Skip to main content
SpringerLink
Log in

An advanced simulator for orthopedic surgical training

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of creating the virtual reality (VR) simulator is to facilitate and supplement the training opportunities provided to orthopedic residents. The use of VR simulators has increased rapidly in the field of medical surgery for training purposes. This paper discusses the creation of the virtual surgical environment (VSE) for training residents in an orthopedic surgical process called less invasive stabilization system (LISS) surgery which is used to address fractures of the femur.

Method

The overall methodology included first obtaining an understanding of the LISS plating process through interactions with expert orthopedic surgeons and developing the information centric models. The information centric models provided a structured basis to design and build the simulator. Subsequently, the haptic-based simulator was built. Finally, the learning assessments were conducted in a medical school.

Results

The results from the learning assessments confirm the effectiveness of the VSE for teaching medical residents and students. The scope of the assessment was to ensure (1) the correctness and (2) the usefulness of the VSE. Out of 37 residents/students who participated in the test, 32 showed improvements in their understanding of the LISS plating surgical process. A majority of participants were satisfied with the use of teaching Avatars and haptic technology. A paired t test was conducted to test the statistical significance of the assessment data which showed that the data were statistically significant.

Conclusion

This paper demonstrates the usefulness of adopting information centric modeling approach in the design and development of the simulator. The assessment results underscore the potential of using VR-based simulators in medical education especially in orthopedic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Peters TM, Linte CA, Moore J, Bainbridge D, Jones DL, Guiraudon GM (2008) Towards a medical virtual reality environment for minimally invasive cardiac surgery. In: International workshop on medical imaging and virtual reality. Springer, Berlin, pp 1–11

  2. Qin J, Pang WM, Chui YP, Wong TT, Heng PA (2010) A novel modeling framework for multilayered soft tissue deformation in virtual orthopedic surgery. J Med Syst 34:261–271

    Article  PubMed  Google Scholar 

  3. Delp Scott L, Peter Loan J (1995) A graphics-based software system to develop and analyze models of musculoskeletal structures. Comput Biol Med 25(1):21–34

    Article  CAS  PubMed  Google Scholar 

  4. Tsai MD, Hsieh MS, Jou SB (2001) Virtual reality orthopedic surgery simulator. Comput Biol Med 31:333–351

    Article  CAS  PubMed  Google Scholar 

  5. Gertsch KR, Kitzmann A, Larson SA, Olson RJ, Longmuir RA, Sacher BA, Longmuir SQ (2015) Description and validation of a structured simulation curriculum for strabismus surgery. J Am Assoc Pediatr Ophthalmol Strabismus 19(1):3–5

    Article  Google Scholar 

  6. Kunkler K (2006) The role of medical simulation: an overview. Int J Med Robot Comput Assisted Surg 2(3):203–210

    Article  Google Scholar 

  7. Cosman PH, Cregan PC, Martin CJ, Cartmill JA (2002) Virtual reality simulators: current status in acquisition and assessment of surgical skills. ANZ J Surg 72(1):30–34

    Article  PubMed  Google Scholar 

  8. https://www.abos.org/abos-surgical-skills-modules-for-pgy-1-residents.aspx

  9. Tolsdorff B, Pommert A, Höhne KH, Petersik A, Pflesser B, Tiede U, Leuwer R (2010) Virtual reality: a new paranasal sinus surgery simulator. Laryngoscope 120(2):420–426

    PubMed  Google Scholar 

  10. Choi KS, Soo S, Chung FL (2009) A virtual training simulator for learning cataract surgery with phacoemulsification. Comput Biol Med 39(11):1020–1031

    Article  PubMed  Google Scholar 

  11. Echegaray G, Herrera I, Aguinaga I, Buchart C, Borro D (2014) A brain surgery simulator. IEEE Comput Graph Appl 34(3):12–18

    Article  Google Scholar 

  12. Luciano C, Banerjee P, DeFanti T (2009) Haptics-based virtual reality periodontal training simulator. Virtual Real 13(2):69–85

    Article  Google Scholar 

  13. Shi Y, Xiong Y, Hua X, Tan K, Pan X (2015) Key techniques of haptic related computation in virtual liver surgery. In: 2015 8th international conference on biomedical engineering and informatics (BMEI). IEEE, pp 355–359

  14. Yu L, Wang T, Wang W, Wang Z, Zhang B (2013) A geometric modeling method based on OpenGL in virtual gallbladder surgery. In: Proceedings of the 2nd international conference on computer science and electronics engineering. Atlantis Press

  15. Sørensen TS, Therkildsen SV, Makowski P, Knudsen JL, Pedersen EM (2001) A new virtual reality approach for planning of cardiac interventions. Artif Intell Med 22(3):193–214

    Article  PubMed  Google Scholar 

  16. Berlage T, Schmitgen A, Schmitz C, Welz A (2001) Simulation and planning of minimally invasive coronary artery bypass surgery. In: International congress series vol 1230. Elsevier, pp 68–72

