PROJECT DESCRIPTION

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a potentially life saving procedure to stem bleeding into the abdomen and lower body. A balloon catheter is inserted through into the common femoral artery in the groin specific zones in the aorta and inflated, temporarily blocking blood flow while repairs are effected. It is typically performed without live imaging assistance, and animal-based training is not suitable. A simulation-based training system is needed to allow military and civilian trauma and emergency physicians to learn standard technique and use of new REBOA catheters.

Expanding our previous works on interventional radiology simulation, we are developing the physics-based models for catheter and guidewire motion, blood flow and graphical rendering towards a novel simulator for REBOA that will include physical vascular access, simulated passage of the IR instruments into the aorta with accompanying training/educational content, device withdrawal and closure.

The system is designed to be compatible with CODA balloon catheters, the newer ER-REBOA catheter and other similar systems. Motion of and reaction forces on the devices passing through the vasculature, and blood flow within virtual vessels is computed in real-time, and synthetic views of virtual instrument motion can be displayed to the trainee to provide understanding of the procedure and illustrate when errors are committed.

Errors such as venous access and incorrect location of balloon inflation can be detected. The underlying software architecture links the wireless, battery powered trackers to a portable tablet or similar interface, which can record performance for later review and evaluation.

For more information on the REBOA procedure, visit this website: http://www.traumaready.com/reboa/

PROJECT DESCRIPTION

EVEREST research project funded by ANR (l’Agence National de la Recherche) is a project that aims at creation of Virtual Platform for Surgical Training.
In this context, Flexible endoscopy is a minimally invasive surgical technique that remains very challenging to learn. We have developed a first version of a training simulator using advanced physics and real-time computation. A final prototype of the simulator is scheduled for delivery mid-2018.

The projects consists of the following steps:

• Development of the endoscopy simulator: Ex-vivo, in-vivo feasibility study with Xsens (operator) and Aurora tracking systems (endoscope).
• Development of the tracking method.
• Validation of a ‘machine learning’  and ‘dynamic time warping’ method for movements recognition during endoscopic gestures.
• Writing of a clinical protocol «Study of both operator and endoscope movements during digestive endoscopy ».

PROJECT DESCRIPTION

Ultrasound (US) imaging is ideal for hepatic surgery guidance, but it has the disadvantage of limited field of view besides poor image quality. Fusing intraoperative US with preoperative data (multi modality registration) will solve these disadvantages and would be ideal during image-guided interventions. To achieve pre and intraoperative registration the vessel features from both modalities will be used. During surgery the liver suffers considerable deformation that needs to be taken into account. These encompass the 2 main objectives of the project:

1. Intraoperative vessel extraction from US, and initial registration of preoperative model.

2. Liver deformation from biomechanical model driven from US images’ vessels.

Related publications:

• Nicholas Stylopoulos, Stéphane Cotin, Sk Maithel, M Ottensmeyer, Pg Jackson, et al.. Computer-enhanced laparoscopic training system (CELTS): bridging the gap. Surgical Endoscopy and Other Interventional Techniques, 2004, 18 (5), pp.782--789.
• Stéphane Cotin, Nicholas Stylopoulos, Mark Ottensmeyer, Paul Neumann, Ryan Bardsley, et al.. Surgical training system for laparoscopic procedures. US Patent App. 10/797,874. 2004.
• Nicholas Stylopoulos, Stéphane Cotin, Steven Dawson, Mark Ottensmeyer, Paul Neumann, et al.. CELTS: a clinically-based Computer Enhanced Laparoscopic Training System. Stud Health Technol Inform., 2003, 94, pp.336--342.
• Stéphane Cotin, Nicholas Stylopoulos, Mark Ottensmeyer, Paul Neumann, David Rattner. Metrics for laparoscopic skills trainers: the weakest link!. International Conference on Medical Image Computing and Computer-Assisted Intervention, . pp.35--43, 2002.

Project Description

Regional Anesthesia Simulator and Assistant (The RASimAs project ) was a European research project with the purpose of gathering European experts from very diverse fields, from computer sciences to anesthesiology, to bring an innovative tool in the hands of the medical doctors to perform safer regional anesthesia for the patient at reduced cost for the society. For that purpose, a virtual reality simulator and assistant were developed, providing an innovative way for medical doctors to train extensively on virtual patients and to be assisted by additional patient-specific information during the procedure.

The project’s goals were to develop two different but complementary end products :

1. a patient-specific Regional Anaesthesia Simulator (RASim) enhanced with ultrasound guidance
2. a Regional Anaesthesia Assistant (RAAs), which will assist the physicians during the actual procedures.

The MIMESIS team was a leader of a Work Package in charge of Patient-Specific Virtual Models.

