Measurements and modelling of the compliance of human and porcine organs

A physics-based algorithm for real-time simulation of electrosurgery procedures in minimally invasive surgery

BACKGROUND

High-frequency electricity is used in the majority of surgical interventions. However, modern computer-based training and simulation systems rely on physically unrealistic models that fail to capture the interplay of the electrical, mechanical and thermal properties of biological tissue.

METHODS

We present a real-time and physically realistic simulation of electrosurgery by modelling the electrical, thermal and mechanical properties as three iteratively solved finite element models. To provide subfinite-element graphical rendering of vaporized tissue, a dual-mesh dynamic triangulation algorithm based on isotherms is proposed. The block compressed row storage (BCRS) structure is shown to be critical in allowing computationally efficient changes in the tissue topology due to vaporization.

RESULTS

We have demonstrated our physics-based electrosurgery cutting algorithm through various examples. Our matrix manipulation algorithms designed for topology changes have shown low computational cost.

CONCLUSIONS

Our simulator offers substantially greater physical fidelity compared to previous simulators that use simple geometry-based heat characterization.

A New Hybrid Viscoelastic Soft Tissue Model based on Meshless Method for Haptic Surgical Simulation

This paper proposes a hybrid soft tissue model that consists of a multilayer structure and many spheres for surgical simulation system based on meshless. To improve accuracy of the model, tension is added to the three-parameter viscoelastic structure that connects the two spheres. By using haptic device, the three-parameter viscoelastic model (TPM) produces accurate deformationand also has better stress-strain, stress relaxation and creep properties. Stress relaxation and creep formulas have been obtained by mathematical formula derivation. Comparing with the experimental results of the real pig liver which were reported by Evren et al. and Amy et al., the curve lines of stress-strain, stress relaxation and creep of TPM are close to the experimental data of the real liver. Simulated results show that TPM has better real-time, stability and accuracy.

On a staggered iFEM approach to account for friction in compression testing of soft materials

An inverse finite element method (iFEM) to estimate material parameters from compression tests of soft materials is presented, where alginate hydrogel was used as a phantom material. The method applies if the boundary conditions at the loaded surfaces are not ideal, i.e. neither free of friction nor fully constrained, as it may be the case in most realistic testing set-ups. Assuming a linear friction law, the friction coefficient μ was considered unknown and estimated in a first step by minimising the difference between the contours of the sample, obtained by optical measurements, and the simulated shape. Force-displacement data were used in a second step to determine the parameters of the constitutive law. Staggering these two steps, both friction and material parameters were identified by optimisation. Skipping the first step and predefining μ instead, a unique parameter set could only be clearly identified if the deviations of the contours were considered in addition to the deviations in the force-displacement data. Finally, forward FEM calculations with differently shaped specimens were used to verify the goodness of the obtained parameter sets.

Real time cancer prediction based on objective tissue compliance measurement in endoscopic surgery

OBJECTIVE

To investigate the feasibility of real time cancer tissue diagnosis intraoperatively based on in vivo tissue compliance measurements obtained by a recently developed laparoscopic smart device.

BACKGROUND

Cancer tissue is stiffer than its normal counterpart. Modern forms of remote surgery such as laparoscopic and robotic surgical techniques diminish direct assessment of this important tissue property. In vivo human tissue compliance of the normal and cancer gastrointestinal tissue is unknown. A Clinical Real Time Tissue Compliance Mapping System (CRTCMS) with a predictive power comparable to the human hand and useable in routine surgical practice has been recently developed.

METHODS

The CRTCMS is employed in the operating theater to collect data from 50 patients undergoing intra-abdominal surgical interventions [40 men, 10 women, aged between 32 and 89 (mean = 66.4, range = 57)]. This includes 10 esophageal and 27 gastric cancer patients. A total of 1212 compliance measurements of normal and cancerous in vivo gastrointestinal tissues were taken. The data were used to calibrate the CRTCMS to predict cancerous tissue in a further 12 patients (3 cancer esophagus and 9 cancer stomach) involving 175 measurements.

RESULTS

The system demonstrated a high prediction power to diagnose cancer tissue in real time during routine surgical procedures (sensitivity = 98.7%, specificity = 99%). An in vivo human tissue compliance data bank of the gastrointestinal tract was produced.

