Search

A videolaryngoscope is a more advanced tool than a traditional laryngoscope that eases endotracheal intubation by visualizing the vocal cords with a camera on the tip of the blade. However, using a videolaryngoscope can present difficulty in passing the tube into the glottic opening in some patients. This study developed a training protocol for intubation with videolaryngoscope and trained 22 anesthesia residents. A Parametrically Adjustable Airway Mannequin (PAAM) was set to provide easy and difficult configurations. Motion data of the videolaryngoscope, stylet, mannequin head, and hyoid bone were captured with 6 axis magnetic position sensors, along with the video image. The time to complete the various components of the task were recorded and used as an indication of competence along with observation by experts. The validity of the mannequin was supported by data that showed that the difficult configuration of PAAM took longer to intubate than the easy configuration (66 vs. 39 seconds during pre-test). The effectiveness of the training protocol was supported by improvement in trainee performance. At the beginning of the training, intubation with the difficult configuration took an average of 66 seconds, immediately after training it averaged 23 seconds, and in retention tests over a month after the training the average duration was 33 seconds.

In this paper, we report a result of an experiment of a field trial of our network-based minimally invasive surgery simulator. In our previous paper, we proposed a network-based visuohaptic surgery training system for laparoscopic surgery. In addition, we proposed a volume-based haptic communication approach, which allows participants at remote sites on the network to simultaneously interact with the same target object in virtual environments presented by multi-level computer performance systems, by only exchanging a small set of manipulation parameters for the target object and additional packet for synchronization of status of binary tree and deformation of shared volume model. We implemented the approach into our network-based surgery simulator, and field trial of the simulator at three locations was performed.

Natural orifice translumenal endoscopic surgery (NOTES) procedures are rapidly being developed in diverse surgical fields. We are developing a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™) built on a modularized platform that facilitates rapid development of virtual reality (VR) NOTES simulators. Both the hardware interface and software components consist of independent reusable and customizable modules. The developed modules are integrated to build a VR-NOTES simulator for training in the hybrid transvaginal NOTES cholecystectomy. The simulator was demonstrated and evaluated by expert NOTES surgeons at the 2015 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit.

There is evidence that both smartphone and tablet integration into medical education has been lacking. At the same time, there is a niche for augmented reality (AR) to improve this process through the enhancement of textbook learning. Gunner Goggles is an attempt to enhance textbook learning in shelf exam preparatory review with augmented reality. Here we describe our initial prototype and detail the process by which augmented reality was implemented into our textbook through Layar. We describe the unique functionalities of our textbook pages upon augmented reality implementation, which includes links, videos and 3D figures, and surveyed 24 third year medical students for their impression of the technology. Upon demonstrating an initial prototype textbook chapter, 100% (24/24) of students felt that augmented reality improved the quality of our textbook chapter as a learning tool. Of these students, 92% (22/24) agreed that their shelf exam review was inadequate and 19/24 (79%) felt that a completed Gunner Goggles product would have been a viable alternative to their shelf exam review. Thus, while students report interest in the integration of AR into medical education test prep, future investigation into how the use of AR can improve performance on exams is warranted.

Control of a powered wheelchair is often not intuitive, making training of new users a challenging and sometimes hazardous task. Collisions, due to a lack of experience can result in injury for the user and other individuals. By conducting training activities in virtual reality (VR), we can potentially improve driving skills whilst avoiding the risks inherent to the real world. However, until recently VR technology has been expensive and limited the commercial feasibility of a general training solution. We describe Wheelchair-Rift, a cost effective prototype simulator that makes use of the Oculus Rift head mounted display and the Leap Motion hand tracking device. It has been assessed for face validity by a panel of experts from a local Posture and Mobility Service. Initial results augur well for our cost-effective training solution.

In this work, we present a novel capacitance-based sensor for teaching hemodialysis cannulation skills. Initial results from a pilot experiment suggest that data from the sensor could be used to indicate puncture events in tissue-like materials.