  17. Park JW, hoi J, Park Y, Sun K (2011) Haptic virtual fixture for robotic cardiac catheter navigation. Artif Organs 35(11):1127–1131. ISSN 0160-564X

  18. Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, Hüfner T (2008) Virtual 3D planning of acetabular fracture reduction. J Orthop Res 26(4):547–552

    Article  PubMed  Google Scholar 

  19. Assassi L, Charbonnier C, Schmid J, Volino P, Magnenat-Thalmann N (2009) From MRI to anatomical simulation of the hip joint. Comput Animat Virtual Worlds 20(1):53–66

    Article  Google Scholar 

  20. Jun Y, Park S (2011) Polygon-based 3D surgical planning system for hip operation. Int J Precis Eng Manuf 12(1):157–160

    Article  Google Scholar 

  21. Kovler I, Joskowicz L, Weil YA, Khoury A, Kronman A, Mosheiff R, Salavarrieta J (2015) Haptic computer-assisted patient-specific preoperative planning for orthopedic fractures surgery. Int J Comput Assist Radiol Surg 10(10):1535–1546

    Article  CAS  PubMed  Google Scholar 

  22. Nahvi A, Moghaddam M, Arbabtafti M, Mahvash M, Richardson B (2016) Virtual bone surgery using a haptic robot. Int J Robot Theory Appl 1(1):1–12

    Google Scholar 

  23. Seah TET, Barrow A, Baskaradas A, Gupte C, Bello F (2014) A virtual reality system to train image guided placement of kirschner-wires for distal radius fractures. In: International symposium on biomedical simulation. Springer, pp 20–29

  24. Tsai MD, Liu CS, Liu HY, Hsieh MS, Tsai FC (2011) Virtual reality facial contouring surgery simulator based on CT transversal slices. In: 2011 5th international conference on bioinformatics and biomedical engineering (ICBBE). IEEE, pp 1–4

  25. Vankipuram M, Kahol K, McLaren A, Panchanathan S (2010) A virtual reality simulator for orthopedic basic skills: a design and validation study. J Biomed Inform 43(5):661–668

    Article  PubMed  Google Scholar 

  26. Blyth P, Stott NS, Anderson IA (2007) A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 38(10):1197–1203

    Article  CAS  PubMed  Google Scholar 

  27. Bayonat S, García M, Mendoza C, Ferniindez JM (2006) Shoulder arthroscopy training system with force feedback. In: International conference on medical information visualisation-biomedical visualisation (MedVis’ 06). IEEE, pp 71–76

  28. Pettersson J, Palmerius KL, Knutsson H, Wahlstrom O, Tillander B, Borga M (2008) Simulation of patient specific cervical hip fracture surgery with a volume haptic interface. IEEE Trans Biomed Eng 55(4):1255–1265

    Article  PubMed  Google Scholar 

  29. Tsai MD, Hsieh MS, Tsai CH (2007) Bone drilling haptic interaction for orthopedic surgical simulator. Comput Biol Med 37(12):1709–1718

    Article  PubMed  Google Scholar 

  30. Lin Y, Wang X, Wu F, Chen X, Wang C, Shen G (2014) Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill. J Biomed Inform 48:122–129

    Article  PubMed  Google Scholar 

  31. Morris D, Sewell C, Blevins N, Barbagli F, Salisbury K (2004) A collaborative virtual environment for the simulation of temporal bone surgery. In: International conference on medical image computing and computer-assisted intervention. Springer, Berlin, pp 319–327

  32. Sabri H, Cowan B, Kapralos B, Porte M, Backstein D, Dubrowskie A (2010) Serious games for knee replacement surgery procedure education and training. Procedia Soc Behav Sci 2(2):3483–3488

    Article  Google Scholar 

  33. Panait L, Akkary E, Bell RL, Roberts KE, Dudrick SJ, Duffy AJ (2009) The role of haptic feedback in laparoscopic simulation training. J Surg Res 156(2):312–316

    Article  PubMed  Google Scholar 

  34. Morris D, Tan H, Barbagli F, Chang T, Salisbury K (2007) Haptic feedback enhances force skill learning. In: EuroHaptics conference, 2007 and symposium on haptic interfaces for virtual environment and teleoperator systems. World Haptics 2007. Second Joint. IEEE, pp 21–26

  35. Debes AJ, Aggarwal R, Balasundaram I, Jacobsen MB (2010) A tale of two trainers: virtual reality versus a video trainer for acquisition of basic laparoscopic skills. Am J Surg 199(6):840–84

    Article  PubMed  Google Scholar 

  36. Hamilton EC, Scott DJ, Fleming JB, Rege RV, Laycock R, Bergen PC, Tesfay ST, Jones DB (2002) Comparison of video trainer and virtual reality training systems on acquisition of laparoscopic skills. Surg Endosc Other Interv Tech 16(3):406–411

