VR arthroscopic wrist simulator for surgeons

Patients with joint disorders, specifically those affecting the wrist, increasingly demand for minimally invasive surgeries, including arthroscopy. However, these procedures require a high level of practitioner skills because of the joint complexity combined with diversity of its related diseases. Inappropriate surgery may increase the incidence of complications and mitigate the curative effect. Such procedures pose a steep learning curve for orthopedic students.  Specifics of the arthroscopy involve surgical techniques that  require surgeons to mentally visualize a three-dimensional environment from two-dimensional images and to perform surgery through specific hand-eye coordination with little tactile feedback.

Given these challenges, an improved focus on joint anatomy training was a top priority for VOKA’s client* – a prominent healthcare educational institution.  There were few, if any, suitable simulators for orthopedic procedures in general and wrist arthroscopy in particular. Recognizing the limited field of vision and reduced doctor-patient interaction, the client came to the conclusion that VR training was the most viable solution. Hence, they turned to VOKA for assistance in creating the simulator.

COLLABORATIVE DEVELOPMENT

To uphold high medical standards and ensure accuracy, we engaged orthopedic surgeons in the development process. Their input determined the design, features, and training modules, creating an authentic learning experience while highlighting the critical technical and psychomotor challenges the practitioners face. 

KEY FEATURES

High-precision anatomy:

The simulator features anatomically accurate 3D Unity-based models of the joints, showcasing the details of bones, ligaments, tendons, nerves, and blood vessels. This multi-layered visualization allows trainees to develop an understanding of spatial relationships within the joints. 

Realistic surgical simulation:

The simulator immerses trainees in a virtual operating room environment which enables realistic patient positioning and manipulation. They can practice a range of orthopedic procedures, including wrist arthroscopy. 

Sample arthroscopy procedure’s key steps are as follows:

• Portal placement:
  Accurately identifying and establishing arthroscopic portals using virtual needles and cannulas, receiving haptic feedback that simulates tissue resistance.
• Instrument navigation:

  Maneuvering arthroscopic instruments, such as probes, shavers, graspers, within the joint space, developing hand-eye coordination and spatial awareness which are extremely hard to develop otherwise.
• Pathology recognition and management:

  The simulator presents various wrist pathologies (e.g., triangular fibrocartilage complex (TFCC) tears, scapholunate ligament injuries, carpal tunnel syndrome) allowing trainees to diagnose and apply relevant surgical techniques risk-free.

Progressive learning modules:

Training modules start with basic anatomy identification and progress to more complex surgical cases. This gradual approach helps build confidence which is then invaluable in the real OR.

Performance feedback and assessment:

The simulator provides real-time feedback on the user’s performance, instrument handling, and on-the-go decision-making. Objective data allows trainees to track their progress and identify areas for improvement. Moreover, it enabled the development of training modules with gradually increasing complexity.

3D modeling and Unity integration:

To plan surgical incisions that simulate physical tissue interaction and replicate a laparoscope camera, the team at VOKA employed multi-layered 3D Unity models of the wrist. These models were created using the high-resolution medical images which enabled creating detailed presentations of the wrist’s bones, joints, ligaments, and more. With the 3D engine, we ensured high-precision model rendering and real physics integration which simulates tissue resistance and instrument interaction.

*Detailed information about the client cannot be disclosed under the provisions of the NDA.