Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 33

VR simulation has been criticized for the lack of realistic haptic feedback [30]; therefore, hybrid, or AR, simulators were developed that combine a live and a virtual environment. A number of AR simulators are commercially available [31]. To date, the most validated system is the ProMIS simulator (CAE Healthcare, Montreal, Quebec; Figure 1.12), which has been used in the VALT laboratory since 2010. Tasks are performed in a box trainer using real instruments, but a virtual interface can be placed over the image of the camera. Three cameras are used for motion tracking of the physical instruments in three planes. Therefore, objective metrics such as instrument path and economy of movement (i.e., velocity and directional changes over time, also expressed as motion smoothness) are provided. The metrics used have showed construct validity in suturing tasks and in the ability to separate expert colorectal surgeons from experienced laparoscopic, but novice colorectal, surgeons [32, 33].

Figure 1.12 The ProMis augmented reality trainer is a combination of a physical box trainer and a virtual reality overlay used in many surgical exercises.

Source: Photo courtesy of CAE Healthcare, © 2014 CAE Healthcare.

In our experience, the use of surgical instruments adds realism to the simulation, which is in agreement with studies comparing AR with VR simulation [29, 33, 34]. However, an even bigger advantage for veterinary surgery is the ability to use novel physical models for simulation. Species‐specific models can be custom made and used in the ProMIS, obtaining motion metrics feedback. The VALT laboratory has recently developed a simulated canine laparoscopic ovariectomy model and is currently working to incorporating this model into AR training. Unfortunately, the ProMIS simulator is currently unavailable because the manufacturing company has changed and the previous model is discontinued. With the advancement of technology, similar products are, however, available with different companies, in combination with VR or 3D technology.