CONCLUSIONS

Real time cancer diagnosis based on in vivo tissue compliance measurements is feasible. The reported data open new avenues in cancer diagnostics, surgical robotics, and development of more realistic surgical simulators.

Biomechanical characterisation of fresh and cadaverous human small intestine: applications for abdominal trauma

Intestinal injuries are responsible for significant morbidity and mortality arising from trauma to the abdomen. The biomechanical characterisation of the small intestine allows for the understanding of the pathophysiological mechanisms responsible for these injuries. Studies reported in the literature focus principally on quasi-static tests, which do not take into account the stresses experienced during high kinetic trauma. In addition, the use of embalmed human tissue can alter the recorded response. The stress-strain curves from 43 tensile tests performed at 1 m/s were analysed. Samples were prepared from four fresh human intestines and from four embalmed cadaveric intestines. The data indicated a two-phase response, with each response consisting of a quasi-linear increase in the stress followed by an inflection in the curve before a peak preceding the loss of stress. The fresh tissue was more deformable than the embalmed tissue, and its first peak stress was lower (P = 0.034). A complementary histological analysis was performed. The results of the analysis enable an investigation of the response of the intestinal wall layers to stress as a two-layer structure and highlight the high sensitivity of the structure's mechanical behaviour to the speed of loading and the method of preservation.

Stable Haptic Rendering Using a Pipelined Threading Architecture

The high force update rate is a key factor for achieving high performance of haptic rendering, which imposes a stringent real-time requirement upon the execution environment of the haptic system. To fulfil this requirement, haptic systems are often limited to simplified virtual environments (VEs) for reducing computational load. This paper presents a novel pipelined threading architecture, which uses several threads running consecutively for implementing haptic rendering algorithms. With the proposed method, the haptic forces updating rate is effectively increased, which leads to improved system performance and makes complex VE scenes possible in haptic rendering. Based on the 3-DOF Delta haptic device, experiments with a virtual wall haptic system are carried out and verify the proposed method.

Quantitative imaging of young's modulus of soft tissues from ultrasound water jet indentation: a finite element study

Indentation testing is a widely used approach to evaluate mechanical characteristics of soft tissues quantitatively. Young's modulus of soft tissue can be calculated from the force-deformation data with known tissue thickness and Poisson's ratio using Hayes' equation. Our group previously developed a noncontact indentation system using a water jet as a soft indenter as well as the coupling medium for the propagation of high-frequency ultrasound. The novel system has shown its ability to detect the early degeneration of articular cartilage. However, there is still lack of a quantitative method to extract the intrinsic mechanical properties of soft tissue from water jet indentation. The purpose of this study is to investigate the relationship between the loading-unloading curves and the mechanical properties of soft tissues to provide an imaging technique of tissue mechanical properties. A 3D finite element model of water jet indentation was developed with consideration of finite deformation effect. An improved Hayes' equation has been derived by introducing a new scaling factor which is dependent on Poisson's ratios v, aspect ratio a/h (the radius of the indenter/the thickness of the test tissue), and deformation ratio d/h. With this model, the Young's modulus of soft tissue can be quantitatively evaluated and imaged with the error no more than 2%.

Experimental mechanical characterization of abdominal organs: liver, kidney & spleen

Abdominal organs are the most vulnerable body parts during vehicle trauma, leading to high mortality rate due to acute injuries of liver, kidney, spleen and other abdominal organs. Accurate mechanical properties and FE models of these organs are required for simulating the traumas, so that better designing of the accident environment can be done and the organs can be protected from severe damage. Also from biomedical aspect, accurate mechanical properties of organs are required for better designing of surgical tools and virtual surgery environments. In this study porcine liver, kidney and spleen tissues are studied in vitro and hyper-elastic material laws are provided for each. 12 porcine kidneys are used to perform 40 elongation tests on renal capsule and 60 compression tests on renal cortex, 5 porcine livers are used to perform 45 static compression tests on liver parenchyma and 5 porcine spleens are used to carry out 20 compression tests. All the tests are carried out at a static speed of 0.05 mm/s. A comparative analysis of all the results is done with the literature and though the results are of same order of magnitude, a slight dissonance is observed for the renal capsule. It is also observed that the spleen is the least stiff organ in the abdomen whereas the kidney is the stiffest. The results of this study would be essential to develop the FE models of liver, kidney and spleen which can be further used for impact biomechanical and biomedical applications.

