Page 399 - Biomedical Engineering and Design Handbook Volume 2, Applications

CHAPTER 13

SURGICAL SIMULATION

TECHNOLOGIES

M. Cenk Cavusoglu
Case Western Reserve University, Cleveland, Ohio

13.1 VIRTUAL ENVIRONMENTS: 13.3 RESEARCH CHALLENGES IN
A GENERAL PERSPECTIVE 378 SURGICAL SIMULATION TECHNOLOGY 381
13.2 DEVELOPMENTS IN SIMULATION- 13.4 CONCLUSION 387
BASED MEDICAL EDUCATION 379 REFERENCES 387

Virtual environment-based surgical simulation is an emerging area of research on the application of
virtual environment technologies to the training of surgery and other medical interventions.
Currently, surgeons are trained through apprenticeship. The basic techniques are taught with
simple training equipment, but the rest of the training is either with books describing surgical pro-
cedures and techniques, or in the operating room by watching and participating in actual operations,
and rarely in animal laboratories. There are inherent limitations associated with each of the estab-
lished training methods. The limitation of reading about surgery is that it provides no practical
experience. The limitation of conventional apprenticeship-based training in the operating room is
the unpredictable availability of case material and the potential for serious injury to the patient as
the student navigates the learning curve for the technique. This method of training also limits the
diffusion of knowledge, since only a limited number of people can be trained by one experienced
surgeon. The mandatory restriction of the work week for medical and surgical residents in the
United States to 80 h will lead to a significant reduction in the total amount of teaching that can be
done in the operating room. Of the existing training methods, the hands-on practical courses offer
the best learning experience, but still fall short of the mark. The limitation of hands-on practical
courses is the lack of standardization and the lack of realistic models of the various pathological
conditions. The dry models (e.g., Styrofoam approximations of the anatomy) lack the realism pro-
vided by live tissue. The wet models (e.g., animal laboratories) are difficult to set up and fail to
mimic true pathological conditions. Furthermore, animal models are complicated by ethical issues,
problems of anesthesia, lack of reproducibility, and formidable cost. Although some basic dexter-
ity training can be achieved, the forced feedback derived from tissues is quite variable, depending
on the quality of the models. Cadavers are expensive and difficult to procure, transport, and pre-
serve. Furthermore, the mechanical properties of the tissue, the visual appearance of anatomy, and
the intraoperative bleeding that is encountered in live surgery cannot be provided by cadaveric spec-
imen training.
Virtual environments present a complement to the contemporary apprenticeship-based training
scheme of surgery and other medical interventions. With virtual environments, it is possible to create

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