Quality Assessment in Virtual Surgical Training

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Role of Visuohaptic Surgical Training Simulator in Resident Education of Orthopedic Surgery.

BackgroundVirtual reality (VR) technology is an ideal alternative of operation training and surgical teaching. However, virtual surgery is usually carried out using the mouse or data gloves, which affects the authenticity of virtual operation. A virtual surgery system with gesture recognition and real-time image feedback was explored to realize more authentic immersion.MethodGesture recognition technology proposed with an efficient and real-time algorithm and high fidelity was explored. The recognition of hand contour, palm and fingertip was firstly realized by hand data extraction. Then, an Support Vector Machine classifier was utilized to classify and recognize common gestures after extraction of feature recognition. The algorithm of collision detection adopted Axis Aligned Bounding Box binary tree to build hand and scalpel collision models. What’s more, nominal radius theorem (NRT) and separating axis theorem (SAT) were applied for speeding up collision detection. Based on the maxillofacial virtual surgical system we proposed before, the feasibility of integration of the above technologies in this prototype system was evaluated.ResultsTen kinds of signal static gestures were designed to test gesture recognition algorithms. The accuracy of gestures recognition is more than 80%, some of which were over 90%. The generation speed of collision detection model met the software requirements with the method of NRT and SAT. The response time of gesture] recognition was less than 40 ms, namely the speed of hand gesture recognition system was greater than 25 Hz. On the condition of integration of hand gesture recognition, typical virtual surgical procedures including grabbing a scalpel, puncture site selection, virtual puncture operation and incision were carried out with realization of real-time image feedback.ConclusionBased on the previous maxillofacial virtual surgical system that consisted of VR, triangular mesh collision detection and maxillofacial biomechanical model construction, the integration of hand gesture recognition was a feasible method to improve the interactivity and immersion of virtual surgical operation training.

Over the last years, with the rapid development of 3D Web technologies, such as Web3D, HTML5 and WebGL, have allowed complex 3D scenes to be rendered interactively, within a web browser. Compared to the traditional virtual training system, the traing system with WebGL, which requires no explicit installation plug-in and is able to achieve cross-platform easily, is getting more and more popular. This foundation has made it possible to build powerful the virtual acupuncture training system. However, designing and implementing a complete virtual training system using WebGL is not straightforward and complex. In this paper, the author presents a virtual acupuncture training system that using WebGL and Three.js 3D Engine. It can be used to learn acupuncture, and also give ordinary people a reference. Our experiment result shows that WebGL and Three.js 3D Engine can easily support the virtual acupuncture training system, and have a good response. By using this system, the trainers can be more familiar with the acupoint of the human body. At the same time, the trainer will improve his ability in acupuncture therapy. We also hope to provide some references for the development of the virtual training system.

Personalized virtual reality simulation training system for percutaneous needle insertion and comparison of zSpace and vive

Virtual reality training simulations to acquire surgical skills are important for increasing patient safety and save valuable resources, e.g., cadavers, supervision and operating room time. However, as surgery is a craft, simulators must not only provide a high degree of visual realism, but especially a realistic haptic behavior. While such simulators exist for surgeries like laparoscopy or arthroscopy, other surgical fields, especially where large forces need to be exerted, like total hip arthroplasty (THA; implantation of a hip joint protheses), lack realistic VR training simulations. In this paper we present for the first time a novel VR training simulation for the five steps of THA (from femur head resection to stem implantation) with realis-tic haptic feedback. To achieve this, a novel haptic hammering device, an upgraded version of the Virtuose 6D haptic device from Haption, novel algorithms for collision detection, haptic rendering, and material removal are introduced. In a study with 17 surgeons of diverse experience levels, we confirmed the realism, usefulness and usability of our novel methods.