Haptic Detection of Artificial Tumors by Hand and with a Tool in a MIS Environment

Minimally invasive surgery uses optical cameras and special surgical tools in order to operate from an environment one step removed from the body cavity of interest to the surgeon. It has been suggested that constraints posed by this arrangement, in particular the lack of direct haptic feedback to the surgeon, may affect the surgeon's ability to identify tissues and accurately maneuver inside the body cavity. In the present study, the ability of laypeople to detect artificial tumors of various hardness values embedded in silicone gels was assessed in a simulated MIS environment. Participants explored the gels under three conditions all with remote viewing; using the unrestricted bare finger, using a stick-like surgical tool also unrestricted, and using the surgical tool restricted by its insertion through an operating port as in MIS. Participants were significantly more accurate and more efficient at tumor detection with the finger as compared to the other methods of exploration, and they were also better at detecting harder tumors as compared to softer ones. The potential implications of these results for the role of haptic perception in minimally invasive surgery are discussed.

Analysis of several biomechanical models for the simulation of lamb liver behaviour using similarity coefficients from medical image

In this study, six biomechanical models for simulating lamb liver behaviour are presented. They are validated using similarity coefficients from Medical Image on reconstructed volumes from computerised tomography images. In particular, the Jaccard and Hausdorff coefficients are used. Loads of 20 and 40 g are applied to the livers and their deformation is simulated by means of the finite element method. The models used are a linear elastic model, a neo-Hookean model, a Mooney-Rivlin model, an Ogden model, a linear viscoelastic model and a viscohyperelastic model. The model that provided a behaviour that is closest to reality was the viscohyperelastic model, where the hyperelastic part was modelled with an Ogden model.

Reviewing the technological challenges associated with the development of a laparoscopic palpation device

Minimally invasive surgery (MIS) has heralded a revolution in surgical practice, with numerous advantages over open surgery. Nevertheless, it prevents the surgeon from directly touching and manipulating tissue and therefore severely restricts the use of valuable techniques such as palpation. Accordingly a key challenge in MIS is to restore haptic feedback to the surgeon. This paper reviews the state-of-the-art in laparoscopic palpation devices (LPDs) with particular focus on device mechanisms, sensors and data analysis. It concludes by examining the challenges that must be overcome to create effective LPD systems that measure and display haptic information to the surgeon for improved intraoperative assessment.

Identifying a minimal rheological configuration: a tool for effective and efficient constitutive modeling of soft tissues

We describe a modeling methodology intended as a preliminary step in the identification of appropriate constitutive frameworks for the time-dependent response of biological tissues. The modeling approach comprises a customizable rheological network of viscous and elastic elements governed by user-defined 1D constitutive relationships. The model parameters are identified by iterative nonlinear optimization, minimizing the error between experimental and model-predicted structural (load-displacement) tissue response under a specific mode of deformation. We demonstrate the use of this methodology by determining the minimal rheological arrangement, constitutive relationships, and model parameters for the structural response of various soft tissues, including ex vivo perfused porcine liver in indentation, ex vivo porcine brain cortical tissue in indentation, and ex vivo human cervical tissue in unconfined compression. Our results indicate that the identified rheological configurations provide good agreement with experimental data, including multiple constant strain rate load/unload tests and stress relaxation tests. Our experience suggests that the described modeling framework is an efficient tool for exploring a wide array of constitutive relationships and rheological arrangements, which can subsequently serve as a basis for 3D constitutive model development and finite-element implementations. The proposed approach can also be employed as a self-contained tool to obtain simplified 1D phenomenological models of the structural response of biological tissue to single-axis manipulations for applications in haptic technologies.

Indentation versus tensile measurements of Young's modulus for soft biological tissues

In this review, we compare the reported values of Young's modulus (YM) obtained from indentation and tensile deformations of soft biological tissues. When the method of deformation is ignored, YM values for any given tissue typically span several orders of magnitude. If the method of deformation is considered, then a consistent and less ambiguous result emerges. On average, YM values for soft tissues are consistently lower when obtained by indentation deformations. We discuss the implications and potential impact of this finding.

