Surgical simulation for medical education is increasingly perceived as a valuable addition to traditional teaching methods. Simulators provide a structured learning experience, permitting practice without danger to patients, and simulators facilitate the teaching of rare or unusual cases. Simulators can also be used to provide an objective assessment of skills. This paper is a survey of current surgical simulator systems. The components of a simulator are described, current research directions are discussed, and key research questions are identified.

This paper presents a critical study of the mechanical and electrical properties of the PHANToM haptic interface and improvements to overcome its limitations for applications requiring high-performance control. Target applications share the common requirements of low-noise/granularity/latency measurements, an accurate system model, high bandwidth, the need for an open architecture, and the ability to operate for long periods without interruption while exerting significant forces. To satisfy these requirements, the kinematics, dynamics, high-frequency dynamic response, and velocity estimation of the PHANToM system are studied. Furthermore, this paper presents the details of how the unknown subsystems of the stock PHANToM can be replaced with known, high-performance systems and how additional measurement electronics can be interfaced to compensate for some of the PHANToM's shortcomings. With these modifications, it is possible to increase the maximum achievable virtual wall stiffness by 35%, active viscous damping by 120%, and teleoperation loop gain by 50% over the original system. With the modified system, it is also possible to maintain higher forces for longer periods without causing motor overheating.

With the introduction of minimally invasive techniques, surgeons must learn skills and procedures that are radically different from traditional open surgery. Traditional methods of surgical training that were adequate when techniques and instrumentation changed relatively slowly may not be as efficient or effective in training substantially new procedures. Virtual environments are a promising new medium for training. This paper describes a testbed developed at the San Francisco, Berkeley, and Santa Barbara campuses of the University of California for research in understanding, assessing, and training surgical skills. The testbed includes virtual environments for training perceptual motor skills, spatial skills, and critical steps of surgical procedures. Novel technical elements of the testbed include a four-DOF haptic interface, a fast collision detection algorithm for detecting contact between rigid and deformable objects, and parallel processing of physical modeling and rendering. The major technical challenge in surgical simulation to be investigated using the testbed is the development of accurate, real-time methods for modeling deformable tissue behavior. Several simulations have been implemented in the testbed, including environments for assessing performance of basic perceptual motor skills, training the use of an angled laparoscope, and teaching critical steps of the cholecystectomy, a common laparoscopic procedure. The major challenges of extending and integrating these tools for training are discussed.

The minimally invasive nature of endoscopic surgery allows operations to be performed through small incisions, producing significantly less damage to good tissue than in conventional open surgery. Patient recovery times are thus greatly reduced. This major advantage has driven a dramatic growth of endoscopic techniques in a wide range of surgical applications. Unfortunately, the surgeon's abilities are severely hampered by the limitations of current endoscopic technology. In many ways endoscopic surgery is similar to teleoperation of a remote manipulator. Although the surgeon is physically close to the patient, the surgical environment is effectively “remote,” with sensing and manipulation transmitted through the endoscope and long instruments. Existing solutions from teleoperation applications could likely be applied to endoscopic surgery. This paper attempts to identify the major problems of current endoscopic technology, particularly in vision and manipulation. Vision issues are discussed in the first half, motivated by an experiment comparing surgeons' performance under different visual conditions. Surgeon subjects perform a three-dimensional positioning task with binocular direct vision, monocular direct vision, and a video endoscope. The lack of a stereoscopic view through the endoscope significantly slows performance of the tasks, but there are additional factors that make endoscopic viewing worse than monocular direct viewing. Relevant previous results which demonstrate the significance of interocular spacing in stereo viewing and the effect of display-control axes misalignment are also discussed. Issues of endoscopic manipulation are discussed in the second half of this paper, motivated by a suturing task comparing surgeons' performance with hand and endoscopic instruments. The constraint of endoscopic instruments' passing through the skin reduces their usable degrees of freedom and significantly increases the time to tie a suture knot. Kinematics of endoscopic instruments are compared to the human hand and arm. A model of the surgeon's precision grasp demonstrates the role of stiffness in fine motion control as an example of an advantage of the hand which is lost in the use of endoscopic instruments. The work described in this paper represents an initial effort in identifying problems and evaluating solutions in endoscopic surgery based on objective measurement of performance.