The Endoscopic Surgical Skill Qualification System was established in Japan to evaluate safe endoscopic surgical techniques and teaching skills. Trainee surgeons obtaining this certification in rural hospitals are disadvantaged by the limited number of surgical opportunities. To address this problem, we established a surgical training system to educate trainee surgeons. Eighteen certified expert surgeons affiliated with our department were classified into an experienced training system group (E group, n = 9) and a non-experienced group (NE group, n = 9). Results of the training system were then compared between the groups. The number of years required to become board certified was shorter in the E group (14years) than that in the NE group (18years). Likewise, the number of surgical procedures performed before certification was lower in the E group (n = 30) than that in the NE group (n = 50). An expert surgeon was involved in the creation of the certification video of all the E group participants. A questionnaire to board-certified surgeons revealed that guidance by a board-certified surgeon and trainee education (surgical training system) was useful for obtaining certification. Continuous surgical training, starting with trainee surgeons, appears useful for expediting their acquisition of technical certification in rural areas.

The emerging changes in healthcare significantly impact structure of surgical training. To achieve parity in surgical training globally significant work needs to be done in developing nations. The aims of this study are to identify and evaluate the current surgical training system in India and also examine the surgical training system of residents from India and compare the results against the US training system, to suggest changes for parity. On-site observations and cross-sectional survey of residents and staff from 22 institutions in India were done. Results were compared with the current US training system. Difference in pattern of surgical training and lack of coordination in curriculum was noted. Contradictory responses were noted for didactic teaching. No guidelines were mentioned for minimum number of surgical case required or certification courses. No work hour restrictions were followed, and supervision was ill defined. Residents were highly interested for fellowships and experience from the US medical system. Results revealed discordance in surgical training within the evaluated country. However, the two training systems studied have their own pros and cons. We strongly feel that incorporation of certain aspects of the American residency can aid in progression of the Indian training system.

Simulation-based training has been widely used in medical education. More specifically, various systems for minimally invasive surgery training have been proposed in the past two decades. The aim of this article is to review and summarize the existing simulation-based training systems for laparoscopic surgery in terms of their technical realizations. Forty-three training systems were found and analyzed. These training systems generally consist of training tasks, a visualization interface, and an instrument interface. Three different approaches—physical, virtual, and augmented reality—to implement visualization interfaces are discussed first. Then, haptic feedback, performance evaluation, and guidance methods are summarized. Portable devices to enable at-home training and instrument tracking technologies to support visualization, evaluation, and guidance are also presented. Based on survey of the relevant literature, we propose several recommendations to design the next-generation training systems in laparoscopic surgery. Novel guidance and assessment schemes with augmented reality visualization are recommended to design an intelligent surgical training simulator. This intelligent simulator enhances the training procedure and ultimately improves the patient safety.

Background Surgical training is a critical component of healthcare, especially in high-income countries such as the United Kingdom (UK) and the United States (US), which have established distinct, well-organised training frameworks. Comparing these systems provides valuable insights that may enhance global surgical education, particularly in low- and middle-income countries, where training and retaining proficient surgeons are considerable challenges. Methodology This comparative study examines the surgical training systems in the UK and the US, focusing on key aspects, including training structure, competency-based assessments, and work-hour regulations. Data were sourced from regulatory organisations such as the General Medical Council, the Royal College of Surgeons, the Accreditation Council for Graduate Medical Education, and the American Board of Surgery. The analysis explores how elements of these models might be adapted to support sustainable surgical education frameworks in resource-limited environments. Ethical approval was not required due to the use of publicly accessible data and no patient involvement. Results The UK and US surgical training systems differ substantially in their structure, training duration, and specialisation timing. The UK employs a tiered approach, offering generalist experience before specialisation, while the US favours early specialisation directly after medical school. Both systems implement competency-based evaluations, though the US system places a greater emphasis on case volume and procedural exposure. Work-hour regulations also vary, with the UK capping weekly hours at 48 under the European Working Time Directive, compared to an 80-hour maximum in the US, which results in differing levels of trainee satisfaction and burnout rates. Conclusions The competency-based assessments in both the UK and the US offer adaptable frameworks for resource-limited settings. The phased training approach in the UK is well-suited for environments requiring versatile surgeons capable of handling a wide range of cases. By implementing these adaptable elements, along with cost-effective training innovations such as simulation tools, e-learning platforms, and international partnerships, resource-constrained regions can foster a sustainable, skilled surgical workforce. These insights offer pathways to improve healthcare outcomes and equity globally by enhancing surgical capacity in regions with limited resources.

