Development of Virtual Environments for Training Skills and Reducing Errors in Laparoscopic Surgery

In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with e orts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create three-dimensional mental models and plans while viewing a two-dimensional image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have di culty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy (gallbladder removal) are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on nite element methods will be used to improve the response of the anatomical models.