Hauck, Robert
(2017)
Virtual surgery and orthopaedic surgery: towards training using haptic technology.
PhD thesis, University of Nottingham.
Abstract
Medical education and practical training in surgery is changing, by shifting from an on the job learning paradigm, which possesses problems such as that it is unpredictable, dependent on clinical needs and that patient safety may be jeopardised, to an evidence-based surgical skills training driven by curricular needs, and acquiring basic surgical skills prior to assisting in the operating theatre and thus reducing operation duration. Towards achieving this goal, virtual reality (VR) simulators are used in minimally invasive surgery for technical skills training at the beginning of the learning curve, but have not yet been adapted for open surgery due to its complexity for simulation. This thesis investigated the potential of using a VR simulator for training in orthopaedic hand surgery, with an emphasis on providing a meaningful, effective and motivating addition to current training methods for surgical procedures.
A review of literature, preliminary research projects and currently available surgical systems revealed limited results on whether a VR simulation of orthopaedic hand surgery could be created, fulfilling the needs of medical experts. Therefore, a study investigating the current state of medical education and to understand the expectations on such a simulator was carried out, which resulted in the identification of promising medical scenarios for simulation (such as carpal tunnel release, distal radius fracture treatment or surgical incision) and in requirements for its development. Different software frameworks have been evaluated for their ability for use by analysing five developed demonstrators, with the result that a custom implementation of a six-degrees-of-freedom haptic algorithm was required. By following a human-centred design approach, a VR surgical simulator with inbuilt objective measures of assessment has been developed, allowing applying a plate, drilling holes, measuring their lengths, inserting screws and taking virtual X-rays, supported by haptic feedback for increased realism and teaching aspects not possible by common computer-based simulators, such as feeling the resistance when drilling through the cortical bone. By close collaboration with medical experts and following user interface design principles, a carried out medical evaluation of the simulator showed that the simulator was well-received by the targeted young doctors and medical students, that relevant aspects of the implemented medical scenario are taught and that the users’ performance can be assessed.
The findings of this work showed that it is possible to create an interactive VR simulator aimed at early stages to learn basic orthopaedic principles of open surgery using the example of the treatment of distal radius fractures in a meaningful manner. It addresses issues in the current medical education and enables learning educational objectives repeatedly in reusable medical scenarios and in a safe and controlled environment, without the risk of harming patients, and thus contributing to improved quality and patient safety when proceeding to the operating theatre.
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