Novel simulator for robotic surgery

An interactive and realistic phantom for cricothyroidotomy simulation of a patient with obesity through a reusable design using 3D-printing and Arduino

BACKGROUND AND OBJECTIVES

Proper airway management during emergencies can prevent serious complications. However, cricothyroidotomy is challenging in patients with obesity. Since this technique is not performed frequently but at a critical time, the opportunity for trainees is rare. Simulators for these procedures are also lacking. Therefore, we proposed a realistic and interactive cricothyroidotomy simulator.

METHODS

All anatomical structures were modeled based on computed tomography images of a patient with obesity. To mimic the feeling of incision during cricothyroidotomy, the incision site was modeled to distinguish between the skin and fat. To reinforce the educational purpose, capacitive touch sensors were attached to the artery, vein, and thyroid to generate audio feedback. The tensile strength of the silicone-cast skin was measured to verify the similarity of the mechanical properties between humans and our model. The fabrication and assembly accuracies of the phantom between the Standard Tessellation Language and the fabricated model were evaluated. Audio feedback through sensing the anatomy parts and utilization was evaluated.

RESULTS

The body, skull, clavicle, artery, vein, and thyroid were fabricated using fused deposition modeling (FDM) with polylactic acid. A skin mold was fabricated using FDM with thermoplastic polyurethane. A fat mold was fabricated using stereolithography apparatus (SLA) with a clear resin. The airway and tongue were fabricated using SLA with an elastic resin. The tensile strength of the skin using silicone with and without polyester mesh was 2.63 ± 0.68 and 2.46 ± 0.21 MPa. The measurement errors for fabricating and assembling parts of the phantom between the STL and the fabricated models were -0.08 ± 0.19 mm and 0.13 ± 0.64 mm. The measurement errors internal anatomy embodied surfaces in fat part were 0.41 ± 0.89 mm. Audio feedback was generated 100% in all the areas tested. The realism, understanding of clinical skills, and intention to retrain were 7.1, 8.8, and 8.3 average points.

CONCLUSIONS

Our simulator can provide a realistic simulation experience for trainees through a realistic feeling of incision and audio feedback, which can be used for actual clinical education.

Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills

We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2^™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci^® Skills Simulator^™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2^™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.

Evaluation of skin cancer resection guide using hyper-realistic in-vitro phantom fabricated by 3D printing

Skin cancer usually occurs in the facial area relatively exposed to sunlight. Medical imaging can confirm the invasiveness and metastasis of skin cancer, which is used to establish a surgical plan. However, there is no method of directly marking this information on the patient's skin in the operating room. We evaluated a skin cancer resection guide that marks resection areas including safety margins on the patient's skin based on medical images and in-vitro phantom fabricated via 3D printing. The in-vitro phantom, which includes the skull, skin, and five different cancer locations was designed and fabricated based on a CT image of a patient. Skin cancer resection guides were designed using a CT image of an in-vitro phantom, with a safety margin, and four injection points at each cancer. The guide was used to insert 16 cc intravenous catheters into each cancer of the phantom, which was rescanned by CT. The catheter insertion point and angle were evaluated. The accuracy of the insertion points was 2.09 ± 1.06 mm and cosine similarities was 0.980 ± 0.020. In conclusion, skin cancer resection guides were fabricated to mark surgical plans on the patient's skin in the operating room. They demonstrated reasonable accuracies in actual clinical settings.

Simulation for Foregut and Bariatric Surgery: Current Status and Future Directions

Simulation offers the opportunity to practice in a safe, controlled, and standardized environment. Surgical simulation, in particular, is very attractive because it avoids learning and practicing surgical skills in the operating room. Many simulators are currently available such as box-lap trainers, virtual-reality platforms, cadavers, live animals, animal-based tissue blocks, and synthetic/artificial models. Endoscopic interventions can be practiced with high-fidelity virtual simulators. Box-lap trainers help practicing basic laparoscopic skills. Cadavers and live animals offer realism to train entire foregut and bariatric procedures. However, limited availability and high expenses often restrict their use. Ex vivo simulators with animal tissue blocks have been recently developed and appear to be a realistic and cost-effective alternative. Three-dimensional printing and real-time navigation systems have also emerged as promising training tools. Overall, further efforts are needed to develop a formal simulation curriculum with validated simulators for foregut and bariatric surgery.