reusable Endoscopic Suturing Simulator

Mo1976 Development and Initial Validation of a Fully Synthetic and Reusable Endoscopic Suturing Simulator

Assessment potential of a new suture simulator in laparoscopic surgical skills training

Background: The skills necessary for performing effective laparoscopic suturing are difficult to acquire; as a result, simulators for learning these skills are rapidly becoming integrated into surgical training. The aim of the study was to verify whether a new hybrid simulator has the potential to measure skill improvement in young, less experienced gastroenterological surgeons.Material and methods: The study included 12 surgeons (median age, 29 (27–38)] years; 11 men (91.7%), one woman (8.3%)) who participated in a two-day laparoscopic training seminar. We used the new simulator before and after the program to evaluate individual performance. Skills were evaluated using five criteria: volume of air pressure leakage, number of full-thickness sutures, suture tension, wound area, and performance time.Results: Air pressure leakage was significantly higher after than before the training (p = .027). The number of full-thickness sutures was significantly higher post-training (p < .01). Suture tension was significantly less post-training (p = .011). Wound opening areas were significantly smaller post-training (p = .018). Performance time was significantly shorter post-training (p = .032).Conclusions: Our study demonstrated the assessment quality of this new laparoscopic suture simulator.

Objective assessment of the suture ligature method for the laparoscopic intestinal anastomosis model using a new computerized system.

The purpose of this study was to develop a new objective assessment system for the suture ligature method employed in the laparoscopic intestinal anastomosis model. Suturing skills were evaluated objectively using this system. This study compared 17 expert surgeons, each of whom had performed >500 laparoscopic procedures, with 36 novice surgeons, each of whom had performed <15 laparoscopic procedures. Each examinee performed a specific skill assessment task using an artificial model that mimics living tissue, which is linked with the Suture Simulator Instruction Evaluation Unit. The model used internal air pressure measurements and image processing to evaluate suturing skills. Five criteria were used to evaluate the skills of participants. The volumes of air pressure leak in the expert and novice groups were 21.13 ± 6.68 and 8.51 ± 8.60 kPa, respectively. The numbers of full-thickness sutures in the expert and novice groups were 2.94 ± 0.24 pairs and 2.47 ± 0.77 pairs, respectively. Suture tensions in the expert and novice groups were 60.99 ± 11.81 and 80.90 ± 16.63 %, respectively. The areas of wound-opening in the expert and novice groups were 1.76 ± 2.17 and 11.06 ± 15.37 mm(2), respectively. The performance times in the expert and novice groups were 349 ± 120 and 750 ± 269 s, respectively. Significant differences between the expert and novice groups for each criterion were observed. The acceptable range of values for each criterion except for the number of full-thickness sutures was statistically defined by the performance of the expert group. Our system is useful for the quantitative assessment of suturing skill in laparoscopic surgery. We believe that this system is a useful tool for training and assessment of laparoscopic surgeons.

MP14-06 SUTURING SIMULATION VERSUS ROBOTIC PRACTICE: AN EVALUATION OF PERFORMANCE IMPROVEMENT, CONTENT, AND FACE VALIDITY IN NOVICE OPERATORS.

