Perform your own online surgery simulation

Manchester 01 October 1998 The world of surgery simulators is getting more crowded everyday. This is very positive news for medical students, trainees and surgeons in the various specialized hospital departments. The performance of complicated procedures and innovative surgical techniques can be trained extensively without having to involve the patient in the impending risks of experimental try-outs. At the Manchester Visualisation Centre, situated at the University of Manchester, Dr. Nigel W. John and Dr. Nick Philips, who is active at the Department of Neurosurgery at Leeds General Infirmary, have decided to establish a resource for online surgical training tools. A first Web-based surgical trainer for simulation of ventricular catheterisation has already been installed. To run the simulator, the researchers have implemented Virtual Reality Modelling Language (VRML).

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The world of surgery simulators is getting more crowded everyday. This is very positive news for medical students, trainees and surgeons in the various specialized hospital departments. The performance of complicated procedures and innovative surgical techniques can be trained extensively without having to involve the patient in the impending risks of experimental try-outs. At the Manchester Visualisation Centre, situated at the University of Manchester, Dr. Nigel W. John and Dr. Nick Philips, who is active at the Department of Neurosurgery at Leeds General Infirmary, have decided to establish a resource for online surgical training tools. A first Web-based surgical trainer for simulation of ventricular catheterisation has already been installed. To run the simulator, the researchers have implemented Virtual Reality Modelling Language (VRML).

Because of its demanding and delicate procedures which heavily depend on qualitative 3D radiological images, the two partners have selected neurosurgery as the most suitable discipline to demonstrate the simulator's potential. One of the most difficult skills for a trainee to acquire constitutes the mapping and cannulation of the ventricular system. Pathological causes often underlie the obstruction in the ventricles of the cerebrospinal fluid. As a result, the patient can easily lapse into a critical condition, which is known as hydrocephalus, and even lose consciousness if the pressure gets too high. In order to save the patient, the surgeon has to drain the fluid and remove the lethal rise in pressure by cannulating the ventricular system.

This kind of intervention has been modelled on the Web simulator by means of VRML 97 and Java tools. The technique of introducing a cannula into the patient's head, then move to a certain target and perform the desired action can now be practised online. Since this surgical action is common to lots of procedures, the training without any problem can be extended to a wide range of operations, from venepuncture to radiofrequency lesioning of the trigeminal ganglion for trigeminal neuralgia. The user or trainee can control the transparency of both head and skull by means of the two sliders on the monitor panel. A series of coloured radio buttons conducts the movements of the cannula.

The two researchers plan to further develop the surgical simulation training tools and build the site into a comprehensive resource of practical skill acquisition and refinement for both students and experienced surgeons. Continuous feedback will help the authors to perfectly adapt the Web-based surgical simulators to the needs of their users. Dr. John and Dr. Philips will welcome all useful comments to turn the online simulator into a clever practice-tool. Please, have a look at the ongoing work and pay a visit to the Ventricular Catheterisation Simulator.


Leslie Versweyveld

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