School of Mechanical Engineering, State Key Laboratory of Mechanical System and Vibration, Institute of Biomedical Manufacturing and Life Quality Engineering, Shanghai 200240, China.
Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China.
J Biomed Inform. 2014 Apr;48:122-9. doi: 10.1016/j.jbi.2013.12.010. Epub 2013 Dec 28.
OBJECTIVE: Bone sawing or cutting is widely used for bone removal processes in bone surgery. It is an essential skill that surgeons should execute with a high level of experience and sensitive force perception. Surgical training simulators, with virtual and haptic feedback functions, can offer a safe, repeatable and cost-effective alternative to traditional surgeries. In this research, we developed a surgical training simulator with virtual and haptic force feedback for maxillofacial surgery, and we validated the effects on the learning of bone-sawing skills through empirical evaluation. METHODS: Omega.6 from Force Dimension was employed as the haptic device, and Display300 from SenseGraphices was used as the 3D stereo display. The voxel-based model was constructed using computed tomography (CT) images, and the virtual tools were built through reverse engineering. The multi-point collision detection method was applied for haptic rendering to test the 3D relationship between the virtual tool and the bone voxels. Bone-sawing procedures in maxillofacial surgery were simulated with a virtual environment and real-time haptic feedback. A total of 25 participants (16 novices and 9 experienced surgeons) were included in 2 groups to perform the bone-sawing simulation for assessing the construct validity. Each of the participants completed the same bone-sawing procedure at the predefined maxillary region six times. For each trial, the sawing operative time, the maximal acceleration, and the percentage of the haptic force exceeding the threshold were recorded and analysed to evaluate the validity. After six trials, all of the participants scored the simulator in terms of safe force learning, stable hand control and overall performance to confirm the face validity. Moreover, 10 novices in 2 groups indentified the transfer validity on rapid prototype skull models by comparing the operative time and the maximal acceleration. RESULTS: The analysed results of construct validity showed that the two groups significantly reduced their sawing operative times after six trials. Regarding maximal acceleration, the curve significantly descended and reached a plateau after the fifth repetition (novices) or third repetition (surgeons). Regarding safe haptic force, the novices obviously reduced the percentage of the haptic force exceeding the threshold, with statistical significance after four trials, but the surgeons did not show a significant difference. Moreover, the subjectively scored results demonstrated that the proposed simulator was more helpful for the novices than for the experienced surgeons, with scores of 8.31 and 7.22, respectively, for their overall performance. The experimental results on skill transference showed that the experimental group performed bone-sawing operation in lower maximal acceleration than control group with a significant difference (p<0.05). These findings suggested that the simulator training had positive effects on real sawing. CONCLUSIONS: The evaluation results proved the construct validity, face validity and the transfer validity of the simulator. These results indicated that this simulator was able to produce the effect of learning bone-sawing skill, and it could provide a training alternative for novices.
目的:在骨外科中,骨锯切广泛用于骨切除过程。这是一项基本技能,外科医生应该具有丰富的经验和敏感的力感知能力。具有虚拟和触觉反馈功能的手术培训模拟器可以为传统手术提供安全、可重复且具有成本效益的替代方案。在这项研究中,我们开发了一种用于颌面外科的具有虚拟和触觉力反馈的手术培训模拟器,并通过实证评估验证了其对骨锯切技能学习的影响。
方法:使用 Force Dimension 的 Omega.6 作为触觉设备,使用 SenseGraphices 的 Display300 作为 3D 立体显示器。基于体素的模型是使用计算机断层扫描 (CT) 图像构建的,虚拟工具是通过逆向工程构建的。多点碰撞检测方法用于触觉渲染,以测试虚拟工具与骨体素之间的 3D 关系。通过虚拟环境和实时触觉反馈模拟颌面外科中的骨锯切过程。共有 25 名参与者(16 名新手和 9 名经验丰富的外科医生)被分为 2 组,以进行骨锯切模拟,以评估构建有效性。每组参与者在预定义的上颌区域完成相同的骨锯切程序六次。对于每个试验,记录并分析锯切操作时间、最大加速度和触觉力超过阈值的百分比,以评估有效性。经过六次试验后,所有参与者根据安全的力学习、稳定的手部控制和整体性能对模拟器进行评分,以确认表面有效性。此外,通过比较操作时间和最大加速度,2 组中的 10 名新手在快速原型颅骨模型上确定了转移有效性。
结果:构建有效性的分析结果表明,两组在六次试验后明显缩短了锯切操作时间。关于最大加速度,曲线在第五次重复(新手)或第三次重复(外科医生)后明显下降并达到平台。关于安全的触觉力,新手明显降低了触觉力超过阈值的百分比,第四次试验后具有统计学意义,但外科医生没有显示出显著差异。此外,主观评分结果表明,该模拟器对新手比经验丰富的外科医生更有帮助,整体表现分别为 8.31 和 7.22。技能转移的实验结果表明,实验组的最大加速度明显低于对照组,差异具有统计学意义(p<0.05)。这些发现表明模拟器培训对实际锯切具有积极影响。
结论:评估结果证明了模拟器的构建有效性、表面有效性和转移有效性。这些结果表明,该模拟器能够产生学习骨锯切技能的效果,并可为新手提供一种培训选择。
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