Restoring airway function is a vital task in many medical scenarios. Although various simulation tools have been available for learning such skills, recent research indicated that fidelity in simulating airway management deserves further improvements. In this study, we designed and implemented a new prototype for practicing relevant tasks including laryngoscopy, intubation and cricothyrotomy. A large amount of anatomical details or landmarks were meticulously selected and reconstructed from medical scans, and 3D-printed or molded to the airway intervention model. This training model was augmented by virtually and physically presented interactive modules, which are interoperable with motion tracking and sensor data feedback. Implementation results showed that this design is a feasible approach to develop higher fidelity airway models that can be integrated with mixed reality interfaces.

Hemorrhages are the leading cause of potentially survivable combat mortalities when patients are unable to reach a treatment facility in time. New tourniquet devices have been developed to combat hemorrhages in the field. However, there is a lack in training systems to properly teach and assess users on tourniquet device application. We have developed an objective feedback system applicable to various full body manikins. We tested the system with expert users and received improvement feedback and verified the system's usefulness in instructing and assessing correct tourniquet device use.

Conventional surgical telementoring systems require the trainee to shift focus away from the operating field to a nearby monitor to receive mentor guidance. This paper presents the next generation of telementoring systems. Our system, STAR (System for Telementoring with Augmented Reality) avoids focus shifts by placing mentor annotations directly into the trainee's field of view using augmented reality transparent display technology. This prototype was tested with pre-medical and medical students. Experiments were conducted where participants were asked to identify precise operating field locations communicated to them using either STAR or a conventional telementoring system. STAR was shown to improve accuracy and to reduce focus shifts. The initial STAR prototype only provides an approximate transparent display effect, without visual continuity between the display and the surrounding area. The current version of our transparent display provides visual continuity by showing the geometry and color of the operating field from the trainee's viewpoint.

Smart glasses, defined as a computerized communicator with a transparent screen and a video camera, wearable as a pair of glasses, have started to be tested for a variety of health related applications. This poster reviews some of the early experiences and gives a series of proposals for possible uses in medicine with a particular emphasis on medical education.

This paper presents the development of extracorporeal suturing simulation in Virtual Basic Laparoscopic Skill Trainer (VBLaST © ). A novel hardware interface is designed to allow the user to perform the physical action of trying a knot and seamlessly integrate the knot into the virtual simulation.

To meet the challenges of providing affordable, efficient ultrasound training, a low-cost, portable personal ultrasound training simulator with structured curriculums and integrated assessment methods has been developed. By using extended image volumes for training, the realistic experience of scanning over a larger body surface is emulated.

Surgical and simulation development have always been closely associated with military activity. The last ten years have continued that trend, allowing for training in real time, under reality-based conditions, learning technical and clinical skills with the dynamic of true human factors and team training in the actual environment. We present data from diverse activities in three separate scenarios: second-year medical students in clinical scenarios; the U.S. Ski Team physicians training in austere conditions; the U.S. Navy Fleet Surgical Team training for sea and land deployment.

This paper presents the pattern cutting and ligating loop simulation in the Virtual Basic Laparoscopic Skill Trainer (VBLaST©). In the simulation, the gauze, tubular foam, and ligating loop thread are modeled by the mass-spring method and constraint projection for the inextensible characteristics. Discrete simulation states defined based on the tool-object interaction types are utilized to efficiently and accurately manages the physics simulation, collision processing, and haptic feedback in real-time. An automated scoring system provides quantitative measurement for evaluation of trainees' skills. The simulation results show advanced visual realism and real-time performances.

Natural orifice translumenal endoscopic surgery (NOTES) is an experimental surgical technique with benefits including reduced pain, post operative recovery period and better cosmesis compared to traditional laparoscopic procedures. In a pure NOTES procedure, a flexible endoscope is used for performing the surgery and visualization. The Virtual Translumenal Endoscopic Surgical Trainer (VTEST(TM)) is being developed as a platform to train for NOTES procedures and innovate NOTES tools and techniques. In this work we report the design specification for the hardware interface to be used for VTEST(TM).

MicroSim is a training simulator for microsurgical tasks. It is based on a virtual reality environment including a realistic interface and a real-time simulation model. The interface consists of real instruments which are tracked by an optical tracking system. The surgical scene is presented to the user through a stereo display which is similar to the view a surgeon has through a microscope. Abstract training modules, which are used to train basic fine motor skills and the prototype of a microvascular anastomosis have been implemented in cooperation with VRmagic GmbH.

