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Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.

Objective: To validate robot-assisted surgery skills acquisition using an augmented reality (AR)-based module for urethrovesical anastomosis (UVA)., Methods: Participants at three institutions were randomised to a Hands-on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure-based training for UVA within the haptic-enabled AR-based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross-over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank-sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross-over group)., Results: A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention., Conclusion: Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand., (© 2014 The Authors. BJU International © 2014 BJU International.)

Objective: • To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System., Patients and Methods: • Participants attending the 2010 International Robotic Urology Symposium were invited to experience RoSS. Afterwards, participants completed a survey regarding the appropriateness of the simulator as a teaching tool., Results: • Forty-two subjects including surgeons experienced with robotics (n= 31) and novices (n= 11) participated in this study. • Eighty per cent of the entire cohort had an average of 4 years of experience with robot-assisted surgery. • Eleven (26%) novices lacked independent robot-assisted experience. The expert group comprised 17 (41%) surgeons averaging 881 (160-2200) robot-assisted cases. Experts rated the 'clutch control' virtual simulation task as a good (71%) or excellent (29%) teaching tool. • Seventy-eight per cent rated the 'ball place' task as good or excellent but 22% rated it as poor. • Twenty-seven per cent rated the 'needle removal' task as an excellent teaching tool, 60% rated it good and 13% rated it poor. • Ninety-one per cent rated the 'fourth arm tissue removal' task as good or excellent. • Ninety-four per cent responded that RoSS would be useful for training purposes. • Eighty-eight per cent felt that RoSS would be an appropriate training and testing format before operating room experience for residents. • Seventy-nine per cent indicated that RoSS could be used for privileging or certifying in robotic surgery., Conclusion: • Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity., (© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.)

Objectives: To assess the face validity of Robotic Surgery Simulator (RoSS), a novel virtual reality training platform for the da Vinci Surgical System (DVSS)., Methods: Urologic surgeons, fellows, and residents attending the 2009 American Urologic Association Annual Meeting in April 2009 were invited to an orientation session with RoSS. Participants completed a questionnaire after orientation and two modules., Results: Thirty participants including 24 surgeons and fellows experienced with robotic surgery and 6 robotic surgery novices participated in the study. Eighty percent participants had at least 4 years of experience with robotic surgery and 77% had performed an average of 340 cases on the DVSS as primary console surgeons. Subjects indicated that RoSS was realistically close to the DVSS console in terms of virtual simulation and instrumentation. Fifty-two percent of subjects rated RoSS somewhat close and 45% rated RoSS very close to the DVSS console. Thirty-seven percent rated RoSS pinch device somewhat close, and 47% very close to the DVSS. With regard to movement of the arms, 43% rated it somewhat close, 40% rated it very close, and 7% felt that it was just like the DVSS. Camera movement and clutch functions were rated not close (11%), somewhat close (57%), and very close (32%) to the DVSS. Data were further analyzed in terms of surgical volume. Thirty-eight percent of subjects had also tried the Mimic dV-Trainer robotic surgery simulator., Conclusions: RoSS provides opportunity for robot-assisted surgical training for future error-free surgery. Further validation will be necessary to assess RoSS and the application of specific modules for robot-assisted surgical training., (Copyright 2010. Published by Elsevier Inc.)

Endovascular neurosurgery has gained acceptance as the best method of treatment of vascular abnormalities like cerebral aneurysms. However, the procedure is associated with difficulties in tool/tissue manipulation. Navigation of stent, catheter and, guide wire through complex arteries without any force information often causes stent snagging, plaque dislocations and formation of thrombosis caused by the damage of the arterial wall. Currently, there is no haptic device available which can provide the surgeons with the force information, related to stent placement procedure. The goal of this work is to create a data base for a fast synthetic endovascular force simulator, which will provide the surgeon with force information during tool-artery interaction, based on the various combinations of tool sizes and vessel complexity, [1, 2] to facilitate better preoperative planning, safer interventions, and advanced training of new surgeons.

Realistic trocar insertion simulator requires reliable and reproducible tissue data. This paper looks at using synthetic surrogate tissue to facilitate creation of data covering a wide range of pathological cases. Furthermore, we propose to map the synthetic puncture force data to the puncture force data obtained on animal/human tissue to create a simulation model of the procedure. We have developed an experimental setup to collect data from surrogate synthetic tissue using a bladeless trocar.

Trocar insertion, the first step to most micro surgery procedures is a difficult procedure to learn and practice because procedure is carried out almost entirely without any visual feedback of the organs underlying the tissue being punctured. A majority of injuries is attributed to the excessive use of force by the surgeon. This paper looks at developing a haptic based trocar insertion simulator which will assist in training and skill advancement in carrying out this procedure. Different issues regarding development of force model and and trocar-tissue interaction is studied.

Subsurface modeling of deformable objects, such as soft tissues and organs, involves the use of non-destructive methods of determining the properties of an object encased by a material. Some of the properties that can be determined from subsurface modeling include: shape, hardness, texture and possibly material. The ability to determine these properties is based on the accuracy of the method used and the properties of the surface encasing the object. As computers become more powerful and are able to produce even more realistic graphics, it will be possible to store and re-create precise duplicates of the original for later analysis. This paper will present a method of approximately modeling both the surface and an object below the surface of the skin by a method of palpation and then present this data in an interactive 3-D model.

Minimally invasive surgical techniques using catheter is now used in many procedures. Development of surgical training of such procedures requires real-time simulation of tool-organ interaction. In such processes, each subsequent step of interaction would be based on the current configuration of the surgical tool (guidewire in this case), leading to development of techniques to solve and visualize the configuration of tool at every time step. This paper presents a Finite Element (FEM) based approach to simulate the tool-organ interaction.

Esophageal intubations are performed for urgent airway control in injured patients. Current methods of training include working on cadavers and mannequins, which lack the realism of a living human being. Work in this field has been limited due to the complex nature of simulating in real-time the interactive forces and deformations which occur during an actual patient intubation. This study addressed the issue of intubation training in an attempt to bridge the gap between actual and virtual patient scenarios. The two haptic devices along with the real-time performance of the simulator give it both visual and physical realism. The three dimensional viewing and interaction available through virtual reality make it possible for physicians, pre-hospital personnel and students to practice many esophageal intubations without ever touching a patient. The ability for a medical professional to practice a procedure multiple times prior to performing it on a patient will both enhance the skill of the individual while reducing the risk to the patient.