Simulation Database

We are constructing a database where CardinalSim user can share simulated cases.  In this way, users will have access to a growing repository of anonymized data from which to learn anatomic variations and surgical approaches to a spectrum of pathology.

Such a simulation database will allow users to share challenging cases and clinical scenarios with a network of users to receive feedback on planned procedures for their patients.

In this way, users will be able to search for specific pathology or anatomic variations that pertain to the clinical challenges they face to gain insight into how others have manages similar scenarios.

Collaborative Rehearsal

We are designing means through which users can refine simulated surgical approaches in a collaborative, iterative process.

This schematic example illustrates a case in which a resident is attempting to optimize an approach to a temporal bone tumor (green) while avoiding the carotid (red) and jugular bulb (blue).  He removes bone (black) to go from A to B, but is unable to reach the tumor.

He would be able to then ask for assistance from a more senior resident, who takes his dissection down a different branch, showing him how to try an alternative approach (C).

Next, the dissection is reviewed by a more senior attending, who recommends removing additional bone (light green) to facilitate the approach as shown in (D).

Provided with this guidance, the initial resident can now refine his initial approach, reaching an optomized solution (E), and saving it to the database as a model case for others to reference.

Soft Tissue Simulation

Soft tissue retraction is often an essential determinant of surgical exposure. The integration of simulated deformable soft tissue will expand the application of CardinalSim to a greater variety of surgical procedures.

We are focusing in realistic physics-based real-time rendering of soft tissue structures as they are relevant in determining exposure in cranial base procedures.  By limiting our efforts to specific cases relevant to exposure, to avoid the complexities of attempting a more generalized solution for simulating deformable tissues.

Material properties of tissues can be approximated from their imaging characteristics, and then fine-tuned by experienced surgeons to replicate expected interaction with surgical instrumentation.

Integration of Sound

We are currently integrating realistic sound created by the removal of bone with an surgical drill.  Experienced surgeons use subtle auditory cues to learn valuable information regarding the state of the drill and bur used, but also the characteristics and geometry of the underlying bone.

By supplying the user with these cues, we hypothesize that CardinalSim will be more realistic – allowing surgeons to achieve their desired goals faster and more accurately.

Data accepted for presentation at AAO/HNS Annual Meeting, 2016

Early work by our team in the simulation of surgical bone removal. Spectral peaks of both cutting and diamond burs are shown

Integration of Simulation into the Operative Experience

We are working on ways of integrating the simulation experience into the actual surgical experience.  We anticipate that in this way, users may effectively apply the insights gained through rehearsal to actual procedures.

We performed preliminary studies in which CardinalSim was integrated into the cadaver dissection laboratory.  Residents were ask to  initially perform virtual dissections based on CT scans of a cadaver specimen.  They then referred to that experience at the laboratory bench to help guide them through the dissection of that specific specimen.  Our subjects found that the insights derived from the virtual experience significantly improved their confidence and performance.

A resident performing a surgical dissection on a cadaver specimen after first rehearsing the dissection on a simulated model.

Demonstration of how virtual anatomy may be superimposed on actual surgery in a right mastoidectomy for cholesteatoma.