The whole operation of regional anesthesia was simulated into SOFA. The anatomy of the patient (skin, bones, muscles, nerves and vessels) was modelized based on the finite element method. A simulated needle is inserted into the limb being headed for the nerve that have to be blocked. The simulator handles an Ultra-Sound visualisation as well as electrical nerve stimulation.

Expected impact

In many cases, general anesthesia is still favored over RA even when RA should theoretically be the method of choice, despite its documented benefits for patients: lower cardiovascular stress and other complications, reduced postoperative pain, earlier mobility, shorter hospital stay, and ultimately significantly lower costs. The slow adoption of RA is due to the lack of physician training.

Therefore, the key challenge is the training of physicians in order to increase the market adoption of RA procedures. RASimAs is expected to bring significant clinical, economic and scientific impacts. In particular the results of RASimAs will enable to stimulate the replacement of general anesthesia by regional anesthesia in many cases, leading to improved patient care, reduced complications and lower costs.

Controlled clinical trials to evaluate computer-based models and patient-specific approach will demonstrate the benefits of the technology in clinical environment. Advanced research in virtual reality medical simulation as well as real-time assistance based on patient-specific data will accelerate the scientific deployment of such technologies in clinical environment. Finally, by replacing general anesthesia with RA and improving the success rate of RA procedures, significant reduction of costs are expected, estimated at 100,000 Euros by year and operating theater.

Publications

Real-time Error Control for Surgical Simulation Huu Phuoc Bui, Satyendra Tomar, Hadrien Courtecuisse, Stéphane Cotin, Stéphane Bordas BIOMECHANICS AND COMPUTER ASSISTED SURGERY MEETS MEDICAL REALITY, Aug 2017, Lille, France. 2017,

General Description

Despite the improvements of surgical techniques and tools, some interventions remain very challenging for clinicians. During abdominal minimally invasive surgery visual feedback is limited. Only a partial view of the organ’s surface is seen through the endoscopic camera. Moreover, the pneumoperitoneum, required for  minimally invasive procedures, strongly deforms the abdominal organs, making it very difficult to mentally register the pre-operative CT data.  Still, the surgeons need to know where internal structures such as tumors or vessels are located. Therefore, they have to mentally register the preoperative images of the organs onto the endoscopic view to locate these structures.

Our contribution is to provide surgeons with an enhanced visualization of organ’s internal structures during the surgery. This involves biomechanical modeling of the liver, including its vascular structures, and real-time, elastic registration of the pre-operative data onto a partial view of the liver surface. This surface is reconstructed from a pair of laparoscopic images acquired with a stereo-endoscopic camera (Storz or Intuitive Surgical).

Related Publications

Using Contours as Boundary Conditions for Elastic Registration during Minimally Invasive Hepatic Surgery. Nazim Haouchine, Frederick Roy, Lionel Untereiner, Stéphane Cotin International Conference on Intelligent Robots and Systems, Oct 2016, Daejeon, South Korea.

Simultaneous Pose Estimation and Augmentation of Elastic Surfaces from a Moving Monocular Camera. Nazim Haouchine, Marie-Odile Berger, Stephane Cotin International Symposium on Mixed and Augmented Reality, Sep 2016, Merida, Mexico.

Patient-specific Biomechanical Modeling for Guidance during Minimally-invasive Hepatic Surgery. Rosalie Plantefève, Igor Peterlik, Nazim Haouchine, Stéphane Cotin Annals of Biomedical Engineering, Springer Verlag, 2015.

Monocular 3D Reconstruction and Augmentation of Elastic Surfaces with Self-occlusion Handling.  Nazim Haouchine, Jeremie Dequidt, Marie-Odile Berger, Stephane Cotin IEEE Transactions on Visualization and Computer Graphics, Institute of Electrical and Electronics Engineers, 2015.

Impact of Soft Tissue Heterogeneity on Augmented Reality for Liver Surgery.  Nazim Haouchine, Stephane Cotin, Igor Peterlik, Jeremie Dequidt, Mario Sanz-Lopez, Erwan Kerrien, Marie-Odile Berger IEEE Transactions on Visualization and Computer Graphics, Institute of Electrical and Electronics Engineers, 2015, 21 (5), pp.584 – 597.

Augmented Reality during Cutting and Tearing of Deformable Objects. Christoph Paulus, Nazim Haouchine, David Cazier, Stephane Cotin IEEE International Symposium on Mixed and Augmented Reality, Sep 2015, Fukuoka, Japan.