Hierarchical task analysis (HTA) and cognitive work analysis (CWA) were applied to laparoscopic surgery to identify critical technical, cognitive, and social challenges. Our purpose was to understand the complexity of laparoscopy and use this knowledge to develop a surgical training system. Five laparoscopic procedures were analyzed using the HTA methodology, while generic laparoscopic approaches were analyzed by applying the five phases of the CWA framework. The results from these analyses were applied to a surgical training system. The focus was on the application of partial-task training to areas that could be more technically challenging. Additionally, practical, social, and cognitive training aspects were included into the training system, based on our findings from the analyses. Practical Relevance: The use of digital training systems is becoming increasingly important in complex work systems, especially when it comes to simulations that can have serious consequences in reality. This paper presents the development of a surgical training system.

New directions in simulation-based surgical education and training: Validation and transfer of surgical skills, use of nonsurgeons as faculty, use of simulation to screen and select surgery residents, and long-term follow-up of learners

During surgical training, it is important for the surgeon develops good motor skills throughout his training. For this reason, various surgical training systems have been developed to enhance these skills. However, one of the great challenges in these training systems is being able to objectively measure the ability and performance of the main surgical tasks, where currently only a global measurement is obtained once the task is completed. In this work, a temporal evaluation scheme is proposed, that is, an evaluation of local surgical performance at different time intervals during the training of typical tasks (knot-tying, needle-passing and suturing). The goal is to automatically classify expert (experience >100 hrs) and non-expert (experience <10 hrs) surgeons according to their performance during training, based on three classifiers: K-Nearest Neighborhood, Random Forest, and Support Vector Machine Unlike other previously reported methods, this work proposes a new evaluation scheme based on segments or time intervals, which can be an indicator of the surgeon's local performance during a robotic surgical task, without the need for direct labeling of the data at the segment level. The classification performance from obtained results was in accuracy 83% to 100%, 88% to 100% of AUC-ROC, and 88% to 100% of F1-Score in the final test between experts and non-experts surgeons, where the Support Vector Machine classifier presented the best performance. These results suggest that this proposed method by time intervals could be used in various surgical trainers to evaluate the local performance of a surgeon during trainingand thus be able to provide a tool for the quantitative visualization of opportunities to improve surgical skills.Clinical relevance- We consider that the proposed method to carry out a local performance evaluation during surgical training can provide useful information in the learning and improvement of surgical skills.

Virtual training is a growing mode of operation within high technology enterprises through virtual technology and virtual operating strategy. The purpose of this paper was to develop a new conceptual framework and propositions to assist understanding of a new training ideology. The approach used was the integration of related literatures and development of arguments for main factors in virtual training system. We argue that basic technology, management theory and system structure are the key factors for constituting virtual training system in high technology companies. Virtual training system application includes knowledge management system, virtual learning society and autonomic training.

Haptic simulation of handling pathological tissues is a crucial component to enhance virtual surgical training systems. In this paper, we introduce a configuration-based optimization approach to simulate the exploration and diagnosis of carious tissues in dental operations. To simulate the six Degree-of-Freedom (6DoF) haptic interaction between the dental probe and the oral tissues, we introduce two interaction states, the sliding state and the penetration state, which simulate the exploration on the surface of and inside of the caries, respectively. Penetration criteria considering a contact force threshold are defined to trigger the switch between the two states. By utilizing a simplified friction model based on the optimization approach, various multi-region frictional contacts between the probe and carious tissues are simulated. To simulate the exploration within the carious tissues for diagnosing the depth of the caries, a dynamic sphere tree is used to constrain the insertion/extraction of the probe within carious tissues along a fixed direction while enabling simulation of additional contacts of the probe with neighboring oral tissues during the insertion/extraction process. Experimental results show that decays with different levels of stiffness and friction coefficients can be stably simulated. Preliminary user studies show that users could easily identify the invisible boundary between the decay and healthy tissues and correctly rank the depth of target decays within a required time limit. The proposed approach could be used for training delicate motor skill of probing target carious teeth in a narrow oral cavity, which requires collaborated control of tool posture and insertion/extraction force, while avoiding damages to adjacent healthy tissues of the tongue and gingiva.