Shear elastic modulus estimation from indentation and SDUV on gelatin phantoms

Tissue mechanical properties such as elasticity are linked to tissue pathology state. Several groups have proposed shear wave propagation speed to quantify tissue mechanical properties. It is well known that biological tissues are viscoelastic materials; therefore, velocity dispersion resulting from material viscoelasticity is expected. A method called shearwave dispersion ultrasound vibrometry (SDUV) can be used to quantify tissue viscoelasticity by measuring dispersion of shear wave propagation speed. However, there is not a gold standard method for validation. In this study, we present an independent validation method of shear elastic modulus estimation by SDUV in three gelatin phantoms of differing stiffness. In addition, the indentation measurements are compared to estimates of elasticity derived from shear wave group velocities. The shear elastic moduli from indentation were 1.16, 3.40, and 5.6 kPa for a 7%, 10%, and 15% gelatin phantom, respectively. SDUV measurements were 1.61, 3.57, and 5.37 kPa for the gelatin phantoms, respectively. Shear elastic moduli derived from shear wave group velocities were 1.78, 5.2, and 7.18 kPa for the gelatin phantoms, respectively. The shear elastic modulus estimated from the SDUV, matched the elastic modulus measured by indentation. On the other hand, shear elastic modulus estimated by group velocity did not agree with indentation test estimations. These results suggest that shear elastic modulus estimation by group velocity will be bias when the medium being investigated is dispersive. Therefore, a rheological model should be used in order to estimate mechanical properties of viscoelastic materials.

Development of in vivo constitutive models for liver: application to surgical simulation

Advancements in real-time surgical simulation techniques have provided the ability to utilize more complex nonlinear constitutive models for biological tissues which result in increased haptic and graphic accuracy. When developing such a model, verification is necessary to determine the accuracy of the force response as well as the magnitude of tissue deformation for tool-tissue interactions. In this study, we present an experimental device which provides the ability to obtain force-displacement information as well as surface deformation of porcine liver for in vivo probing tasks. In addition, the system is capable of accurately determining the geometry of the liver specimen. These combined attributes provide the context required to simulate the experiment with accurate boundary conditions, whereby the only variable in the analysis is the material properties of the liver specimen. During the simulation, effects of settling due to gravity have been taken into account by a technique which incorporates the proper internal stress conditions in the model without altering the geometry. Initially, an Ogden model developed from ex vivo tension and compression experimentation is run through the simulation to determine the efficacy of utilizing an ex vivo model for simulation of in vivo probing tasks on porcine liver. Subsequently, a method for improving upon the ex vivo model was developed using different hyperelastic models such that increased accuracy could be achieved for the force characteristics compared to the displacement characteristics, since changes in the force variation would be more perceptible to a user in the simulation environment, while maintaining a high correlation with the surface displacement data. Furthermore, this study also presents the probing simulation which includes the capsule surrounding the liver.

Ionically cross-linked hyaluronic acid: wetting, lubrication, and viscoelasticity of a modified adhesion barrier gel

Hyaluronic acid (HA), in linear or cross-linked form, is a common component of cosmetics, personal care products, combination medical products, and medical devices. In all cases, the ability of the HA solution or gel to wet surfaces and/or disrupt and lubricate interfaces is a limiting feature of its mechanism of action. We synthesized ferric ion-cross-linked networks of HA based on an adhesion barrier, varied the degree of cross-linking, and performed wetting goniometry, viscometry, and dynamic mechanical analysis. As cross-linking increases, so do contact angle, viscosity, storage modulus, and loss modulus; thus, wetting and lubrication are compromised. These findings have implications in medical device materials, such as adhesion barriers and mucosal drug delivery vehicles.