Virtual surgical skills trainers are proving to be very useful for the medical training community. With efforts to increase patient safety and surgeon expertise, the need for surgical skills trainers that provide training in an operating room (OR) like condition is now more pressing. To allow for virtual surgery simulators to be instructed in an OR-like setting we have created a large display based immersive surgical simulation environment. Using the Microsoft Kinect we have created a real-time simulation environment that tracks the test user and appropriately adjust the perspective of the virtual OR for an immersive virtual experience.

We introduce a novel platform for medical device training: hybrid physical-virtual simulators of medical devices, combining touchscreen-enabled virtual emulations of real devices with sensorized physical peripherals to enable tactile, hands-on interaction between the trainee, simulated device and standardized patients or mannequins. The system enables objective measurement and recording of trainee performance, including interactions with both the virtual device elements and the physical components, and can include metrics and feedback not available in the real device. The system also includes an integrated wireless signaling device for use with standardized patients. We present the implementation of an example system, a virtual defibrillator with sensorized paddles and wireless signaling of successful defibrillator operation.

Surgical training plays an important role in assisting residents to develop critical skills. Providing effective surgical training, however, remains as a challenging task. Existing videotaped training instructions can only show imagery from a fixed viewpoint that lacks both depth perception and interactivity. We present a new portable immersive surgical training system that is capable of acquiring and displaying high fidelity 3D reconstructions of actual surgical procedures. Our solution utilizes a set of Microsoft Kinect sensors to simultaneously recover the participants, the surgical environment, and the surgical scene itself. We then develop a space-time navigator to allow the trainees to witness and explore a prior procedure as if they were there. Preliminary feedback from residents shows that our system is much more effective than conventional videotaped system.

Natural orifice translumenal endoscopic surgery is an emerging procedure. High fidelity virtual reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing a Virtual Transluminal Endoscopic Surgery Trainer (VTEST TM) for this purpose. In this work, objective performance measures derived from motion tracking sensors attached to an endoscope was tested for the transgastric NOTES appendectomy procedure performed with ex-vivo pig organs using the EASIE-R(TM) trainer box. Results from our study shows that both completion time and economy of motion parameters were able to differentiate between expert and novice NOTES surgeons with p value of 0.039 and 0.02 respectively. Jerk computed on sensor 2 data also showed significant results (p = 0.02). We plan to incorporate these objective performance measures in VTEST(TM).

There are currently few Virtual Reality simulators for orthopedic trauma surgery. The current simulators provide only a basic recreation of the manual skills involved, focusing instead on the procedural and anatomical knowledge required. One factor limiting simulation of the manual skills is the complexity of adding realistic haptic feedback, particularly torques. This paper investigates the requirements, in terms of forces and workspace (linear and rotational), of a haptic interface to simulate placement of a lag screw in the femoral head, such as for fixation of a fracture in the neck of the femur. To measure these requirements, a study has been conducted involving 5 subjects with experience performing this particular procedure. The results gathered are being used to inform the design of a new haptic simulator for orthopedic trauma surgery.

Airway management skills are essential for healthcare providers within military and civilian settings. To maintain competency in these skills, it is crucial for the provider to have opportunities for review and retraining. Virtual airway training or telementoring can be an effective means to fulfilling these requirements for healthcare providers located in remote sites. The projection of high quality imagery to far forward locations is essential for health care practitioners in the provision of telemedicine and distance training. The Storz C-CAM was developed to interface with existing endoscopy equipment to facilitate implementation of telemetric devices in remote locations. This work describes the use of the Storz C-CAM in providing medical device training to deployed medical personnel at a far forward location.

Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive procedure, known for its scar-less nature and short post operative recovery periods. A critical skill necessary for a NOTES procedure is the surgeon's ability to navigate and gain visualization of the target organ, which is done by moving the endoscope tip using the dials on the handle. We have developed an accurate and high resolution optical encoder based system to measure that dial manipulations, as part of a larger project to develop a VR-NOTES surgical simulator.