Surgical Augmented Reality with Topological Changes. Christoph Paulus, Nazim Haouchine, David Cazier, Stephane Cotin Medical Image Computing and Computer Assisted Interventions, Oct 2015, München, Germany

Handling Topological Changes during Elastic Registration: Application to Augmented Reality in Laparoscopic Surgery
Christoph Joachim Paulus, Nazim Haouchine, Seong-Ho Kong, Renato Vianna Soares, David Cazier, Stéphane Cotin International Journal of Computer Assisted Radiology and Surgery, Springer Verlag, 2016

General Description

Many approaches have been proposed to represent and structure anatomy in order to facilitate its learning: illustrations, books, cadaver dissections and 3D models. However, in these static media, it is difficult to understand and analyse motion, which is essential for a better understanding of anatomy. We have developed an original and innovative tool to learn anatomy named "Anatomime". It allows the user to visualize a human-size virtual anatomical model (skin, skeleton, muscles, nerves, veins, arteries and organs) while it follows the user's movements. A Kinect is used to capture body motions, and a physics-based model is used to provide a robust, realistic animation of the virtual body.

General Description

At the center of HelpMeSee’s global campaign to reduce cataract blindness is a simulation-based training program focused on training specialists in MSICS (Manual Surgical Incision Cataract Surgery), a high quality and low-cost procedure that treats cataract blindness. Our training program prepares eye care professionals to deliver the high-volume MSICS procedures needed to reduce the backlog of patients awaiting treatment.

To make this large-scale training possible, we are developing HelpMeSee’s Eye Surgical Simulator, which combines realistic computer graphics and physics modeling with motion controls and haptic feedback to accurately simulate the MSICS procedure. This surgical simulator is part of an integrated learning system designed to support the training of tens of thousands of cataract surgeons. The benefits of simulation-based training include

• Ability to achieve a higher level of proficiency before completing the live surgery that is part of training
• Monitoring of surgical performance and improved instructors’ feedback
• Unlimited repetition of surgical steps until the desired level of proficiency is achieved
• Documentation of the specialist’s proficiency level through each stage of training

The HelpMeSee simulation training program is intended to replace the traditional MSICS training, which is primarily dependent on performing live surgery. HelpMeSee believes that the Eye Surgical Simulator will reduce the time required to acquire surgical skills and qualifying for independent surgery. Once completed, simulation-based training will likely prove to be a more effective method to train the large numbers of qualified surgeons who are needed to significantly reduce the number of blind people due to cataracts.

Related publications

Real-time simulation of contact and cutting of heterogeneous soft-tissues - Hadrien Courtecuisse, Jeremie Allard, Pierre Kerfriden, Stephane Pierre-Alain Bordas, Stephane Cotin, Christian Duriez. Medical Image Analysis, Elsevier, 2014, 18 (2), pp.394-410.

Preconditioner-Based Contact Response and Application to Cataract Surgery - Hadrien Courtecuisse, Jérémie Allard, Christian Duriez, Stéphane Cotin. G. Fichtinger and A. Martel and T. Peters. MICCAI - 14th International Conference on Medical Image Computing and Computer Assisted Intervention - 2011, Sep 2011, Toronto, Canada. Springer, 6891, pp.315-322, 2011, Lecture Notes in Computer Science.

A Prototype of Simulation System for Cataract Surgery Training - Elodie Dumortier, Stephane Cotin, Jérémie Dequidt, Jean-Francois RoulandEuropean Society of Cataract & Refractive Surgeons Winter Meeting, 2011, Istanbul, Turkey. 2011

Assessment Metrics For A Prototype Of Simulation System For Cataract Surgery Training - Elodie Dumortier, Stephane Cotin, Jérémie Dequidt, Jean-Francois RoulandAnnual Meeting of the Association for Research in Vision and Opthalmology, 2011, Fort Lauderdale, United States. 2011

Computer-Based Simulation of Cataract Surgery: Toward a New Teaching Paradigm - Nadia Boubchir, Stephane Cotin, Olivier Comas, Frederick Roy, Christian Duriez, Jérémie Dequidt, Jeremie Allard, Jean-Francois RoulandAnnual Meeting of the American Academy of Ophthalmology, 2010, Fort Lauderdale, United States. 2010

Computer-Based Simulation of IOL Injection: Toward a Full Featured Cataract Surgery Training System - Nadia Boubchir, Stephane Cotin, Christian Duriez, Jérémie Dequidt, Jeremie Allard, Jean-Francois RoulandAnnual Meeting of the American Academy of Ophthalmology, 2009, San Diego, United States. 2009

Project Description

According to the world health organization, retinal diseases are responsible for at least 10 millions of blind people. They represent already 15% of the causes of visual impairment and are probably underestimated.

