Denis Laroche

NeuroTouch: A physics-based virtual simulator for cranial microneurosurgery training

BACKGROUND: A virtual reality neurosurgery simulator with haptic feedback may help in the training and assessment of technical skills requiring the use of tactile and visual cues. OBJECTIVE: To develop a simulator for craniotomy-based procedures with haptic and graphics feedback for implementation by universities and hospitals in the neurosurgery training curriculum. METHODS: NeuroTouch was developed by a team of more than 50 experts from the National Research Council Canada in collaboration with surgeons from more than 20 teaching hospitals across Canada. Its main components are a stereovision system, bimanual haptic tool manipulators, and a high-end computer. The simulation software engine runs 3 processes for computing graphics, haptics, and mechanics. Training tasks were built from magnetic resonance imaging scans of patients with brain tumors. RESULTS: Two training tasks were implemented for practicing skills with 3 different surgical tools. In the tumor-debulking task, the objective is complete tumor removal without removing normal tissue, using the regular surgical aspirator (suction) and the ultrasonic aspirator. The objective of the tumor cauterization task is to remove a vascularized tumor with an aspirator while controlling blood loss using bipolar electrocautery. CONCLUSION: NeuroTouch prototypes have been set up in 7 teaching hospitals across Canada, to be used for beta testing and validation and evaluated for integration in a neurosurgery training curriculum. ABBREVIATIONS: DOF, degrees of freedom

The Development of a Virtual Simulator for Training Neurosurgeons to Perform and Perfect Endoscopic Endonasal Transsphenoidal Surgery

BACKGROUND A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. OBJECTIVE This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use. METHODS The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves. CONCLUSION The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training. ABBREVIATIONS CTA, cognitive task analysisVR, virtual reality.BACKGROUND: A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. OBJECTIVE: This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use. METHODS: The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves. CONCLUSION: The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training.

Computer prediction of friction in balloon angioplasty and stent implantation

The success of balloon angioplasty and stent implantation depends on a balance between two conflicting objectives: maximization of artery lumen patency and minimization of mechanical damage. A finite element model for the patient-specific prediction of balloon angioplasty and stent implantation is proposed as a potential tool to assist clinicians. This paper describes the general methodology and the algorithm that computes device/artery interaction during stent deployment. The potential of the model is demonstrated with examples that include artery model reconstruction, device deployment, and prediction of friction on the arterial wall

A viscoelastic soft tissue model for haptic surgical simulation

Brain surgeons distinguish tumors from healthy tissue by the way the tissue deforms. Accurately simulating these deformations at haptic update rates is still a challenge. Biological tissues exhibit complex viscoelastic behavior and undergo large deformation during surgery. For this purpose we evaluate the accuracy and computational performance of the Christensen viscoelastic material model in combination with non-linear finite elements. Our results show that realistic viscoelastic properties of brain tissue can be simulated with haptic feedback at 70% of the update rate of the non-viscoelastic large deformation Neo-Hookean model

Virtual Reality Simulator: Demonstrated Use in Neurosurgical Oncology

Background. The overriding importance of patient safety, the complexity of surgical techniques, and the challenges associated with teaching surgical trainees in the operating room are all factors driving the need for innovative surgical simulation technologies. Technical development. Despite these issues, widespread use of virtual reality simulation technology in surgery has not been fully implemented, largely because of the technical complexities in developing clinically relevant and useful models. This article describes the successful use of the NeuroTouch neurosurgical simulator in the resection of a left frontal meningioma. Conclusion. The widespread application of surgical simulation technology has the potential to decrease surgical risk, improve operating room efficiency, and fundamentally change surgical training.

Haptic collision handling for simulation of transnasal surgery

Simulation of endoscopic navigation in the narrow nasal cavity poses important challenges to the computation of adequate and near‐realistic collision response and haptic feedback because extensive multidirectional contact and massive tissue deformations are inevitable. We present a virtual coupling algorithm that provides stable collision response as well as intuitive and smooth haptic interaction in all phases of the simulation. In each iteration, continuous collision detection between the point shell representing the surface of the virtual patient anatomy and the endoscope, represented by a cylinder, is performed. This allows for rolling back the instrument movement to the point in time the first collision occurred. Subsequently, a relaxation process locally optimizes the position and orientation of the instrument. A novel method of applying contact forces to colliding tissues and thus triggering appropriate deformations improves the fluency of navigation. This paper describes the algorithm and presents experimental results.