The proposed Surgery and Therapy Simulation Facility (STSF) will provide a completely new research environment that will accelerate the development and evaluation of complex surgical and therapeutic procedures without the restrictions that accompany testing with living subjects. (This approach will significantly increase the development and use of such procedures to the benefit of patients, practitioners and the health care system).
For the first time, researchers will be able to work with simulated images of tissues, organs and surgical tools to plan, develop, and evaluate entire minimally invasive surgical procedures without the use of animal models or humans. The importance of computer modeling in minimally invasive procedures has not yet been realized. However, just as simulation has played a major role in the aerospace industry for development, testing, guidance and training, simulation will increasingly perform critical roles in the development and implementation of an increasing number of new, less invasive and more complex therapeutic and diagnostic procedures.
A multidisciplinary team of scientists with backgrounds in physics, engineering, image science, computing, medicine, surgery, and psychology will design and develop the research components of the simulation environment as outlined below.
For many procedures, the primary task will be to replicate the environment observed in reality. We begin this process with standard visual images combined with mathematically defined models of the appropriate organ. Images of pathological and normal tissues will be created by simulating CT, MRI, both static and dynamic 2D and 3D ultrasound images, as well as optical images that represent both endoscopic and external views.
Many procedures, particularly in the brain and heart, rely on electrophysiological measurements of the organ both to define pathology and to recognize regions that are functioning normally. Electrophysiological database information collected within our own laboratories, and those of our colleagues (Sadikot-Montreal) will be integrated with our heart and brain models to provide realistic responses to simulated electrophysiological interrogation.
Some procedures require accurate visual representations of actual organs, benefit from global "organ overview", or rely entirely upon accurate computer generated models that represent organ surfaces. We will generate realistic surface representation of organ surfaces based on standard techniques as well as our own work in merging optical endoscopic images with image derived models.
Many instances of minimally invasive surgery rely on lesions created by mechanical or thermal (heating and cooling) disruption. Our existing models of such mechanisms will be incorporated into this environment, and these will be extended as needed. In addition, standard radiation dosimetry models will be incorporated into the environment for prediction of responses to brachytherapy and radiosurgery.
Mechanical Tissue Properties:
Accurate simulation of many procedures requires that the model behave naturally under the influence of gravity and instrumental forces. Such characteristics will be incorporated into the simulator, along with the ability to dynamically model the effects of breathing and cardiac motion.
For both existing and proposed procedures, effective simulation will require accurate modeling of surgical and robotic tools (actual and hypothetical) that can function and be controlled within the artificial therapeutic environment.
The system will support user interfaces ranging from simple probe based interaction devices and standard 2D displays, to multiple degrees-of-freedom robotic manipulandums with haptic feedback and 3D augmented reality displays.
As the simulation environment capabilities are developed, they will be applied initially to extend our current research in minimally invasive surgery and therapy of the brain, heart, and cancer of the prostate and breast.