1. Principles of Virtual Reality in Surgical Training and Practice By Dr S. Sanyal

2. Contents Definition and classification Technical aspects Angled laparoscope simulation Simulated cholecystectomy Simulated gynecological surgery Virtual endoscopy / angiography Augmented reality imaging – Neurosurgery Visible Human Project – NLM Summary References and URLs

3. Definition VR 1 st coined by Jaron Lanier, head of VPL Research Inc. California 2 nd of 3 types of Cyberspace System that provides realistic sense of being immersed in an environment. Computer-generated visual, auditory and tactile multimedia experience. Teledildonics: Virtual sex (or e-sex!!??)

4. Classification

5. Augmented reality systems

6. Technical aspects of VR VR surrounds human body with artificial sensorium of sight, sound and touch. –Stereo headphones –‘Eyephones’: Head mounted stereo TV goggles – able to simulate 3-D –‘Datagloves’: Wired gauntlets –‘Datasuits’: Computerized clothing

8. Technical aspects of VR in medicine 3-D computer graphics: Texture mapping Interaction devices and trackers Tactile feedback Force (haptic) feedback: Reverse robotic units Other sensory feedback: Auditory, olfactory etc

12. Angled laparoscope training simulator Spatial reasoning is required to focus objective lens in line with narrow cavity.

13. Angled laparoscope training simulator Virtual environment through a Virtual Laparoscopic Interface: All 4 corners of 6 targets have to be viewed in sequence.

14. Angled laparoscope training simulator After viewing all 4 corners of 1 st target, hit a button: Next object comes into view

15. Angled laparoscope training simulator Go through the whole sequence for all targets.

16. Angled laparoscope training simulator

18. Automatic timer records the time taken

19. Virtual cholecystectomy Occluding tissue is dissected

20. Virtual cholecystectomy Lateral traction is placed on gallbladder and cystic duct is clipped

21. Virtual cholecystectomy

22. Cystic duct is successfully cut

23. Simulated gynecological surgery Endoscopic Surgery Simulation: Perform surgical tasks on elasto-dynamic objects in virtual surgery scene in real time; grasping, cutting and setting of clips

24. Simulated gynecological surgery Concept of ADO has been introduced for modeling organ motility

25. Simulated gynecological surgery © Dr. H. Cakmak, Institut für Angewandte Informatik, Forschungszentrum Karlsruhe Simulation of pulsatile bleeding, irrigation, suction, animation of coagulation smoke, causing steaming of endoscope lens…

26. Virtual endoscopy

27. Virtual bronchoscopy

28. Virtual colonoscopy

29. Virtual arthroscopy

30. Virtual angiography

31. Augmented reality imaging

35. Visible Human Project – NLM Visible Human Male Database Visible Human Female Database

36. Visible Human Project – NLM

38. Virtual scalpel incision

39. Summary VR is an immersive and interactive simulation of an environment VR applications are playing a great role in teaching, training and testing of medical students and graduates Computer simulated 3-D reconstruction of radiological c-sections are important diagnostic tools

40. Summary Computer assisted pre-operative planning and outcome prediction are on the horizon Integration of hybrid (real and imaginary) systems in augmented reality play a role in image-guided surgery VR also plays a role in telemedine and telesurgery

41. References and URLs Edelman V. Touch goes high-tech. http://cms.psychologytoday.com/articles/pto- 19960101-000031.html http://cms.psychologytoday.com/articles/pto- 19960101-000031.html Boulos MNK. University of Plymouth. Virtual reality in medicine Tendick F. University of California San Francisco. http://itsa.ucsf.edu/~frankt/vesta.html http://itsa.ucsf.edu/~frankt/vesta.html Cakmak HK. Institut für Angewandte Informatik, Forschungszentrum Karlsruhe. http://www- kismet.iai.fzk.de/VRTRAIN/phD_main.html http://www- kismet.iai.fzk.de/VRTRAIN/phD_main.html

42. References and URLs The Visible Human Project, NLM, NIH: http://www.nlm.nih.gov/research/visible/visible _human.html http://www.nlm.nih.gov/research/visible/visible _human.html University of Colorado, Center of Human Simulation: http://www.uchsc.edu/sm/chs/browse/browse_ m.html http://www.uchsc.edu/sm/chs/browse/browse_ m.html http://www.uchsc.edu/sm/chs/browse/browse_f.html http://www.uchsc.edu/sm/chs/browse/browse_f.html NHSIA. Virtual Reality System Predicts Surgical Outcomes. http://www.informatics.nhs.uk/cgi- bin/item.cgi?id=1206 Feb-2005 http://www.informatics.nhs.uk/cgi- bin/item.cgi?id=1206