Objective. The study assesses user acceptance and effectiveness of a surgeon-authored virtual reality (VR) training module authored by surgeons using the Toolkit for Illustration of Procedures in Surgery (TIPS). Methods. Laparoscopic adrenalectomy was selected to test the TIPS framework on an unusual and complex procedure. No commercial simulation module exists to teach this procedure. A specialist surgeon authored the module, including force-feedback interactive simulation, and designed a quiz to test knowledge of the key procedural steps. Five practicing surgeons, with 15 to 24 years of experience, peer reviewed and tested the module. In all, 14 residents and 9 fellows trained with the module and answered the quiz, preuse and postuse. Participants received an overview during Surgical Grand Rounds session and a 20-minute one-on-one tutorial followed by 30 minutes of instruction in addition to a forcefeedback interactive simulation session. Additionally, in answering questionnaires, the trainees reflected on their learning experience and their experience with the TIPS framework. Results. Correct quiz response rates on procedural steps improved significantly postuse over preuse. In the questionnaire, 96% of the respondents stated that the TIPS module prepares them well or very well for the adrenalectomy, and 87% indicated that the module successfully teaches the steps of the procedure. All participants indicated that they preferred the module compared to training using purely physical props, one-on-one teaching, medical atlases, and video recordings. Conclusions. Improved quiz scores and endorsement by the participants of the TIPS adrenalectomy module establish the viability of surgeons authoring VR training

Enabling surgeon-educators to themselves create virtual reality (VR) training units promises greater variety, specialization and relevance of the units. This paper describes a software bridge that semi-automates the scene-generation cycle, a key bottleneck in authoring, modeling and developing VR units. Augmenting an open-source modeling environment with physical behavior attachment and collision specifications yields single-click testing of the full force-feedback enabled anatomical scene

To broaden the use of simulation for teaching, in particular of new procedures and of low-volume procedures, we propose an environment and workflow that allows surgeon-educators create teaching modules. Our challenge is to make the simulation tools accessible, modifiable and sharable by users with moderate computer and VR experience. Our contribution is a workflow that promotes consistency between instructional material and measured criteria and makes the authoring process efficient, both for the surgeon, and for computer scientists supporting the simulation environment.

We describe a fully interactive, low-overhead and robust peritoneum representation allowing for probing and cutting. The peritoneum implementation has been tested within a surgical illustration environment.

Modeling soft tissue for surgery simulation is a challenging task due to the complex way that the tissue can deform and interact with virtual surgical tools manipulated by user. One soft tissue that is ubiquitous but often not modeled, is fatty tissue. Here we present a novel fatty tissue model based on the mass-spring system on the Graphics Processing Unit (GPU) as part of our Toolkit for Illustration of Procedures in Surgery (TIPS). The user can interact with the fatty tissue in real time via a handheld haptic stylus that represents a virtual surgical tool in TIPS environment. The currently available interactions are palpation, grasp, and cut.

Good surgical training depends greatly on case experiences that have been difficult to model in software since current training technology does not provide the flexibility to teach and practice uncommon procedures, or to adjust a training scenario on the fly. The TIPS kit aims to overcome these limitations. To the expert, it presents visual and haptic tools that make illustrating procedures easy and can model unusual anatomic variations. For a non-specialist, it provides a locally customized learning environment and repeated practice in a safe environment. We used the toolkit to illustrate removal of the adrenal gland.

We have developed a computer based simulation process which allows a surgical expert to create a customized operative environment. This virtual environment, the Toolkit for Illustration of Procedures in Surgery (3D TIPS), is deployed on a low-cost computer system and requires minimal training for the programmer. The learner can be engaged in training immediately and the educator can modify the system and annotate the procedure to highlight specific points using video clips, operative images, and the like. A laparoscopic adrenalectomy is presented as a proof of concept in the accompanying article.

The rapid development and deployment of novel laparoscopic instruments present the surgical educator and trainee with a significant challenge. Several useful instruments have been particularly difficult to teach the novice. We have developed a platform that allows the combination of the actual instrument handle with a virtual re-creation of the instrument tip. We chose the Autosuture™ Endo Stitch™ device as the prototypical instrument because it satisfies our subjective experience of “useful, but hard to teach.” A software package was developed to support the re-creation of the needle and suture that accompany the device. The apparatus has haptic capabilities and collision detection so that the needle driver is “aware” of suture and instrument contact. The developed virtual environment allows re-creation of the necessary motion to simulate the instrument, the trainee can use the actual instrument handle, and the system can be altered to accommodate other instruments.

Real-time, plausible visual and haptic feedback of deformable objects without shape artifacts is important in surgical simulation environments to avoid distracting the user. We propose to leverage highly parallel stream processing, available on the newest generation graphics cards, to increase the level of both visual and haptic fidelity. We implemented this as part of the University of Florida's haptic surgical authoring kit.