    Article  CAS  Google Scholar 

  37. Jalote-Parmar A, Badke-Schaub P (2008) Workflow integration matrix: a framework to support the development of surgical information systems. Des Stud 29(4):338–368

  38. Jannin P (2013) Surgical process modeling: methods and applications. In: Presentation at the 2013 medicine meets virtual reality conference (NEXTMED/ MMVR20), Feb 20–23. San Diego

  39. Nemani A, Sankaranarayan G, Roberts K, Panait L, Cao, C, De S (2013) Hierarchical task analysis of hybrid rigid scope natural orifice translumenal endoscopic surgery (NOTES) Cholecystectomy Procedures. In: Proceedings of the 2013 medicine meets virtual reality conference (NEXTMED/ MMVR20), Feb 20-23, San Diego, pp 293–297

  40. Cecil J, Ramanathan P, Prakash A, Pirela-Cruz M (2013) Collaborative virtual environments for orthopedic surgery. In: Proceedings of the 9th annual IEEE international conference on automation science and engineering (IEEE CASE 2013), Aug 17–21, Madison

  41. Cecil J, Avinash G, Miguel PC, Rajkumar M, Ramanathan P (2016) A virtual reality based simulation environment for orthopedic surgery, Industry Case Studies Program, OTM, Oct 24–28, Rhodes, Greece

  42. Muthaiyan A, Cecil J (2008) A virtual environment for satellite assembly. Comput Aided Des Appl 5(1–4):526–538

    Article  Google Scholar 

  43. Cecil J (2015) Modeling the process of creating virtual prototypes. Comput Aided Des Appl 6(1–4):1–4

    Google Scholar 

  44. IDEF methods. http://www.idef.com/

  45. The systems modeling language. https://en.wikipedia.org/wiki/Systems_Modeling_Language

  46. Class diagrams. https://www.visual-paradigm.com/VPGallery/diagrams/Class.html

  47. https://www.tutorialspoint.com/uml/uml_class_diagram.htm

  48. Abdurazik A, Offutt J (2000) Using UML collaboration diagrams for static checking and test generation. In: International conference on the unified modeling language. Springer, Berlin, pp 383–395

  49. Cecil J, Pirela-Cruz M (2010) Development of an information model for a virtual surgical environment. In: Proceedings of the TMCE 2010, Apr 12–16, Ancona, Italy

  50. Cecil J, Pirela-Cruz M (2013) An information model for designing virtual environments for orthopedic surgery. In: Proceedings of the 2013 EI2N workshop, OTM workshops, Graz, Austria. Vol 8186, Lecture notes in computer science. Springer, pp 218-227

  51. SYNTHES (2000) Less invasive stabilization system (LISS). http://www.synthes.com

  52. Class diagrams. https://www.visual-paradigm.com/VPGallery/diagrams/Class.html

  53. Sequence diagrams. https://en.wikipedia.org/wiki/Sequence_diagram

  54. NASA TLX test. https://en.wikipedia.org/wiki/NASA-TLX

  55. Nielsen J (2012) “Usability 101: introduction to usability”. Nielsen Norman Group. Retrieved 7 Aug 2016

  56. Tergas AI, Sheth SB, Green IC, Giuntoli RL (2013) A pilot study of surgical training using a virtual robotic surgery simulator. JSLS J Soc Laparoendosc Surg 17(2):219

  57. Verdaasdonk EGG, Dankelman J, Lange JF, Stassen LPS (2008) Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc 22(7):1636–1642

    Article  CAS  PubMed  Google Scholar 

  58. Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL (2008) Transferring simulated arthroscopic skills to the operating theatre. Bone Joint J 90(4):494–499

Download references

Acknowledgements

We would like to acknowledge funding received from the National Science Foundation through Grant Number CNS 1257803 and the Interdisciplinary Planning Grant program from Oklahoma State University (Office of the Provost).

Author information

Authors and Affiliations

  1. Center for Cyber Physical Systems, Computer Science, Oklahoma State University, Stillwater, OK, 74078, USA

    J. Cecil & Avinash Gupta

  2. Orthopaedic Surgery, Paul Foster School of Medicine, Texas Tech Health Sciences Center (TTHSC), El Paso, TX, USA

    Miguel Pirela-Cruz

Authors
  1. J. Cecil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Avinash Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Pirela-Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Cecil.

Ethics declarations

Conflict of interest

J. Cecil, Avinash Gupta and Miguel Pirela-Cruz declare that they have no conflict of interest.

Ethical approval

All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Declaration of Helsinki, as revised in 2008 (5). This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cecil, J., Gupta, A. & Pirela-Cruz, M. An advanced simulator for orthopedic surgical training. Int J CARS 13, 305–319 (2018). https://doi.org/10.1007/s11548-017-1688-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-017-1688-0

Keywords

Search

Navigation