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Tech Explained

Simulated Surgery

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PCQ Bureau
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Simulated patient
His father’s death in the hands of an inexperienced physician led Bill Clark (a military flight and submarine simulator) to set up Medical Simulation Corp. Clark and a handful of engineers who had built simulators for the military, Ford Motor Co and the airline industry, started working in a garage in 1991 with a machine that could realistically simulate heart-catheterization procedures. 



Today the company produces high-tech simulators to recreate the toughest of medical cases. Using Medical Simulation’s SimSuite, doctors can practice on 70 different patient cases, each an hour long. All simulations are based on actual cases and many scenarios are designed to present out-of-the-ordinary situations for doctors.


The simulators, including educational software and training programs, will be leased to hospitals, physician practices and medical-device manufacturers. They plan to have around 30 of them running by the end of 2003. The cost of working on the simulator works out to about $120 per hour. More at
www.simsuiteed.com 

Surgical simulation simulates the working environment of a surgical procedure using a computer and puts doctors in the perspective of the camera that is at the point of operation. 

The first major shift from ‘hand-eye connect’ medical procedures was with the advent of tiny cameras and instruments that

could be inserted into a patient’s tract and monitored closely on a video monitor. Modern day endoscopic surgery relies on these tools to perform surgeries faster and with minimal risks. This is called MIS (Minimally Invasive Surge- ry). Doctors, however, found it a little difficult to adjust to them; hence, the surgical simulation. This concept is not restricted only to endoscopic procedures. 

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How it works



Surgery simulations are manipulations of already existing 3D models of organs. In essence, a surgical simulator performs three tasks: model organs and deformations, simulate actions like cutting of tissue and calculate and generate force feedback reactions. Models are generated by 3D-modeling software from real images taken during actual procedures. Data on the geometric and elastic properties of organs is also fed into the simulator. So much so that 3D models of the vascular system are also superimposed to simulate the blood flow. To iteratively calculate the actions and reactions, FEM (Finite Element Modeling) is used. The force feedback system uses detachable surgical tools mounted on force-feedback devices. Untoward event scenarios and multimedia clips are also incorporated to aid the process of learning.

VR (virtual reality) is extensively used in simulations for surgical training. This extends the concept of MIS, which already use video monitors extensively. An MIS simulation involves a computer-generated 3D model of surgical representations like body organs. The doctor then inserts instruments into the model and performs the surgery virtually. 

VR ensures that the organs look and behave like them. So, organs would move, reflect light and get compressed when touched virtually. By means of VRML (Virtual Reality Modeling Language) and Java, the simulation is easy to model and implement. End users could even work on VRML-capable browsers. Doctors could go through multiple iterations on the virtual model before carrying out the procedure on the live patient.

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Robot surgeon
Zeus, a robotic surgery system, aims to increase the scope of MIS (Minimally Invasive Surgery). For instance, currently heart bypass surgery causes a lot of trauma to the patient, as this type of surgery needs a 1-foot incision in the chest. However, with the Zeus system, it is possible to operate on the heart by making three small incisions in the chest, each only about 1 centimeter in diameter. With such MIS, the patient experiences less pain and bleeding, which means faster recovery. System like Zeus, also reduce fatigue and can eliminate hand tremors of surgeons. In addition, the use of computer systems opens another field of telesurgery, where the physical location of the expert will be redundant. He could be in the next room or continents across. Thus, the patient could have access to the best of experts, irrespective of their geographical locations.

Existing, virtual surgery tables are still in infancy. These are actual physical operating tables that have multi-user projection systems. They incorporate active and passive, high-resolution stereo projection system to enable a group of users to work on either side of the table on same or different sets of data.

Ashish Sharma

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