Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer
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Old Dominion University ODU Digital Commons Computational Modeling & Simulation Computational Modeling & Simulation Engineering Theses & Dissertations Engineering Fall 2017 Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer Mohammad F. Obeid Old Dominion University, [email protected] Follow this and additional works at: https://digitalcommons.odu.edu/msve_etds Part of the Biomedical Engineering and Bioengineering Commons, and the Surgery Commons Recommended Citation Obeid, Mohammad F.. "Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer" (2017). Doctor of Philosophy (PhD), Dissertation, Computational Modeling & Simulation Engineering, Old Dominion University, DOI: 10.25777/5nd5-v736 https://digitalcommons.odu.edu/msve_etds/11 This Dissertation is brought to you for free and open access by the Computational Modeling & Simulation Engineering at ODU Digital Commons. It has been accepted for inclusion in Computational Modeling & Simulation Engineering Theses & Dissertations by an authorized administrator of ODU Digital Commons. For more information, please contact [email protected]. DEVELOPMENT AND VALIDATION OF A HYBRID VIRTUAL/PHYSICAL NUSS PROCEDURE SURGICAL TRAINER by Mohammad F. Obeid B.S. June 2011, German-Jordanian University M.S. August 2013, Old Dominion University A Dissertation Submitted to the Faculty of Old Dominion University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY MODELING AND SIMULATION OLD DOMINION UNIVERSITY December 2017 Approved by: Frederic D. McKenzie (Director) Yuzhong Shen (Member) Michel Audette (Member) Robert E. Kelly, JR. (Member) ABSTRACT DEVELOPMENT AND VALIDATION OF A HYBRID VIRTUAL/PHYSICAL NUSS PROCEDURE SURGICAL TRAINER Mohammad F. Obeid Old Dominion University, 2017 Director: Frederic D. McKenzie With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high- fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform. iii Copyright, 2017, by Mohammad F. Obeid, All Rights Reserved. iv My humble work I dedicate to the person whose presence in my life for the past twenty nine years taught me diligence, confidence, perseverance, and full belief in myself: My Father (Brigadier General) Dr. Fayez Radi Obeid Ayasra. For supporting me to pursue my dreams and ambitions, for your firm counsel yet gentle heart, for giving us everything even though you grew up with nothing, and for instilling in me the values of life and the fear of God Almighty. With equivalent appreciation and love: To Suzan Abandah: my dear, warm, and amazing Mother. Your care, tireless prayer, and love are what kept me going all these years. The proud and profound smile I saw on your and on my Father’s faces at the completion of my doctoral work is the ultimate outcome that has continuously fueled my momentum. To Mariam: my extraordinary Wife. My partner, better half, and source of energy. Your infinite patience during my busy hours and unconditional care despite the nuisance of my restless schedule, made my Ph.D. journey an achievable and even an enjoyable ride. To my brothers: First Lieutenant Obada Obeid and Dr. Katadah Obeid; and to my sisters: Dema, Dana, Rama and Noor. Your companionship despite the long distance has flavored my mornings and colored my days. To you I owe my high spirit and everlasting determination. Last but not least, to my parents-in-law, Aladdin and Mayada. Your kindness and affection are things I don’t take for granted. You bring joy to our life just by being in it. v ACKNOWLEDGMENTS This work would be incomplete without expressing my sincere gratitude to my kind advisor and mentor Dr. Frederic McKenzie, Professor and Chair of the Modeling, Simulation, and Visualization Engineering department, for his continuous guidance, optimism, patience, and trust. His direction and encouragement throughout my doctoral work helped me grow from a student to a scholar. His technical and editorial advice was imperative to my progress in completing this dissertation. Finally, his friendship and understanding provided me with the comfortable environment and freedom for exploration that I needed to develop an autonomous and self-driven work attitude. I would also like to extend my thanks to the members of my doctoral committee: Dr. Yuzhong Shen, MSVE’s Associate Professor and GPD; Dr. Michel Audette, MSVE’s Associate Professor; and Dr. Robert Kelly, Surgeon-in-Chief and Vice President for Surgical Affairs at the Children’s Hospital of The King’s Daughters for their treasured insights and constructive criticisms. I would like to particularly acknowledge Dr. Kelly’s efforts in providing a wealth of input and instruction from the medical perspective and facilitating many activities that helped complete this work. These activities included, among many: providing me access to the operating room to observe live operations, facilitating my participation at international medical meetings, as well as his collaboration in organizing validation studies involving medical professionals at the hospital. Furthermore, as I conclude my six years in graduate studies, I would also like to mention my family, my colleagues at the MSVE department, my professors at the German- Jordanian University’s Industrial Engineering department, as well as my friends who all, directly or indirectly, helped me complete this work. vi TABLE OF CONTENTS Page LIST OF TABLES ........................................................................................................... viii LIST OF FIGURES ........................................................................................................... ix Chapter 1. INTRODUCTION ........................................................................................................ 1 1.1 Motivation ............................................................................................................ 2 1.2 Problem Statement ............................................................................................... 3 1.3 Proposed System .................................................................................................. 5 1.4 Contributions........................................................................................................ 6 1.5 Dissertation Organization .................................................................................... 9 2. BACKGROUND AND PREVIOUS WORK ............................................................. 11 2.1 Pectus Excavatum .............................................................................................. 12 2.2 Nuss Procedure .................................................................................................. 13 2.3 Approaches for Surgical Simulation .................................................................. 18 2.4 Validation of Surgical Simulators and Trainers................................................. 22 2.5 Related Work: Nuss Procedure Simulation and Planning ................................. 27 2.6 Related Work: Virtual Reality (VR) VS. Physical (manikin-based) Simulators .......................................................................................................... 27 2.7 A Framework for Surgical Simulation: Virtuality and Interactivity .................. 40 2.8 Considerations for a Hybrid Surgical Trainer .................................................... 43 3. A FULLY VIRTUAL NUSS PROCEDURE SIMULATOR ..................................... 45 3.1 Methods.............................................................................................................. 46 3.2 Results ................................................................................................................ 64 3.3 Advantages and Limitations of a Fully Virtual Simulation ............................... 68 4. A FULLY PHYSICAL NUSS PROCEDURE SIMULATOR ................................... 69 4.1 Methods.............................................................................................................. 69 4.2 Results ................................................................................................................ 74 4.3 Advantages