Having introduced NeuroSim, the prototype of a neurosurgical training simulator at MMVR18, we present our first medical training module. NeuroSim is based on virtual reality and uses real-time algorithms for simulating tissue. It provides a native interface by using a real surgical microscope and original instruments. Having implemented some abstract tasks to train basic skills like hand-eye coordination or the handling of the microscope last year, we now present a medical module where an aneurysm has to be clipped. NeuroSim has been developed in cooperation with the neurosurgical clinic of the University of Heidelberg and VRmagic GmbH in Mannheim.

Regarding the impact of visceral dysfunction on quality of life, bowel and bladder management is a very important problem. The management of the patient with neurological bladder is often a source of uncertainty for both patients and healthcare personnel. Since the need of specialized training is growing, two CME e-learning courses have been developed to provide physicians and nurses competencies for the enhancement of the daily life of the patients. The present study aims at evaluating courses attendance and outcomes. Attendance data confirm the interest for both courses. The results document a pretty good objective and subjective effectiveness of the e-learning courses but low attitude to exploit he support of an asynchronous tutor. The analysis of test results gives some hints for eventual quality improvement of the courses themselves.

Cognitive stimulation workshops (CSW) are recommended for elderly people with a decline in cognitive functions, for example, mild cognitive impairment. Information and Communication Technology (ICT) has the potential to enrich and facilitate preparation, facilitation and assessment of CSW interventions. We present the first steps of our co-design approach towards a Web 2.0 based software, called STIMULEE, for the design and the facilitation of CSW. Its achievement will provide novel therapeutic practices to our clinical partners.

Palpation (the application of touch to the surface of the body) is an essential clinical skill. Correct palpation is part of a complete physical examination and it assists a clinician in making an accurate diagnosis, while poor palpatory skills can lead to diagnostic errors. As with any clinical skill, palpation is best learned through repetitive practice with constructive feedback. Unfortunately, changes in healthcare provide fewer opportunities for hands-on learning of this essential skill. Unlike other clinical skills, palpation has no immediate feedback to the learner regarding their performance. For example, when students are learning how to insert an intravenous catheter, failure to perform the technique correctly results in no blood return in the catheter. However, students do not know if they are palpating an abnormality if they have never felt it before. This inherent difficulty makes expert feedback even more vital to learning correct palpation. Existing research tools have addressed some of these challenges through simulation techniques that do not require experts, and can provide feedback on palpation pressures and palpation patterns. We describe a novel computer-based palpation training system, leveraging existing approaches, with an emphasis on sensing accuracy, directed-feedback, portability, and user experience.

The construct validity of a surgical bench-top simulator with built-in computer acquired assessments was examined. It features two parallel elastic tubes instrumented with flexion sensors that simulate the walls of a wound. Participants from three groups (9 novices, 7 intermediates, 9 experts) performed 10 two-handed, double square knots. The peak tensions at the initiation of the first knot, the completion of the first knot and the completion of the second knot, as well as measures of movement economy indicated technical performance. Product quality was indicated by knot stability defined as the amount of slippage of the knot under the tension. There were significant differences between experts and novices for peak tension on first knot (p=.03), movement economy (p=.02), and knot stability (p=.002). The results support the construct validity of these objective measures.

Intended for medical students studying the evaluation and diagnosis of heart arrhythmias, the beating heart arrhythmia simulator combines visual, auditory, and tactile stimuli to enhance the student's retention of the subtle differences between various conditions of the heart necessary for diagnosis. Unlike existing heart arrhythmia simulators, our simulator is low cost and easily deployable in the classroom setting. A design consisting of solenoid actuators, a silicon heart model, and a graphical user interface has been developed and prototyped. Future design development and conceptual validation is necessary prior to deployment.

We present NeuroSim, the prototype of a training simulator for open surgical interventions on the human brain. The simulator is based on virtual reality and uses real-time simulation algorithms to interact with models generated from MRT- or CT-datasets. NeuroSim provides a native interface by using a real surgical microscope and original instruments tracked by a combination of inertial measurement units and optical tracking. Conclusively an immersive environment is generated. In a first step the navigation in an open surgery setup as well as the hand-eye coordination through a microscope can be trained. Due to its modular design further training modules and extensions can be integrated. NeuroSim has been developed in cooperation with the neurosurgical clinic of the University of Heidelberg and the VRmagic GmbH in Mannheim.

