دانلود رایگان ترجمه مقاله شبیه ساز جراحی چشم ارزان قیمت با مولفه برآورد مهارتی

شبیه ساز جراحی چشم ارزان قیمت با ارزیابی مولفه مهارتی

Low Cost Eye Surgery Simulator with Skill Assessment Component

Abstract

Ophthalmic surgeons require years of training and continuous practice to successfully manipulate the delicate tissues of the human eye. Development of the fine motor skills is a crucial component of this training. Virtual eye surgery simulators have come on the market in recent years leveraging the advantages of virtual procedures. However adoption is limited by the high initial investment and availability of models. Our approach consists of a low cost hybrid approach that employs a standard porcine model for cataract training and a platform that is instrumented to record interaction forces and video. In a preliminary study we have recorded procedure data for a small number of experts which shows good signalto-noise ratio suitable for development of objective skill assessment models.

۱ Introduction

he human eye is one of the most delicate structures in the human body. Ophthalmic surgeons need years of training and continuous practice to carefully and successfully manipulate the tissues. Tool motions and forces used in these procedures are extremely small. Development of the fine motor skills is therefore an important component of resident training and generally consists of wetlab practice on cadaveric eyes and assisting experts with surgery in live cases in the operating room. For wetlab practice a cadaveric eye is mounted in a Styrofoam training prop. The ex-vivo specimens are used to practice various common intraocular surgical procedures such as cataract removal, glaucoma and retinal surgery [1]. In a simulated wetlab procedure the resident in training can carry out several complete procedures in a short time frame and practice critical steps without risk to a patient. However in order to obtain performance feedback for the resident, a skilled surgeon has to observe and evaluate the practice session [2]. Due to the workload demands on expert surgeons and high cost of their time, residents currently go through only one supervised and 5 to 10 unsupervised wetlab sessions. The residents are quickly transitioned into the OR working live cases. The expert surgeon will perform most of the procedure at first and assign increasingly larger and more difficult parts of the procedure to the resident. With this approach, the resident will practice critical steps in the procedure for only a few brief periods per patient once basic skills are fully mastered. Virtual eye surgery simulators such as the EYESI R from VRmagic GmbH have come on the market in recent years leveraging the advantages of simulated procedures [3,4]. Due to the virtual nature of the model, they are well suited to simulate standard procedures as well as unexpected and rare circumstances. Performance assessment is feasible since the state of the model is known. These simulators currently do not provide tactile feedback for tissue interaction [5,6,7,8,9]. This component is critical in developing the motor skills necessary to successfully handle the extremely delicate tissues of the human eye. With availability of high fidelity data of surgeon/tool and tool/tissue interaction, objective skill assessment for surgical applications has recently been subject to intense study. Integrative and averaged metrics have been employed to this goal [10,11]. More recently approaches using stochastic tools such as Markov models have been employed to capture the dynamic nature of the surgical task. [12,13,14,15,16] The goal of this project is to improve the understanding of the biomechanical properties of the human eye, eye socket and surgical tools, leading to the development of objective surgical skill assessment methodology and improved training tools for ophthalmic surgeons. Current trends in medical training indicate that simulator based certification for surgical procedures may become more common. The device proposed here lends itself to training and certification of proficient surgeons for new procedures and materials. In the initial phase of this project, we developed, built and tested a surgical platform for data collection during cataract procedures on porcine and human ex-vivo eyeballs and collected preliminary data.