Strain rate-dependent viscohyperelastic constitutive modeling of bovine liver tissue

The mechanical response of most soft tissue is considered to be viscohyperelastic, making the development of accurate constitutive models a challenging task. In this article, we present a constitutive model for bovine liver tissue that utilizes a viscous dissipation potential, and use it to model the response of bovine liver tissue at strain rates ranging from 0.001 to 0.04 s(-1). On the material modeling front of this study, the free energy is assumed to depend on the right Cauchy-Green deformation tensor, whereas a separate rate-dependent viscous potential is posited to characterize viscoelasticity. This viscous dissipation component is a function of the time rate of change of the right Cauchy-Green deformation tensor. On the experimental front, no-slip uniaxial compression experiments are conducted on bovine liver tissue at various strain rates. A numerical correction approach is used to account for the no-slip edge conditions, and the constitutive model is fit to the resulting corrected stress-strain data. The complete derivation of the material model, its implementation in the finite element software package ABAQUS, and a validation study are presented in this article. The results show that bovine liver tissue exhibits a strong strain-rate dependence even at the low strain rates considered here and that the proposed constitutive model is able to accurately describe this response.

Effect of Preservation Period on the Viscoelastic Material Properties of Soft Tissues With Implications for Liver Transplantation

The liver harvested from a donor must be preserved and transported to a suitable recipient immediately for a successful liver transplantation. In this process, the preservation period is the most critical, since it is the longest and most tissue damage occurs during this period due to the reduced blood supply to the harvested liver and the change in its temperature. We investigate the effect of preservation period on the dynamic material properties of bovine liver using a viscoelastic model derived from both impact and ramp and hold experiments. First, we measure the storage and loss moduli of bovine liver as a function of excitation frequency using an impact hammer. Second, its time-dependent relaxation modulus is measured separately through ramp and hold experiments performed by a compression device. Third, a Maxwell solid model that successfully imitates the frequency- and time-dependent dynamic responses of bovine liver is developed to estimate the optimum viscoelastic material coefficients by minimizing the error between the experimental data and the corresponding values generated by the model. Finally, the variation in the viscoelastic material coefficients of bovine liver are investigated as a function of preservation period for the liver samples tested 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 36 h, and 48 h after harvesting. The results of our experiments performed with three animals show that the liver tissue becomes stiffer and more viscous as it spends more time in the preservation cycle.

The Effect of Glisson’s Capsule on the Superficial Elasticity Measurements of the Liver

In the past decade, novel tools for surgical planning and disease diagnosis have been developed to detect the liver’s mechanical properties. Some tools utilize superficial indentation type measurements to determine the elasticity of the liver parenchyma and to assume material homogeneity. In fact, the liver is a soft tissue covered with a connective sheathing that is called Glisson’s capsule. This article quantifies the effect of this capsule on the measured or “effective” elastic modulus obtained by indentation with a spherical geometry. Two sets of parametric computational studies in which the Glisson capsule thickness and elasticity were varied, demonstrated the relationship between the measured elastic response and the underlying parenchymal elastic response. Previously reported in vivo indentation data on the human liver were utilized to determine the elasticity of its parenchyma. The results indicated a linear relationship between the effective (measured) elastic response and the underlying parenchyma for the Glisson capsule thicknesses considered. When previously published human liver indentation data were analyzed, the measured elastic modulus was nearly 6.9% greater than the underlying parenchyma elastic modulus. Although the analyzed data were obtained from a single liver and yet displayed a significant variation, the Glisson capsule elasticity induced a significant but systematic error as well. The Glisson capsule thickness error was negligible for capsule parameters associated with a normal liver. Based on this work, an emphasis on the Glisson capsule’s contribution to the mechanical response of the liver would enhance the clinical potential of indentation-based novel tools for liver care.

Real-time simulation of the nonlinear visco-elastic deformations of soft tissues

PURPOSE

Mass-spring-damper (MSD) models are often used for real-time surgery simulation due to their fast response and fairly realistic deformation replication. An improved real time simulation model of soft tissue deformation due to a laparoscopic surgical indenter was developed and tested.

METHOD

The mechanical realization of conventional MSD models was improved using nonlinear springs and nodal dampers, while their high computational efficiency was maintained using an adapted implicit integration algorithm. New practical algorithms for model parameter tuning, collision detection, and simulation were incorporated.

RESULTS

The model was able to replicate complex biological soft tissue mechanical properties under large deformations, i.e., the nonlinear and viscoelastic behaviors. The simulated response of the model after tuning of its parameters to the experimental data of a deer liver sample, closely tracked the reference data with high correlation and maximum relative differences of less than 5 and 10%, for the tuning and testing data sets respectively. Finally, implementation of the proposed model and algorithms in a graphical environment resulted in a real-time simulation with update rates of 150 Hz for interactive deformation and haptic manipulation, and 30 Hz for visual rendering.

