Touch of Life Technologies and the American Academy of Orthopaedic Surgeons develop arthroscopic training system

San Francisco 05 March 2008Touch of Life Technologies (ToLTech) in partnership with the American Academy of Orthopaedic Surgeons (AAOS), has developed a surgical simulator for training and testing the diagnostic knee arthroscopy skills of physicians. This simulator allows training to take place with zero risk to the patient - while providing the surgeon with the "virtual reality" of feeling, as well as seeing, the anatomic detail of a human knee on the computer screen, in the same manner as when a patient is examined in the clinic.


Each year orthopaedic surgeons perform more than 600.000 arthroscopic knee surgeries in the United States alone. By using a touch-enabled computer-based system, ToLTech's approach vastly improves the efficiency of training surgeons by displaying external views of the knee joint not available in the clinic, as well as performance feedback and measurement during the examination. All of this is provided using virtual reality-like technology without risk to any "real" patient, and allows for unlimited practice until competence is achieved.

"This simulator changes the training paradigm for orthopaedic surgeons and residents. Now training will focus on reaching proficiency and this represents the beginning of a movement away from the apprenticeship model that has been our educational approach for the past 100 years", stated Dilworth Cannon, MD, the AAOS Project team leader.

The ToLTech Diagnostic Knee Arthroscopy Simulator is a total learning environment including a comprehensive virtual Mentor to guide surgeons to proficiency. Three years of this six-year development effort were provided by a National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Diseases SBIR Grant. An AAOS Project Team provided content development support for the simulator and created the content for the educational programme used in the virtual Mentor. The Arthroscopy Association of North America and the American Board of Orthopaedic Surgery supported development of the simulator.

The key features of the ToLTech Diagnostic Knee Arthroscopy Simulator are the reality of the anatomy, both in appearance and response, and evaluation of the surgeon's performance during the procedure. The reality of the anatomy is provided by the combination of thousands of colour photographs of a real human knee - similar to the data of the National Library of Medicine's Visible Human Project.

The realistic feel of probing tissue during the surgeon's examination is provided by the use of a touch-enabled or haptic device called a PHANTOM from SensAble Technologies of Woburn, Massachusetts. At the American Association of Orthopaedic Surgeons 75th annual meeting in San Francisco, several of SensAble Technologies Inc.'s customers have been displaying innovative solutions based on the company's touch-enabled technology for surgical simulation and medical modelling. These include patient-specific artificial joints from Biomet; medical study models and implants from Medical Modeling; and, of course, the breakthrough arthroscopic simulator from Touch of Life Technology jointly funded by the AAOS. Several other companies that rely on SensAble solutions to produce implants and prosthetics, or create virtual training solutions, were also exhibiting at the AAOS meeting.

As touch-enabled technology - haptics - comes of age, medical modelling and surgical simulation are benefiting significantly from the ability to literally "feel" images displayed on a computer screen. Surgeons, physicians and health care professionals no longer must train only on cadavers or in highly supervised settings with patients, but can experience a virtual reality environment that incorporates tools, visual images, sensory feedback and performance feedback to foster skill acquisition.

Similarly, touch-enabled technology provides medical implant and device designers with a more natural, faster way to create digital models of implants and prosthetics, medical devices and body parts. Designers can more readily model the organic, often irregular shapes of the human body for an accurate and exacting fit, or create study models for difficult cases.

"We believe the knee arthroscopy simulator establishes a new standard in surgical training for orthopaedic surgeons and residents", stated Victor Spitzer, PhD, president, ToLTech. "With SensAble's touch-enabled technology we can create a realistic experience with far greater value to the surgeon." For medical modelling, SensAble's FreeForm supports easy learning and is compatible with other major file formats such as .STL for import, prototyping and milling.

The ToLTech simulator will be validated, starting in April, by the AAOS in several Orthopaedic Residency Programmes during 2008. The Knee Arthroscopy Simulator can be purchased today for delivery in June 2008.

"At Biomet we use FreeForm to replace a formerly cumbersome and time-consuming process of modifying digitized CT images in an effort to design the implant to match the patient's specific bone anatomy and contour to match the bone surface", stated Troy Hershberger, director of the patient-matched implants division of Biomet. "With FreeForm, our engineers literally feel like they are pushing putty into a shape that perfectly matches the desired region of the implant. As a result, Biomet's patient-matched implants team can work more efficiently."

"One of our areas of expertise is creating study models used in pre-surgical planning for complex cases, and FreeForm allows us to produce extremely accurate models from a patient's CT scan", stated Andy Christensen, president of Medical Modeling. "Our cases come from all over the world, and by using electronic files, we can import, enhance and output a file quickly and accurately using FreeForm's file import and export capabilities. We have really pushed the envelope with some of these cases, and improved the quality of many patients' lives."

Founded in 1933, the AAOS, an organisation of more than 31.000 worldwide members, is the pre-eminent provider of musculoskeletal education to orthopaedic surgeons and others in the world. Touch of Life Technologies Inc. was formed in 1998 to develop and market medical education products based on technology related to the Visible Human Project, developed at the University of Colorado Center for Human Simulation. In addition to this Surgical Simulator ToLTech also sells a revolutionary, visual anatomical resource - the VH Dissector.

Founded in 1993, SensAble Technologies is a developer of 3D touch-enabled - force feedback - solutions and technology that allow users to not only see and hear an on-screen computer application, but to actually "feel" it. With 32 patents granted and over 6000 systems installed worldwide, SensAble Technologies' haptic technology is being used in applications ranging from surgical simulation and stroke rehabilitation, to dental restorations, to designing toys and footwear; as well as a range of research and robotic applications.

The company markets its own 3D modelling solutions as well as its haptic devices and developer toolkits to medical, dental, design, and manufacturing companies; educational and research institutions; and OEMs. SensAble products are available through direct and reseller channels worldwide. More company news is available in the VMW March 2008 article SensAble Technologies eases the transition to digital dentistry with introduction of SensAble Dental Lab System.

Leslie Versweyveld

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