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment II1 Apr 2014MP14-06 SUTURING SIMULATION VERSUS ROBOTIC PRACTICE: AN EVALUATION OF PERFORMANCE IMPROVEMENT, CONTENT, AND FACE VALIDITY IN NOVICE OPERATORS. Samuel M. Lindner, Michael J. Amirian, Edouard J. Trabulsi, and Costas D. Lallas Samuel M. LindnerSamuel M. Lindner More articles by this author , Michael J. AmirianMichael J. Amirian More articles by this author , Edouard J. TrabulsiEdouard J. Trabulsi More articles by this author , and Costas D. LallasCostas D. Lallas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.634AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Virtual reality (VR) simulation has been advocated for improving robotic surgery skills for novice trainees. In the absence of dedicated suturing simulation, however, VR simulation has not translated to increases in real-world suturing performance, and the incremental benefit of VR simulation over dry lab practice is unclear. The aim of this study is to evaluate the effectiveness of VR simulation versus dry lab suturing practice at improving suturing performance in robotic surgery. METHODS Nineteen novice participants with no prior robotic suturing experience were randomized to two groups (VR simulation and dry lab). Each group underwent baseline suturing evaluation using a validated, objective suture score method. Groups were next assigned to train on the Simbionix™ Suturing Module (SSM) or undertake suturing practice using the da Vinci Surgical System in a dry lab. At the conclusion of training or practice, final suturing performance was evaluated using the objective suture scoring method. Participants in the VR simulation group were surveyed at the conclusion of the final suturing evaluation to assess the face and content validity of the SSM. RESULTS Both groups experienced significant improvement after training (VR simulation group p=0.0078; dry lab group p=0.0039). There was no significant difference in improvement between the two groups after undergoing training with either SSM use or suturing practice using the robotic surgical system in a dry lab. Improvement in composite timing scores were 123 and 172 in the VR simulation and dry lab test groups, respectively (p=0.36). In the validity assessment, participants rejected the face validity of the SSM with regard to simulated tissue behavior, and confirmed face validity for clutching, needle driving, depth/spatial relationship, and visual appearance. The participants confirmed content validity of the SSM in all categories, finding simulated tissue behavior, clutching, needle driving, depth/spatial relationship, and visual appearance useful and relevant for training. CONCLUSIONS In this sample of novice operators, there was no significant advantage to training with VR simulation using the SSM over dry lab training in improving suturing performance. While users of the SSM did not find all aspects of the simulator realistic in their face validity assessment, they found it useful and relevant as a training tool for improving suturing performance. Performance Data Summary Dry Lab (n=9) VR Simulation (n=10) Mean (SD) Median [Min, Max] Mean (SD) Median [Min, Max] p-value Timing Score Initial 235.22 (119.01) 265 [0, 353] 254.3 (144.75) 318.5 [0, 401] 0.5928 Final 407.67 (74.22) 440 [263, 476] 377.5 (51.52) 375.5 [302, 453] Difference 172.44 (114.38) 154 [18, 360] 123.20 (115.44) 98 [-34, 302] 0.3602 Time (Sec) Initial 355.67 (120.96) 313 [247, 600] 337.7 (146.6) 270 [195, 600] Final 185.22 (70.1) 159 [123, 327] 212.6 (53.13) 214.5 [143, 291] Difference -170.44 (117.30) -142 [-350, -15] -125.10 (117.38) -101.50 [-309, 27] 0.4023 Accuracy (mm) Initial 1.38 (1.3) 1 [0, 4] 2.11 (1.27) 2 [0, 4] Final 0.75 (1.16) 0 [0, 3] 0.78 (1.09) 0 [0, 3] Difference -0.63 (1.06) -0.50 [-2, 1] -1.33 (1.32) -1 [-3, 1] 0.2726 Gap (mm) Initial 0.13 (0.35) 0 [0, 1] 0.11 (0.33) 0 [0, 1] Final 0.50 (0.76) 0 [0, 2] 0.56 (1.13) 0 [0, 3] Difference 0.38 (0.92) 0 [-1, 2] 0.44 (1.24) 0 [-1, 3] 0.8734 Integrity Secure 3 5 3 3 Loose 3 3 6 6 Coming Apart 2 1 0 1 Incomplete 1 0 1 0 Total 9 9 10 10 0.0945 Square Knots Square 0 3 0 2 Not Square 8 6 9 8 Incomplete 1 0 1 0 Total 9 9 10 10 0.6825 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e169 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Samuel M. Lindner More articles by this author Michael J. Amirian More articles by this author Edouard J. Trabulsi More articles by this author Costas D. Lallas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

3P1-A04 柔軟組織の実時間縫合シミュレーション(医療ロボティクス・メカトロニクス(2))

3P1-A04 柔軟組織の実時間縫合シミュレーション(医療ロボティクス・メカトロニクス(2))

Bauchdeckenverschluss und Narbenhernienprävention - Was braucht die Chirurgie?

