In vivo biomechanical measurement and haptic simulation of portal placement procedure in shoulder arthroscopic surgery

Abstract

A survey of 67 experienced orthopedic surgeons indicated that precise portal placement was the most important skill in arthroscopic surgery. However, none of the currently available virtual reality simulators include simulation / training in portal placement, including haptic feedback of the necessary puncture force. This study aimed to: (1) measure the in vivo force and stiffness during a portal placement procedure in an actual operating room and (2) implement active haptic simulation of a portal placement procedure using the measured in vivo data. We measured the force required for port placement and the stiffness of the joint capsule during portal placement procedures performed by an experienced arthroscopic surgeon. Based on the acquired mechanical property values, we developed a cable-driven active haptic simulator designed to train the portal placement skill and evaluated the validity of the simulated haptics. Ten patients diagnosed with rotator cuff tears were enrolled in this experiment. The maximum peak force and joint capsule stiffness during posterior portal placement procedures were 66.46 (±10.76N) and 2560.82(±252.92) N/m, respectively. We then designed an active haptic simulator using the acquired data. Our cable-driven mechanism structure had a friction force of 3.763 ± 0.341 N, less than 6% of the mean puncture force. Simulator performance was evaluated by comparing the target stiffness and force with the stiffness and force reproduced by the device. R-squared values were 0.998 for puncture force replication and 0.902 for stiffness replication, indicating that the in vivo data can be used to implement a realistic haptic simulator.

An Insight into the Difficulties in the Discovery of Specific Biomarkers of Limbal Stem Cells

“…The application of interdisciplinary technology has been rapidly developed. There are many reports on application of virtual simulation technology to solve medical problems [ 146 , 147 ]. Recently, virtual simulation technology also has been applied for the study of LSCs.…”

A review of computer‐assisted orthopaedic surgery systems

“…One system 70 has a simple structure, portability, and low cost and is more suitable for medical students to improve their basic skills in knee arthroscopic detection and triangulation. Several systems 27,62‐67 can train users, improve users' surgery skills and shorten users' learning curve, but they cannot distinguish between novice and expert users. The systems 27,65,67 has a tactile system that provides tactile feedback to the user.…”

“…Several systems 27,62‐67 can train users, improve users' surgery skills and shorten users' learning curve, but they cannot distinguish between novice and expert users. The systems 27,65,67 has a tactile system that provides tactile feedback to the user. Some of the systems 68,70 provide natural tactile feedback, while other systems 62‐64,66,69 cannot provide tactile feedback.…”

“…Chae et al 67 developed an active tactile simulator for arthroscopic surgery that can train users in portal vein placement skills. The dynamic tactile virtual reality force feedback system of the simulator was realized by obtaining biomechanical data from 10 patients undergoing shoulder surgery.…”

Early Detection of Cartilage Degeneration: A Comparison of Histology, Fiber Bragg Grating-Based Micro-Indentation, and Atomic Force Microscopy-Based Nano-Indentation

“…However, in vivo detection of structural and biomechanical changes in early OA remains challenging. Especially during arthroscopy, the surgeon is currently dependent on the localization of the degenerated tissue by optical examination and by palpating the cartilage surface by hand or by using a hook [ 5 , 6 ]. This presupposes a great experience of the surgeon and shows high variations resulting from the subjective judgment of the examiner.…”