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3.3. Training 33
In laparoscopic operations, there are many standard procedures: needle
insertion thr ough a port, suturing, cutting, stapling, suction, holding and or-
gan displacement. During each of these tasks, the surgeon must carry out
close inspection, as well as using the camera to obtain a broad overview of
the operation and tool delivery volumes. A broad camera overview permits
the surgeon to become oriented and find complex structures that are often
difficult to identify. Positioning the camera requires careful synchronization
and understanding between the surgeon and the endoscopic camera assistant.
Unfortunately, no matter how good the video image augmentation is, it is a
fact that vital anatomical structures remain concealed beneath the immedi-
ately visible tissue. The ultimate challenge is to map the visible field of view
against a 3D description of the surrounding anatomy, ideally the anatomy of
the actual patient. (This is somewhat analogous to the way in which Google
Maps blends street and highway detail with satellite images of the same area
to give an extremely useful, informative and striking result.) The first and
most obvious way to do this is to use scan data, MRI and CT.
3D reconstruction of patient anatomy from CT and MRI images can be
utilized to project images of the patient’s anatomy that is obstructed from the
surgeon’s view. Using this special technology, surgeons can interactively ma-
nipulate the view they have in real time. In addition to advances made to the
actual surgery, training simulators have also been developed which allow sur-
geons to practice many different types of surgery prior to the operation. For
example, Dr. Joseph Rosen [7] of Dartmouth University Medical Center has
a VR model of a face with deformable skin which allows surgeons to practice
a plastic surgical procedure and demonstrate the final outcome before making
the incision on a patient. And indeed, Immersion Medical has a whole range
of surgical simulators available for purchase, those being endoscopy, endovas-
cular, hysteroscopy and laparoscopy simulators. Studies show that physicians
who train on simulators which are lifelike mannequins with hearts that beat,
lungs that breathe, and veins that respond to injection make fewer errors and
work more quickly than those who practiced on animals or learned by obser-
vation. And since we are talking about training, we can move onto the next
large application area of VR technology.
3.3 Training
Training is one of the most rapidly growing application areas of VR. We all
know about the virtual training simulators for pilots. These simulators rely
on visual and haptic feedback to simulate the feeling of flying whilst being