In the light of an incisional hernia incidence of between 10 and 20 % that remains constantly high in spite of modifications of suture materials and suture techniques, intensified scientific efforts aiming at incisional hernia prevention are -required. This article reviews the scientific results dealing with incisional hernia incidence, time of manifestation, risk factors and the influence of suture material and suture technique. A lack of evidence-based data and no current consensus concerning the ideal material and technique to close laparotomies has to be mentioned. To encourage a novel approach to incisional hernia -prevention, the results of experimental studies which demonstrate the negative effects of conventional laparotomy closure on the abdominal wall are discussed. Histology and additionally -laser-fluorescence angiography reveal the weak-en-ing of abdominal wall structures and abdominal wall perfusion after directly suturing the -incisional edges. Additionally, inadequate suture -tension has an influence on collagen quantity and quality in the healing incision. Further investigations with a suture simulator have made clear that surgical sutures vary widely in precision and reproducibility of suture tension when completed only under visual and tactile control. As suture tension dynamics cannot be measured due to the lack of adequate devices, an implantable sensor has been developed that reveals a loss of suture tension of up to 60 % of the initial tension in the first 2 hours after completion of laparotomy closure. These results have led to the development and experimental use of a bridging closure with a tension-banding technique. This technique has almost no influence on abdominal wall per-fusion, leaves the architecture and dynamics of the abdominal wall intact, and results in a favour-able ultra-structural composition of collagen and a mechanically stable laparotomy healing after 15 months. Measures to prevent incisional hernia formation - which is in fact the post-operative complication in surgery most frequently leading to re-operation - require intensified research activities. Success will only be achieved if the development of -unconventional closure techniques is encouraged and the beaten path of suturing the incisional edges is discarded.

Virtual Suturing Simulation Based on Commodity Physics Engine for Medical Learning

Development of virtual-reality medical applications is usually a complicated and labour intensive task. This paper explores the feasibility of using commodity physics engine to develop a suturing simulator prototype for manual skills training in the fields of nursing and medicine, so as to enjoy the benefits of rapid development and hardware-accelerated computation. In the prototype, spring-connected boxes of finite dimension are used to simulate soft tissues, whereas needle and thread are modelled with chained segments. Spherical joints are used to simulate suture's flexibility and to facilitate thread cutting. An algorithm is developed to simulate needle insertion and thread advancement through the tissue. Two-handed manipulations and force feedback are enabled with two haptic devices. Experiments on the closure of a wound show that the prototype is able to simulate suturing procedures at interactive rates. The simulator is also used to study a curvature-adaptive suture modelling technique. Issues and limitations of the proposed approach and future development are discussed.

What is the ideal interval between training sessions during proficiency-based laparoscopic simulator training?

Background The aim of this study was to identify the ideal interval between training sessions in a proficiency-based laparoscopic suturing simulator curriculum. Methods We analyzed performance data from 3 randomized controlled trials of novices (n = 66) who followed a similar proficiency-based simulator curriculum in laparoscopic suturing on the Fundamentals of Laparoscopic Surgery model. The change in performance and intertraining interval were correlated. Results Overall participant performance improved from 530 ± 58 seconds at baseline to 81 ± 14 seconds at training completion ( P < .001). Intertraining intervals ranged from 1 to 43 days and performance change between training sessions varied widely. There was no correlation of performance change with intertraining interval ( r = .05, P = .30). Performance deterioration was similar at different intertraining intervals. Shorter intervals were associated, however, with shorter training duration ( r = .35, P = .005). Conclusions No association was found between intertraining interval and change in performance during proficiency-based laparoscopic simulator training but shorter intervals were associated with improved skill acquisition. Further study is needed to confirm these findings.

The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation

Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic suturing training. All participants of several European Association for Endoscopic Surgery (EAES)-approved laparoscopic skills courses (N = 45) filled out a questionnaire on their opinion on laparoscopic suturing training. Additionally, participants with little or no laparoscopic suturing experience were allotted to two groups: group A (N = 10), who started training on the box trainer and subsequently the VR simulator (SimSurgery), and group B (N = 10), who began on the VR simulator followed by the box. Finally, suturing and knot-tying skills were assessed by an expert observer, using a standard evaluation form (eight items on five-point-Likert scale). The same was done after the initial training on the box in group A, as a control. Significant differences were calculated with the independent-sample t-test and the paired t-test. The total score of group A was higher than both group B and control (means of 30.80, 27.60, 28.20, respectively), but not significantly. The only tendency to a significant difference between group A and B was found in 'taking proper bites' (mean 4.10 versus 3.60, p = 0.054). All the participants scored the features of the box trainer significantly higher than those of the VR simulator (p < 0.001), 46.7% was of the opinion that the box alone would be sufficient for laparoscopic suturing training. From this study we can conclude that VR simulation does not have a significant additional value in laparoscopic suturing training, over traditional box trainers. One should consider that the future development in VR simulation should focus on basic skills and component tasks of procedural training in laparoscopic surgery, rather than laparoscopic suturing.

