New Virtual Surgical Simulator Debuts in Germany

Researchers present new virtual surgical simulator, known as “HandsOn.Surgery,” at MEDICA 2018.

The HandsOn.surgery trainer allows surgoens to practice on virtual bones with risk structures and surgical bur (top right) and with a haptic arm for virtual milling (bottom right). Image courtesy of Fraunhofer IIS.

Researchers presented the latest innovation in surgical training at this year’s MEDICA 2018 conference in Düsseldorf, Germany — the HandsOn.surgery trainer. The new prototype was designed to help surgeons prepare for individual patient surgeries by enabling them to practice the surgery on a virtual simulator.

The new technology, created by Fraunhofer Institute for Integrated Circuits, offers surgeons the opportunity to extensively train for difficult procedures, such as the surgical placement of implantable hearing aids and the surgical treatment of tumor diseases. The new HandsOn.Surgery technology can help support physicians and surgeons in their education, all in an effort to minimize surgery time and reduce surgical mistakes.

“The current approach of ‘see one, do one, teach one’ is obsolete,” said Volker Bruns, group manager of medical image processing for Fraunhofer. “Especially, as for risky interventions, patients cannot be used as a practice vehicle. Thus, training on patients is risky, and training with cadavers is expensive. Training on animal cadavers becomes more and more expensive, and training on 3D printed artifacts, while feasible, only allows for printed bones to be used once. Surgeons need to train on various models that range from easy to super complicated. They also need to train on both common and rare pathologies. This is where the idea of a haptic training system for hard tissue removal was born.”

With the new virtual surgery technology, surgeons can practice individual procedures in oral and maxillofacial surgery as well as in orthopedics and other areas before ever stepping foot into an actual operating room. They can use a patient’s digital twin at any time, and as often as they want, to practice the procedure without any risk to the patient. The highly immersive technology allows the surgeon to see and feel using real CT patient data, force feedback from the surgical instrument, an intuitive touchscreen, and a 3-D monitor or virtual reality headset to allow surgeons to experience the operation as if it were live — including original operating room sounds.

“The feedback we’ve gotten from the MEDICA conference was all positive,” said Bruns. “We will now focus on implementing a scoring system and add a serious game layer to the technology. It is key that [a] surgeon is motivated to practice over a longer period of time so we can begin to track a learning curve. We’d also like to implement other scenarios into the technology for orthopedics, neurosurgery, and eventually model the interaction with soft tissue instead of just bone.”

The technology was created as part of the “HaptiVist” project funded by the German Federal Ministry of Education and Research. The aim of the project was to develop and evaluate a haptic-visual learning system for surgical procedures that can be used in both urban and rural hospitals to help address the need for more medical specialists. As the company moves forward with the technology, Bruns said that they hope to partner vendors and begin to market the technology for release sometime in the next year.

“Fraunhofer is a research organization at heart,” Bruns said. “We are currently looking for a commercialization partner and have had very good discussions both with medical simulator vendors and surgical tools vendors. We are confident that we will roll out the first units in 2019.”

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