腹腔鏡手術訓練模擬系統是應用虛擬實境與影像重建技術發展出一套高效率、低成本、影像逼真具臨場感且符合醫師手術訓練需求之模擬系統。腹腔鏡手術的研發使外科手術提昇至另外一個嶄新的境界，由於傷口小、流血少、復原快，因此成為外科手術的主流。然而其技術層次高，需經過長期有計畫的訓練，才能成為腹腔鏡手術之主治醫師。而傳統的訓練方式有許多缺點存在，且耗費大量訓練成本，包括訓練的時間空間受限、模擬系統成本過高、模擬訓練的真實性不高、動物實驗訓練成本高、臨床訓練風險大等等。
本研究乃就上述缺點，設計開發出一種創新的啟發式訓練方法，搭配手術模擬系統硬體開發與外在介面的整合，設計出一套符合訓練需求、易操作且成本低廉的訓練系統。
此模擬系統其特點乃是以手術時真實的腹腔鏡影像進行訓練，取代舊有道具的不真實或需耗費大量電腦運算資源的虛擬器官動態模擬系統。此創新構想之優點在於：
（一）以真實影像進行訓練較符合實際需求。
（二）主治醫師或教授可根據欲訓練的手術技術或項目，自行設計訓練課程。
硬體方面，本手術模擬系統，採用低成本的滑鼠與搖桿所改裝而成的輸入設備，減少了一般模擬系統所需的伺服馬達等高成本之硬體，大量降低了模擬系統硬體的成本。
此外，在空間定位方面，在手術刀上設計特殊的記號，再用影像處理技術，來計算出示範醫師的手術刀尖端軌跡，而不需要昂貴的定位系統，即可達到定位效果，大幅降低研發成本。
本研究擬設計研發之模擬系統，除了上述種種優點外，配合虛擬實境技術之進步，利用電腦輔助進行手術前的規劃與預演，將是指日可待的，如此一來不僅可縮短手術時間、獲得較佳的手術效果、提高手術成功率、且可節省大量之醫療成本，並造福病患。

This surgical simulation system of laparoscope is a high - efficiency, low-cost, and more realistic system that were designed by Virtual-Reality.
Laparoscopic technology has promoted the surgical field into a new era, by which the operator manipulates extra corporeal instruments via small wound to achieve motion for excision, remedy, suturing and removal. However, the poor coordination between instruments and 2-Dimensional images requires special training system to overcome the steep learning curve. There are many drawbacks for the training system such as pelvic trainer, animal laboratory or classical 3-D virtual reality trainer, etc. The t trainer at present is not only unreal, but also poor training efficiency; the animal laboratory is expensive and has an inherited problem on animal life wasting; the 3-D simulator is more expensive and difficult to develop.
Therefore, the objective of this research is to develop a heuristic Laparoscopic Surgical Training System (LSTS) using Virtual Reality and Image Reconstruction Technologies. The advantages of the system are the instructors can easily design the training courses using user-friendly interfaces, and the trainees’ laparoscopic surgical skill can be greatly improved by this low cost and higher realistic training system.

The first and the most distinct feature of the design is to simulate abdominal cavity using real 2D images captured from laparoscope instead of building the physical 3D models of organs using high performance computer graphics system. Live Laparoscopic surgical processes are recorded into Digital Video Discs (DVD) to simulate the virtual environment of an abdominal cavity. The paths of surgical tools are recorded using image analysis technology, which are used to evaluate the trainees’ surgical skill during the training courses. Since it is not necessary to build the expensive and non-realistic physical models of organs by complex theorems and time consuming calculations, the system is easily implemented using regular computer.
The second feature of the design is that the input hardware of the system was made by the mechanism of joystick and mouse, which lower down the cost of the input system. Joystick and mouse are used to develop the 3D position tracking system to detect the hand motions of instructors and trainees. The 3-D robot arm systems assembled by expensive servomotors and AD/DA cards were not needed in this system anymore.

An important innovative design is that two markers film recording together with the image analysis technology to get the paths of surgical tools. It is not necessary to use the expensive optic or magnetic 3-D locators. This will make the laparoscopic surgical training system affordable by medical centers so that new surgeons can be trained continuously and economically. It is important to note that the same ideas and the design logic might be extended to other surgical training systems, either open or endoscopic scenario, to improve new surgeons’ surgical skills in cost-effective ways.

[1] D. Ota, B. Loftin, T. Saito, R. Lea, and J. Keller, "Virtual Reality In Surgical Education," Comput. Biol. Med., vol. 25, pp. 127-137, 1995.

[2] G. C. Burdea and P. Coiffet, Virtual Reality Technology. New York: John Wiley and Sons, 1994.

[3] A. Nahvi, D. D. Nelson, J. M. Hollerbach, and D. E. Johnson, "Haptic Manipulation of Virtual Mechanisms from Mechanical CAD Designs," Proc. of 1998 IEEE International Conference on Robotics and Automation, pp. 375-380, 1998.

[4] T. S. R. Yoo, P., "Digital design of a surgical simulator for interventional MR imaging," Visualization '99. Proceedings, pp. 393 -548, 1999.

[5] M. Dinsmore, N. Langrana, G. C. Burdea, and J. Landeji, "Virtual Reality Training Simulation for Palpation Subsurface Tumors," Proc. of 1997 IEEE International Conference on Virtual Reality Annual International Symposium, pp. 54-60, 1997.

[6] T. Massie, "A Tangible goal 3D Modeling," IEEE Computer Graphics and Applications, vol. 18, pp. 62-65, 1998.

[7] A. C. M. Dumay and G. J. Jense, "Endoscopic Surgery Simulation in a Virtual Environment," Comput. Biol. Med., vol. 25, pp. 139-148, 1995.