Efficient collision handling of dynamically deforming anatomical models is a very challenging problem in real-time surgery simulation. In this paper, we present a new, efficient approach that detects collisions and self-collisions of deformable models. Our algorithm is integrated in a simulation framework for multiple interacting objects. This framework consists of three components. The first one computes the dynamic behavior of deformable structures using an efficient and robust approach with distance- and volume-preserving constraints. The second component detects collisions and self-collisions of deformable models. A novel image-space technique is employed that detects volumetric intersections. This allows to compute the penetration depth which is used to resolve collisions in the third component of our framework. Our system handles volumetric deformable models of up to several thousand surface triangles and tetrahedra in real-time and can be used in surgical training systems.

We present schemes for real-time generalized mesh cutting. Starting with the a basic example, we describe the details of implementing cutting on single and multiple surface objects as well as hybrid and volumetric meshes using virtual tools with single and multiple cutting surfaces. These methods have been implemented in a robust surgical simulation environment allowing us to model procedures ranging from animal dissection to cleft lip correction.

This paper introduces the Virtual Anatomy Lab software platform for coordinating on-line gross anatomy learning sessions over time.

Realistic laparoscopic surgical simulators will require real-time graphic imaging and tactile feedback. Our research objective is to develop a cost-effective haptic workstation for the simulation of laparoscopic procedures for training and treatment planning. The physical station consists of a custom-built frame into which laparoscopic trocars and surgical tools may be attached/inserted and which are continuously adjustable to various positions and orientations to simulate multiple laparoscopic surgical approaches. Instruments inserted through the trocars are attached to end effectors of two haptic devices and interfaced to a high speed PC with fast graphics capability. The haptic device transduces 3D motion of the two manually operated surgical instruments into slave maneuvers in virtual space. The slave instrument tips probe the simulated organ. Simulations currently in progress include: 1) Surface-only renderings, deformation, and haptic interactions with elements in the gall gladder surgical field; 2) Voxel-based simulations of the bulk manipulation of tissue; 3) laparoscopic herniorrhaphy. This system provides force feed-forward from the grasped tools to the contact tissue in virtual space, with deformation of the tissue by the virtual probe, and force feedback from the deformed tissue to the operator's hands.

In this article, we present an Interventional Cardiology Training System developed by the Medical Application Group at Mitsubishi Electric in collaboration with the Center for Innovative Minimally Invasive Therapy. The core of the ICTS is a computer simulation of interventional cardiology catheterization. This simulation integrates clinical expertise, research in learning, and technical innovations to create a realistic simulated environment. The goal of this training system is to augment the training of new cardiology fellows as well as to introduce cardiologists to new devices and procedures. To achieve this goal, both the technical components and the educational content of the ICTS bring new and unique features: a simulated fluoroscope, a physics model of a catheter, a haptic interface, a fluid flow simulation combined with a hemodynamic model and a learning system integrated in a user interface. The simulator is currently able to generate--in real-time--high quality x-ray images from a 3D anatomical model of the thorax, including a beating heart and animated lungs. The heart and lung motion is controlled by the hemodynamic model, which also computes blood pressure and EKG. The blood flow is then calculated according to the blood pressure and blood vessel characteristics. Any vascular tool, such as a catheter, guide wire or angioplasty balloon can be represented and accurately deformed by the flexible tool physics model. The haptics device controls the tool and provides appropriate feedback when contact with a vessel wall is detected. When the catheter is in place, a contrast agent can be injected into the coronary arteries; blood and contrast mixing is computed and a visual representation of the angiogram is displayed by the x-ray renderer. By bringing key advances in the area of medical simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the ICTS opens new perspectives for computer based training systems.