Retina surgery is complex, various and patient-specific. The full breadth of training for a retina specialist represents on average more than 10 years. This is obviously related to the difficulty of accessing the retina and possible complication rates in case of errors, but also due to the relatively large number of surgical options: retinal laser surgery (used to treat a variety of problems including retinal tears, retinal holes, small retinal detachments and leaking blood vessels); scleral buckling surgery (considered as the traditional surgery for retinal detachments); pneumatic retinopexy (involves the intraocular injection of an inert gas bubble to press on the retina and seal the retinal break); and vitrectomy (used to treat the most severe retinal detachments).

Throughout this project we have developed a high-fidelity training system for retinal surgery. The simulator uses a custom-designed hardware (developed by MOOG, in collaboration with HelpMeSee) which includes a haptic interface and a binocular. The haptics uses an admittance control paradigm, involving a force sensor for high fidelity feel. On the software side, we have continued the development of a realistic eye model (work initially started for our project on cataract surgery). The main novelties include the interactive placement of trocars, the insertion of various instruments through the trocars, and the manipulation of the epiretinal membrane. The membrane is modeled as a set of shell elements solved using a FEM method. Tearing of the virtual membrane is computed using stress or strain analysis. All computations are performed in real-time and include the computation of the deformation, collision detection, collision response and realistic rendering.

Related Publications

RESET: REtinal Surgery systEm for Training. S. Cotin, J.J. Keppi, J. Allard, R. Bessard, H. Courtecuisse, D. Gaucher.  European Association for Vision and Eye Research Conference, 2015.

Haptic Rendering of Hyperelastic Models with Friction. H. Courtecuisse, Y. Adagolodjo, H. Delingette, C. Duriez. International Conference on Intelligent Robots and Systems (IROS), 2015.

Description

Recent progress in cardiac catheterization and devices allowed the development of new therapies for severe cardiac diseases like arrhythmias and heart failure. The skills required for such interventions are still very challenging to learn, and typically acquired over several years. Virtual reality simulators can reduce this burden by allowing to practice such procedures without consequences on patients.

Our contribution: Proposition of the first training system dedicated to cardiac electrophysiology, including pacing and ablation procedures. This framework involves a catheter navigation that faithfully reproduces issues intrinsic to intracardiac catheterization and an efficient GPU-based electrophysiological model. We developed a multithreading approach to compute both real-time simulations (navigation and electrophysiology) asynchronously. With this method, the simulation reaches high computational performance that allows to account for user interactions in real-time. Based on a scenario of cardiac arrhythmia, the user-guided simulator is able to navigate inside vessels and cardiac cavities with a catheter and to reproduce an ablation procedure involving tasks:

• extra-cellular potential measurements,
• endocardial surface reconstruction,
• electrophysiology mapping,
• RF ablation,
• electrical stimulation.

This work is a step towards computerized medical learning curriculum.

Related Publications

PhD Thesis:

Interactive Patient-Specific Simulation of Cardiac Electrophysiology Hugo Talbot Computer Science [cs]. Université des Sciences et Technologies de Lille, 2014.  English

Reports:

Deliverable D10.4.2 Hugo Talbot, Federico Spadoni, Maxime Sermesant, Nicholas Ayache, Hervé Delingette [Research Report] 2013, pp.22

Publications:

Interactive Training System for Interventional Electrocardiology Procedures Medical Image Analysis (2016)Talbot, H. and Spadoni, F. and Duriez, C. and Sermesant, M. and O ‘Neill, M. and Jaïs, P. and Cotin, S. and Delingette, H.

Personalization of Cardiac Electrophysiology Model using the Unscented Kalman Filtering  Hugo Talbot, Stephane Cotin, Reza Razavi, Christopher Rinaldi, Hervé Delingette Computer Assisted Radiology and Surgery (CARS 2015), Jun 2015, Barcelona, Spain

Interactive Training System for Interventional Electrocardiology Procedures H Talbot, F Spadoni, Christian Duriez, M Sermesant, Stéphane Cotin, Hervé Delingette 6th International Symposium on Biomedical Simulation – ISBMS 2014, Oct 2014, Strabsourg, France. pp.11 – 19, 2014

Surgery Training, Planning and Guidance Using the SOFA Framework Hugo Talbot, Nazim Haouchine, Igor Peterlik, Jeremie Dequidt, Christian Duriez, Hervé Delingette, Stephane Cotin Eurographics, May 2015, Zurich, Switzerland

Towards an Interactive Electromechanical Model of the Heart Hugo Talbot, Stéphanie Marchesseau, Christian Duriez, Maxime Sermesant, Stéphane Cotin, Hervé Delingette Interface Focus, Royal Society publishing, 2013, The Virtual Physiological Human: Integrative Approaches to Computational Biomedicine, 3 (2), pp.4.

Towards An Interactive Electromechanical Model of the Heart Interface Focus Royal Society (2012) Talbot, H. and Marchesseau, S. and Duriez, C. and Sermesant, M. and Cotin, S. and Delingette, H.