CONCLUSION

The proposed real time simulation model of soft tissue deformation due to a laparoscopic surgical indenter was efficient, realistic, and accurate in ex vivo testing. This model is a suitable candidate for testing in vivo during laparoscopic surgery.

A proto-type design of a real-tissue phantom for the validation of deformation algorithms and 4D dose calculations

The purpose of this study is to design a real-tissue phantom for use in the validation of deformation algorithms. A phantom motion controller that runs sinusoidal and non-regular patient-based breathing pattern, via a piston, was applied to porcine liver tissue. It was regulated to simulate movement ranges similar to recorded implanted liver markers from patients. 4D CT was applied to analyze deformation. The suitability of various markers in the liver and the position reproducibility of markers and of reference points were studied. The similarity of marker motion pattern in the liver phantom and in real patients was evaluated. The viability of the phantom over time and its use with electro-magnetic tracking devices were also assessed. High contrast markers, such as carbon markers, implanted in the porcine liver produced less image artifacts on CT and were well visualized compared to metallic ones. The repositionability of markers was within a measurement accuracy of +/-2 mm. Similar anatomical patient motions were reproducible up to elongations of 3 cm for a time period of at least 90 min. The phantom is compatible with electro-magnetic tracking devices and 4D CT. The phantom motion is reproducible and simulates realistic patient motion and deformation. The ability to carry out voxel-based tracking allows for the evaluation of deformation algorithms in a controlled environment with recorded patient traces. The phantom is compatible with all therapy devices clinically encountered in our department.

Mechanical property characterization of prostate cancer using a minimally motorized indenter in an ex vivo indentation experiment

OBJECTIVES

To measure the mechanical property of prostatic tissues using a minimally motorized indenter and to determine whether measurable differences in mechanical property exist between cancerous and noncancerous tissues in an ex vivo experiment.

METHODS

A total of 552 sites from 46 prostate specimens taken during radical prostatectomy underwent an indentation experiment with a minimally motorized indenter, and the elastic modulus (Young's modulus) of the tissue was estimated.

RESULTS

The mean elastic modulus of the regions containing cancer and noncancer was 24.1 ± 14.5 and 17.0 ± 9.0 kPa, respectively. In the noncancerous regions, the prostate was separated into 5 parts according to the post hoc test for comparing the elastic modulus between the 2 groups: part 1, lateral apex; part 2, medial apex; part 3, lateral-mid; part 4, lateral base; and part 5, medial-mid and medial base. In the regions containing cancer tissue, the prostate was also separated into 5 parts: part 1, lateral apex and medial apex; part 2, lateral-mid; part 3, lateral base; part 4, medial base; and part 5, medial-mid. The elastic modulus was greater in the tissue with a Gleason score of 8 than in the other tissue. The elastic modulus was significantly greater in the tissue with a tumor volume >5 cm(3) than in the other tissue.

CONCLUSIONS

We determined the elastic moduli of prostatic tissue as a quantitative and objective parameter according to the regions of the prostate, the presence of cancerous tissue, the tumor volume, and the Gleason score.

Estimating zero-strain states of very soft tissue under gravity loading using digital image correlation

This paper presents several experimental techniques and concepts in the process of measuring mechanical properties of very soft tissue in an ex vivo tensile test. Gravitational body force on very soft tissue causes pre-compression and results in a non-uniform initial deformation. The global digital image correlation technique is used to measure the full-field deformation behavior of liver tissue in uniaxial tension testing. A maximum stretching band is observed in the incremental strain field when a region of tissue passes from compression and enters a state of tension. A new method for estimating the zero-strain state is proposed: the zero strain position is close to, but ahead of the position of the maximum stretching band, or in other words, the tangent of a nominal stress-stretch curve reaches minimum at lambda greater or similar 1. The approach, to identify zero strain by using maximum incremental strain, can be implemented in other types of image-based soft tissue analysis. The experimental results of 10 samples from seven porcine livers are presented and material parameters for the Ogden model fit are obtained. The finite element simulation based on the fitted model confirms the effect of gravity on the deformation of very soft tissue and validates our approach.