Unlabelled: PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems., Tools and Methods: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system., Results: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems., Conclusion: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

Training of medical staff on minimally invasive surgery (MIS) is an area where new effective training methods are needed. We have studied stent grafting, a type of MIS, which is used to treat abdominal aortic aneurysm. Our analysis revealed that this procedure requires a range of motor, perceptual and cognitive skills. In this paper, we present a training environment that could be used to acquire these skills. Our proposed solution differs from the usual VR solutions by operating within the World Wide Web as an environment for our system. This paper discusses how our solution covers the training skills and presents the results of an appraisal process, which we conducted to evaluate our solution.

Shoulder arthroscopy is a difficult procedure, commonly used for both diagnostic and therapeutic purposes. Until now, the majority of training has been done in theatre, assisting and practising under supervision. Few good simulations exist. Procedicus VA, from Prosolvia Clarus, is a virtual reality simulation of shoulder arthroscopy, with interactive graphics and haptic feedback. The simulator has various modes including anatomy manipulation pathology subacromial decompression. We describe our experience with the simulator, attempting to validate some of the scoring mechanisms, and highlighting some of the pitfalls discovered as the simulator is first trialled by surgeons. This early experience has highlighted both successful aspects of the simulator, and some of the initial pitfalls. Our initial experience confirms the need for close collaboration between virtual programmers and surgical trainers. We are revising the assessment criteria over the coming months.

We have developed a Virtual Environment Knee Arthroscopy Training System (VE-KATS). Formative analysis indicated several features which surgical trainees indicated were necessary for a system to be useful. We have addressed this need by incorporating both rigid and deformable objects, simultaneous use of camera and surgical instrument, improved optical modeling, portability and low cost. A major advance has been the incorporation of automated objective scoring of performance. VE-KATS has now progressed to a viable training system which will be of practical benefit to trainee orthopaedic surgeons.

The development of a medical simulator that incorporates substantial training value and realism into an affordable product has been a huge challenge for the simulation community. A large hurdle to making an inexpensive simulator has been the high cost of the computers needed for adequate realism. We have met this challenge by developing CathSim, a low-cost medical simulator that integrates force feedback, multimedia, and 3D graphics simulation technology on an industry standard PC. This product is commercially available and is currently being used by numerous training institutions and hospitals. The CathSim system includes software and a force feedback interface device. The platform and device can be used to train health care providers to perform needle-stick medical procedures. Our first module teaches users the techniques of peripheral intravenous (i.v.) catheterization. Other training modules that will be added to the CathSim platform include central venous catheter (CVC) insertion and peripherally inserted central catheter (PICC) placement. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We describe our process of analyzing and prioritizing the medical tasks necessary to correctly perform peripheral intravenous catheterization. This analysis and prioritization was used to decide which tasks would be included in the simulator and how the included tasks would be replicated. We discuss the method by which we obtained the needed realism in the 3D graphics rendering and in the tactile feedback of the input device. We illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.

Virtual reality (VR) based surgical simulator systems offer very elegant possibilities to both enrich and enhance traditional education in endoscopic surgery. However, while a wide range of VR simulator systems have been proposed and realized in the past few years, most of these systems are far from able to provide a reasonably realistic surgical environment. We explore the basic approaches to the current limits of realism and ultimately seek to extend these based on our description and analysis of the most important components of a VR-based endoscopic simulator. The feasibility of the proposed techniques is demonstrated on a first modular prototype system implementing the basic algorithms for VR-training in gynaecologic laparoscopy.

AxioHOME is a new concept in microscope design. It is a microscope with a visual display unit mounted in the head permitting computer generated displays to be projected on to the real microscope image when viewed down the eyepieces. This allows the annotation of the microscope image with both text and graphics. The AxioHOME system was used for the construction of complex interactive tutorials for the training and assessment of students. The basis of a tutorial is that features of interest on a microscope slide are indicated to the student who is then provided with either information or questions about those features. In turn the student can also annotate the slide with comments for later discussion with the teacher. The system therefore allows a dialogue between teacher and student. The creation of tutorials is time consuming. It takes approximately 10 min of teacher time to create 1 min of student time. However since the same tutorial can be used by numerous students this releases the teacher from repetitive training. The student response to this teaching method has been very positive. The main criticism being that insufficient teaching material was available.