The UNIPI EndoCAS and DII researchers, in close collaboration with all the robotic surgeons of the multidisciplinary Center for Robotic Surgery, as well as other dedicated clinicians, collected the needs for training that are suitable to be implement with physical simulator.
The aim is to end this activity with a draft of feasible and effective surgical in different surgical specialties, offering an innovative patient-specific phantom lab.
Five surgical specialties were selected according to surgeon needs and proposal: Gynaecologic Surgery, Orthopaedic Surgery, Spinal Surgery, Thoracic Surgery and General Surgery. For each of them a surgical task suitable for physical phantom simulation was defined and its requirements listed. In the following a list of the surgical procedures selected to be addressed by the development simulators and the training task/s that will be evaluated:
Gynaecologic Surgery:
- Procedure to simulate: Sarcocolpoplexy
- Primary training task: Sacral area robotic dissection
- Requirements: Stratified tissues to replicate in vivo stratification of visceral adipose tissue, bone tissue, and arterial and venous tissue.
Initial testing has been carried out on non-anatomical shapes also with the intention to calibrate a robot with an haptic interface hand effector with the double objectives to (1) give haptic feedback to surgeon in order to find the safe area for the stitching task of the intervention and (2) train a robot to autonomously find and show the surgeon the safe area. The forthcoming stages will concentrate on creating molds for crafting anatomically shaped phantoms and assessing their effectiveness as a training simulator with clinical personnel.
Orthopaedic Surgery:
- Procedure to simulate: Robotic knee replacement surgery
- Primary training task: Ligament balancing
- Requirements: (1) Accurate anatomical reproduction with matching morphology, color, texture, and density; (2) Patient-specific bone replicas with cortico-cancellous interface; (3) Bones structures: femur, patella, tibia, fibula; (4) Ligaments: lateral and medial collateral, patellar, cruciates.
The knee phantom design is ready together with the constructive strategy. Initial evaluations and good feedback from surgeons affirm that the phantom is a valid simulator. The next steps will be to carry out further useful tests to verify face, content, and construct validity and build a training course on top of the developed phantom.
Spinal Surgery:
- Procedure to simulate: Posterior pedicle screw placement surgery
- Primary training task: Pedicles drilling and screw insertion
- Requirements: (1) Accurate anatomical reproduction with matching morphology, color, texture, and density; (2) Patient-specific bone replicas with cortico-cancellous interface; (3) Flexible intervertebral discs for natural movements; (4) Flexible anterior longitudinal ligament for stability and motion; (5) Realistic radiodensities for bony structures; (6) Surgical Teather Depth and bulkiness.
The spinal phantom is realized by e-Spres3D s.r.l., a spin-off compnay of University of Pisa. The design is ready together with the constructive strategy and an initial validation. The simulator went through a quantitative and qualitative validation test. Five phantoms of the thoracolumbar region have been fabricated, the phantoms were instrumented in three training sessions by a five-year resident who performed full training on all six phantoms, he/she placed a total of 57 pedicle screws completing the learning curve outside the surgical room. The phantom’s efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource.
In the remaining months of this activity the training curriculum design will be finalized.
Thoracic Surgery
- Task to simulate: Robotic dissection
- Primary training task: Force awareness during structures dissection
The pad for robotic dissection was already developed by SSSA in the mainframe of a different project. In THE we will focus on testing and possible translation to different surgeries.
CardioThoracic Surgery
- Task to simulate: Robot arms placement for robotic cardiac surgery
- Primary training task: Robot arms placement