Modeling, Simulation, and Optimal Initiation Planning For Needle Insertion Into the Liver

Needle insertion simulation and planning systems (SPSs) will play an important role in diminishing inappropriate insertions into soft tissues and resultant complications. Difficulties in SPS development are due in large part to the computational requirements of the extensive calculations in finite element (FE) models of tissue. For clinical feasibility, the computational speed of SPSs must be improved. At the same time, a realistic model of tissue properties that reflects large and velocity-dependent deformations must be employed. The purpose of this study is to address the aforementioned difficulties by presenting a cost-effective SPS platform for needle insertions into the liver. The study was constrained to planar (2D) cases, but can be extended to 3D insertions. To accommodate large and velocity-dependent deformations, a hyperviscoelastic model was devised to produce an FE model of liver tissue. Material constants were identified by a genetic algorithm applied to the experimental results of unconfined compressions of bovine liver. The approach for SPS involves B-spline interpolations of sample data generated from the FE model of liver. Two interpolation-based models are introduced to approximate puncture times and to approximate the coordinates of FE model nodes interacting with the needle tip as a function of the needle initiation pose; the latter was also a function of postpuncture time. A real-time simulation framework is provided, and its computational benefit is highlighted by comparing its performance with the FE method. A planning algorithm for optimal needle initiation was designed, and its effectiveness was evaluated by analyzing its accuracy in reaching a random set of targets at different resolutions of sampled data using the FE model. The proposed simulation framework can easily surpass haptic rates (>500 Hz), even with a high pose resolution level (∼30). The computational time required to update the coordinates of the node at the needle tip in the provided example was reduced from 177 s to 0.8069 ms. The planning accuracy was acceptable even with moderate resolution levels: root-mean-square and maximum errors were 1 mm and 1.2 mm, respectively, for a pose and PPT resolution levels of 17 and 20, respectively. The proposed interpolation-based models significantly improve the computational speed of needle insertion simulation and planning, based on the discretized (FE) model of the liver and can be utilized to establish a cost-effective planning platform. This modeling approach can also be extended for use in other surgical simulations.

A strain-hardening bi-power law for the nonlinear behaviour of biological soft tissues

Biological soft tissues exhibit a strongly nonlinear viscoelastic behaviour. Among parenchymous tissues, kidney and liver remain less studied than brain, and a first goal of this study is to report additional material properties of kidney and liver tissues in oscillatory shear and constant shear rate tests. Results show that the liver tissue is more compliant but more strain hardening than kidney. A wealth of multi-parameter mathematical models has been proposed for describing the mechanical behaviour of soft tissues. A second purpose of this work is to develop a new constitutive law capable of predicting our experimental data in the both linear and nonlinear viscoelastic regime with as few parameters as possible. We propose a nonlinear strain-hardening fractional derivative model in which six parameters allow fitting the viscoelastic behaviour of kidney and liver tissues for strains ranging from 0.01 to 1 and strain rates from 0.0151 s(-1) to 0.7s(-1).

Graphic and haptic modelling of the oesophagus for VR-based medical simulation

BACKGROUND

Medical simulators with vision and haptic feedback have been applied to many medical procedures in recent years, due to their safe and repetitive nature for training. Among the many technical components of the simulators, realistic and interactive organ modelling stands out as a key issue for judging the fidelity of the simulation. This paper describes the modelling of an oesophagus for a real-time laparoscopic surgical simulator.

METHODS

For realistic simulation, organ deformation and tissue cutting in the oesophagus are implemented with geometric organ models segmented from the Visible Human Dataset. The tissue mechanical parameters were obtained from in vivo animal experiments and integrated with graphic and haptic devices into the laparoscopic surgical simulation system inside an abdominal mannequin.

RESULTS

This platform can be used to demonstrate deformation and incision of the oesophagus by surgical instruments, where the user can haptically interact with the virtual soft tissues and simultaneously see the corresponding organ deformation on the visual display.

CONCLUSIONS

Current laparoscopic surgical training has been transformed from the traditional apprenticeship model to simulation-based methods. The outcome of the model could replace conventional training systems and could be useful in effectively transferring surgical skills to novice surgeons.