[8] J. K. Salisbury and M. A. Srinivasan, "Phantom-based haptic interaction with virtual objects," IEEE Computer Graphics and Applications, vol. 17, pp. 6-10, 1997.

[9] C. Bosdogan, C. Ho, and M. A. Srinivasan, "Virtual Environments for Medical Training: Graphical and Haptic Simulation of Laparoscopic Common Bile Duct Exploration," IEEE/ASME Transactions on Mechatronics, vol. 6, pp. 269-285, 2001.

[10] F. Tendick, M. Downes, D. Feygin, and R. Eyal, "A Virtual Environment Testbed for Training Laparoscopic Surgical Skills," Medicine Meets Virtual Reality, vol. 9, pp. 236-255, 2000.

[11] D. P. Mahoney, "Getting the Feel of Virtual Surgery," Computer Graphics World, pp. 19-20, 1999.

[12] J. Kim, S. De, and M. A. Srinivasan, "Computationally efficient techniques for real time surgical simulation with force feedback," Haptic Interfaces for Virtual Environment and Teleoperator Systems ,10th Symposium on , 2002, pp. 51 -57, 2002.

[13] H. Delingette, S. Cotin, and N. Ayache, "A hybrid elastic model allowing real-time cutting, deformations and force-feedback for surgery training and simulation," Computer Animation, pp. 70 -81, 1999.

[14] G. Picinbono, J.-C. Lombardo, H. Delingette, and N. Ayache, "Anisotropic elasticity and force extrapolation to improve realism of surgery simulation," Robotics and Automation, 2000. Proceedings ICRA '00. IEEE International Conference, vol. 1, pp. 596 -602, 2000.

[15] J. W. Ward, D. P. M. Wills, K. P. Sherman, and A. M. M. A. Mohsen, "The Development of an Arthroscopic Surgical Simulator with Haptic Feedback," Future Generation Computer System, vol. 14, pp. 243-251, 1998.

[16] M. Lin and S. Gottschalk, "Collision Detection between Geometric Models: A survey," Proc. of IMA Conference on Mathematics of Surfaces, 1998.

[17] G. Picinbono, H. Delingette, and N. Ayache, "Nonlinear and anisotropic elastic soft tissue models for medical simulation," Robotics and Automation, 2001. Proceedings 2001 ICRA. IEEE International Conference, vol. 2, 2001.

[18] C. Ho, C. Basdogan, and M. A. Srinivasan, "Efficient Point-Based Rendering Techniques for Haptic Display of Virtual Objects," Presence, vol. 8, pp. 477-491, 1999.

[19] K. Montgomery, L. Heinrichs, C. Bruyns, S. Wildermuth, C. Hasser, S. Ozenne, D. Bailey, L. Heinrichs, C. Bruyns, S. Wildermuth, C. Hasser, S. Ozenne, and D. Bailey, "Surgical simulator for hysteroscopy: a case study of visualization in surgical training," Visualization,VIS '01. Proceedings, pp. 449 -452, 2001.

[20] S. Cotin, H. Delingette, and N. Ayache, "Real-time elastic deformations of soft tissue for surgery simulation," IEEE Trans.On Visualization and computer graphics, vol. 5, pp. 62-73, 1999.

[21] K. J. Bathe, Finite Element Procedures, Springer ,1996.

[22] G.Szekely, Ch.Brechbuhler, R.Hutter, A.Rhomberg, N.Ironmonger, and P.Schmid, "Modeling of Soft Tissue Deformation for Laparoscopic Surgery," Medical Image Analysis, vol. 4, pp. 57-66, 2000.

[23] S. De and K. J. Bathe, "The Method of Finite Spheres," Computational Mechanics, vol. 25, pp. 329-345, 2000.

[24] J. K. S. De and M. A. Srinivasan, "A Meshless Numerical Technique for Physically Based Real Time Medical Simulations," Proceeding of MMVR 2001, pp. 35-43, 2001.

[25] A. M.Derossis, G. M.Fried, M. Abrahamowicz, H. H.Sigman, J. S.Barkun, and J. L.Meakins, "Development of a Model for Training and Evaluation of Laparoscope," The American Journal of Surgery, vol. 175, pp. 87-93, 1998.

[26] E.J. Chen, J.Novakofski, W.K.Jenkins, and J. W.D.O Merien, "Young's Modulus Measurements of Soft Tissues with Application to Elasticity Imaging," IEEE Trans.on Ultrasonics, Ferroelectrics and Frequency Control,, vol. 43, pp. 54-61, 1996.

[27] K. Kawasue and T. Ishimatsu, "3-D Measurement of Moving Particles by Circular Image Shifting," IEEE Transactions on Industrial Electronics, vol. 44, pp. 703-706, 1997.

[28] C. Swain, A. Peters, and K. Kawamura, "Depth Estimation from Image Defocus using Fuzzy Logic," IEEE Transactions on Pattern Analysis and Machine Intelligence, pp. 94-100, 1994.

[29] R. C. Gonzalez and R. E. Woods , Digital Image Processing, Springer , 1992.

[30] S. K. Nayar and Y. Nakagawa, "Shape from Focus," IEEE Transactions on Pattern Analysis and Machine Intelligence, vol. 16, pp. 824-831, 1994.

[31] M. Subbarao and T. Choi, "Accurate Recovery of Three-Dimensional Shape from Image Focus," IEEE Transactions on Pattern Analysis and Machine Intelligence, vol. 17, pp. 266-275, 1995.

[32] M. Subbarao and J.-K. Tyan, "Selecting the Optimal Focus Measure for Autofocusing and Depth-From-Focus," IEEE Transactions on Pattern Analysis and Machine Intelligence, vol. 20, pp. 864-870, 1998.