Training in the operating room can increase risk to the patient and slows the operation, resulting in greater costs. It also has drawbacks in teaching effectiveness. A stressful environment can reduce learning, and students are not free to experiment with different techniques to see which one might be best for them. Because every mentor teaches his or her own technique, it is impossible to develop standards for training or assessment.
Other methods of training have limitations. Books are not interactive and cannot portray anatomy in three dimensions. Cadavers and live animals are expensive and usually cannot demonstrate pathologies. Animal anatomy is not the same as human anatomy. In vitro training models made of synthetic materials can be useful, but it would be difficult to maintain a library of models with all important pathologies and anatomical variations, especially if the models are of little use after being ``dissected.''
Computer-based training has many potential advantages. It is interactive, yet an instructor's presence is not necessary, so students may practice in their free moments. Any pathology or anatomical variation could be created. Simulated positions and forces can be recorded to compare with established performance metrics for assessment and credentialing. Students could also try different techniques and look at anatomy from perspectives that would be impossible during surgery.
This project will include developing a virtual environment made of objects of various geometries representing organs. The user will hold a special 4 degree-of-freedom "joystick" with a fulcrum as if orienting the scope through an incision. He or she must navigate through the environment to look for hidden targets. A second "joystick" representing a grasping instrument might be used to open trapdoor-like folds of tissue to reveal some of the targets.
At the end of the semester, we will use this simulation in a course at UCSF where practicing surgeons come to learn minimally invasive techniques. If we can show that training in a VE transfers to improved performance in vivo, this work will be quite exciting and will make a significant publication.
a. Interactive Viewing of Complex Anatomy. Navigating through a 3-D model of a complex organ or anatomical region, such as the eye. Perhaps this could include interacting with the model, e.g., taking it apart, activating muscles, or looking through it as the optics changed.
b. Misunderstanding the anatomy of ducts between the liver and gall bladder can lead a surgeon to cut the wrong duct when removing the diseased gall bladder. This can potentially lead to a liver transplant or death. A relatively simple model can be developed which must be "dissected" by removing small chunks of fat. The user would be asked to identify the 3-D configuration of the ducts after removing as little fat as possible.
c. I have an MRI data set of a head, both in slices and with volume interpolation. A project could be designed to segment brain parts, reconstruct them in three dimensions, and/or render surfaces from the segmentation with interactive viewing.