Compact polyelectrolyte complexes: "saloplastic" candidates for biomaterials

Precipitates of polyelectrolyte complexes were transformed into rugged shapes suitable for bioimplants by ultracentrifugation in the presence of high salt concentration. Salt ions dope the complex, creating a softer material with viscous fluid-like properties. Complexes that were compacted under the centrifugal field (CoPECs) were made from poly(diallyldimethyl ammonium), PDADMA, as polycation, and poly(styrene sulfonate), PSS, or poly(methacrylic acid), PMAA, as polyanion. Dynamic mechanical testing revealed a rubbery plateau at lower frequencies for PSS/PDADMA with moduli that decreased with increasing salt concentration, as internal ion pair cross-links were broken. CoPECs had significantly lower modulii compared to similar polyelectrolyte complexes prepared by the "multilayering" method. The difference in mechanical properties was ascribed to higher water content (located in micropores) for the former and, more importantly, to their nonstoichiometric polymer composition. The modulus of PMAA/PDADMA CoPECs, under physiological conditions, demonstrated dynamic mechanical properties that were close to those of the nucleus pulposus in an intervertebral disk.

Constitutive modeling of liver tissue: experiment and theory

Realistic surgical simulation requires incorporation of the mechanical properties of soft tissue in mathematical models. In actual deformation of soft-tissue during surgical intervention, the tissue is subject to tension, compression, and shear. Therefore, characterization and modeling of soft-tissue in all these three deformation modes are necessary. In this paper we applied two types of pure shear test, un-confined compression and uniaxial tension test to characterize porcine liver tissue. Digital image correlation technique was used to accurately measure the tissue deformation field. Due to gravity and its effect on the soft tissue, a maximum stretching band was observed from the relative strain field on sample undergoing tension and pure shear test. The zero strain state was identified according to the position of this maximum stretching band. Two new constitutive models based on combined exponential/logarithmic and Ogden strain energy were proposed. The models are capable to represent the observed non-linear stress-strain relation of liver tissue for full range of tension and compression and also the general response of pure shear.

Surgical simulators

The use of emerging virtual reality technology for surgical skill training has recently attracted a lot of attention. Computerized surgical simulators offer a significant potential for providing a realistic and configurable training environment that bridges the gap between basic training and performing the actual interventions on patients. This paper summarizes the current state of this rapidly developing field and analyses the major problems to be addressed in order to make this technology an indispensable tool for routine clinical training and education.

The phenomenon of twisted growth: humeral torsion in dominant arms of high performance tennis players

This manuscript is driven by the need to understand the fundamental mechanisms that cause twisted bone growth and shoulder pain in high performance tennis players. Our ultimate goal is to predict bone mass density in the humerus through computational analysis. The underlying study spans a unique four level complete analysis consisting of a high-speed video analysis, a musculoskeletal analysis, a finite element based density growth analysis and an X-ray based bone mass density analysis. For high performance tennis players, critical loads are postulated to occur during the serve. From high-speed video analyses, the serve phases of maximum external shoulder rotation and ball impact are identified as most critical loading situations for the humerus. The corresponding posts from the video analysis are reproduced with a musculoskeletal analysis tool to determine muscle attachment points, muscle force vectors and overall forces of relevant muscle groups. Collective representative muscle forces of the deltoid, latissimus dorsi, pectoralis major and triceps are then applied as external loads in a fully 3D finite element analysis. A problem specific nonlinear finite element based density analysis tool is developed to predict functional adaptation over time. The density profiles in response to the identified critical muscle forces during serve are qualitatively compared to X-ray based bone mass density analyses.

In vivo characterization of skin using a Weiner nonlinear stochastic system identification method

This paper describes an indentometer device used to identify the linear dynamic and nonlinear properties of skin and underlying tissue using an in vivo test. The device uses a Lorentz force actuator to apply a dynamic force to the skin and measures the resulting displacement. It was found that the skin could be modeled as a Wiener system (i.e. a linear dynamic system followed by a static nonlinearity). Using a stochastic nonlinear system identification technique, the method presented in this paper was able to identify the dynamic linear and static nonlinear mechanical parameters of the indentometer-skin system within 2 to 4 seconds. The shape of the nonlinearity was found to vary depending on the area of the skin that was tested. We show that the device can repeatably distinguish between different areas of human tissue for multiple test subjects.