Korzeniowski Przemyslaw, Barrow Alastair, Sodergren Mikael H, Hald Niels, Bello Fernando
Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Int J Comput Assist Radiol Surg. 2016 Dec;11(12):2303-2315. doi: 10.1007/s11548-016-1401-8. Epub 2016 Jun 17.
Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians.
We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods.
We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES.
VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.
经自然腔道内镜手术（NOTES）是微创手术中的一项新技术，通过自然腔道插入柔性内镜进入腹腔，不留体表瘢痕。这种对柔性内镜的创新性应用带来了诸多新挑战，且临床医生的学习曲线较陡。
我们开发了NOViSE——首个支持柔性内镜的用于NOTES训练的力反馈虚拟现实模拟器。触觉设备是定制的，虚拟柔性内镜的行为基于一个既定的理论框架——弹性杆的柯塞尔理论。
我们展示了NOViSE在模拟经胃杂交胆囊切除术过程中的应用。先前进行的表面效度、内容效度和结构效度的初步结果表明，NOViSE为NOTES特有的内镜操作技能训练提供了所需的真实感水平。
NOTES手术的虚拟现实模拟有助于手术训练并改善教育体验，同时不会使患者面临风险、引发伦理问题或需要昂贵的动物或尸体设施。在一项实验技术的背景下，NOViSE可能会促进NOTES的发展，并通过使从业者跟上这种新型手术技术的发展步伐，推动其更广泛的应用。NOViSE是首个原型，初步结果表明它为进一步发展提供了有前景的基础。