Construct validity for the LAPSIM laparoscopic surgical simulator

The skills required for laparoscopic surgery are amenable to simulator-based training. Several computerized devices are now available. We hypothesized that the LAPSIM simulator can be shown to distinguish novice from experienced laparoscopic surgeons, thus establishing construct validity. We tested residents of all levels and attending laparoscopic surgeons. The subjects were tested on eight software modules. Pass/fail (P/F), time (T), maximum level achieved (MLA), tissue damage (TD), motion, and error scores were compared using the t-test and analysis of variance. A total of 54 subjects were tested. The most significant difference was found when we compared the most (seven attending surgeons) and least experienced (10 interns) subjects. Grasping showed significance at P/F and MLA (p < 0.03). Clip applying was significant for P/F, MLA, motion, and errors (p < 0.02). Laparoscopic suturing was significant for P/F, MLA, T, TD, as was knot error (p < 0.05). This finding held for novice, intermediate, and expert subjects (p < 0.05) and for suturing time between attending surgeons and residents (postgraduate year [PGY] 1-4) (p < 0.05). LAPSIM has construct validity to distinguish between expert and novice laparoscopists. Suture simulation can be used to discriminate between individuals at different levels of residency and expert surgeons.

Real-time finite element modeling for surgery simulation: An application to virtual suturing

Real-time finite element (FE) analysis can be used to represent complex deformable geometries in virtual environments. The need for accurate surgical simulation has spurred the development of many of the new real-time FE methodologies that enable haptic support and real-time deformation. These techniques are computationally intensive and it has proved to be a challenge to achieve the high modeling resolutions required to accurately represent complex anatomies. The authors present a new real-time methodology based on linear FE analysis that is appropriate for a wide range of surgical simulation applications. A methodology is proposed that is characterized by high model resolution, low preprocessing time, unrestricted multipoint surface contact, and adjustable boundary conditions. These features make the method ideal for modeling suturing, which is an element common to almost every surgical procedure. This paper describes constraints in the context of a Suturing Simulator currently being developed by the authors.

Cranial suture simulator for ultrasound diagnosis of craniosynostosis

In evaluating the effectiveness of ultrasound as a screening tool for craniosynostosis it was discovered that sonologists and sonographers needed more experience scanning and visualizing cranial sutures on ultrasound. To create an ultrasound simulator to train radiologists and technologists to locate and recognize patent and fused cranial sutures in children. The hypoechoic appearance of patent sutures was simulated by cutting lines into life-sized plastic doll heads and filling them with a commercial hypoechogenic material. Fused hyperechoic sutures were simulated by not cutting into the hard plastic region of a suture. The simulator's teaching value was evaluated on three radiology residents and three fellows. Subjects performed pre-training scans on unknown simulators, received feedback and an opportunity to scan a training simulator, and then performed post-training scans on random unknown simulators. Accuracy was recorded as percentage of correctly demonstrated sutures. The suture simulator reproduces the sonographic appearance of patent and fused cranial sutures. Accuracy of acquisition, interpretation, and overall diagnosis increased from 64 to 91%, 79 to 91%, 61 to 97%, respectively, between pre and post training scans. An ultrasound simulator can reproduce the appearance of patent and fused cranial sutures in children and can be used to train radiologists and technologists in the performance of a screening protocol.

Banded matrix approach to Finite Element modelling for soft tissue simulation

Realistic deformation of computer-simulated anatomica structures is computationally intensive. As a result, simple methodologies not based in continuum mechanics have been employed for achieving real-time deformation of virtual anatomy. Since the graphical interpolations and simple spring models commonly used in these simulations are not based on the biomechanical properties of tissue structures, these ‘quick and dirty” methods typically do not represent accurately the complex deformations and force-feedback interactions that can take place during surgery. Finite Element (FE) analysis is widely regarded as the most appropriate alternative to these methods. Extensive research has been directed toward applying this method to modelling a wide range of biological structures, and a few simple FE models have been incorporated into surgical simulations. However, because of the highly computational nature of the FE method, its direct application to real-time force-feedback and visualisation of tissue deformation has not been practical for most simulations. This limitation is due primarily to the overabundance of information provided by the standard FE approaches. If the mathematics are optimised through preprocessing to yield only the information essential to the simulation task, run-time computation requirements can be reduced drastically. We are currently developing such methodologies, and have created computer demonstrations that support real-time interaction with soft tissue. To illustrate the efficacy and utility of these fast “banded matrix” FE methods, we present results from a skin suturing simulator which we are developing on a PC-based platform.