Development of a Virtual Simulator for Microanastomosis: New Opportunities and Challenges

  • Valerio De Luca
  • Antonio Meo
  • Antonio MongelliEmail author
  • Pietro Vecchio
  • Lucio T. De Paolis
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 9769)


The paper deals with the development of virtual surgical simulator for microanastomosis developed within the INTERREG (Italy-Greece) MICRO project. Microanastomosis is a surgical technique that involves, under optical magnification, the conjunction of blood vessels of a few millimeters diameter and is used also to support the surgical treatment of tumours. This manuscript describes the two principal solutions analysed during the progress of the MICRO project. The first step concerns the development of the simulator using the Unity3D engine; the second step describes an evolution of the surgical simulator to support remote control by a haptic interface via web using the WebGL platform based on JavaScript code. For both, a force feedback module has been implemented that reads data coming from the simulator and converts them to generate a servo control action on the haptic interface. For both solutions, some results of the implemented simulator are described .


Surgical simulator Microanastomosis Virtual reality 


  1. 1.
    Xie, J.: Research on key technologies base Unity3D game engine. In: ICCSE 2012 - Proceedings of 2012 7th International Conference on Computer Science and Education, pp. 695–699 (2012)Google Scholar
  2. 2.
  3. 3.
  4. 4.
  5. 5.
    Erel, E., Aiyenibe, B., Butler, P.E.M.: Microsurgery simulators in virtual reality: review. Microsurgery 23, 147–152 (2003)CrossRefGoogle Scholar
  6. 6.
    Alaraj, A., Lemole, M.G., Finkle, J.H., Yudkowsky, R., Wallace, A., Luciano, C., Banerjee, P.P., Rizzi, S.H., Charbel, F.T.: Virtual reality training in neurosurgery: review of current status and future applications. Surg. Neurol. Int. 2, 52 (2011)CrossRefGoogle Scholar
  7. 7.
    Malone, H.R., Syed, O.N., Downes, M.S., D’ambrosio, A.L., Quest, D.O., Kaiser, M.G.: Simulation in neurosurgery: a review of computer-based simulation environments and their surgical applications. Neurosurgery 67, 1105–1116 (2010)CrossRefGoogle Scholar
  8. 8.
    Davies, J., Khatib, M., Bello, F.: Open Surgical Simulation - a Review. J. Surg. Educ. 70, 618–627 (2013)CrossRefGoogle Scholar
  9. 9.
    Ricciardi, F., Pastorelli, E., Paolis, L.T.D., Herrmann, H.: Scalable medical viewer for virtual reality environments. In: Augmented and Virtual Reality - Second International Conference, AVR 2015, Lecce, Italy, 31 August – 3 September 2015, Proceedings, pp. 233–243 (2015)Google Scholar
  10. 10.
    Livatino, S., De Paolis, L.T., D’Agostino, M., Zocco, A., Agrimi, A., De Santis, A., Bruno, L.V., Lapresa, M.: Stereoscopic visualization and 3-D technologies in medical endoscopic teleoperation. IEEE Trans. Industr. Electron. 62, 525–535 (2015)CrossRefGoogle Scholar
  11. 11.
    O’Toole, R.V., Playter, R.R., Krummel, T.M., Blank, W.C., Cornelius, N.H., Roberts, W.R., Bell, W.J., Raibert, M.: Measuring and developing suturing technique with a virtual reality surgical simulator. J. Am. Coll. Surg. 189, 114–127 (1999)CrossRefGoogle Scholar
  12. 12.
    Mimic Technologies MSim 2.1 software upgrade enables dV-Trainer customers to perform tube anastomosis and tube closure exercises. Accessed 25 Feb 2016
  13. 13.
    dV-Trainer - Proven, cost-effective training for the da Vinci Surgical System. Accessed 25 Feb 2016
  14. 14.
    Hüsken, N., Schuppe, O., Sismanidis, E., Beier, F.: MicroSim-a microsurgical training simulator. In: Studies in Health Technology and Informatics, pp. 205–209 (2013)Google Scholar
  15. 15.
    Wang, F., Su, E., Burdet, E., Bleuler, H.: Development of a microsurgery training system. In: 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS 2008, pp. 1935–1938 (2008)Google Scholar
  16. 16.
    Park, Y., Shinke, M., Kanemitsu, N., Yagi, T., Azuma, T., Shiraishi, Y., Kormos, R., Umezu, M.: A surgical training simulator for quantitative assessment of the anastomotic technique of coronary artery bypass Grafting. In: IFMBE Proceedings, pp. 1179–1182 (2009)Google Scholar
  17. 17.
    Brown, N., Natsupakpong, S., Johannsen, S., Manjila, S., Cai, Q., Liberatore, V., Cohen, A.R., Cavusoglu, M.C.: Virtual environment-based training simulator for endoscopic third ventriculostomy. Stud. Health Technol. Inform. 119, 73–75 (2006)Google Scholar
  18. 18.
    Lemole, G.M., Banerjee, P.P., Luciano, C., Neckrysh, S., Charbel, F.T.: Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback. Neurosurgery 61, 142–148 (2007)CrossRefGoogle Scholar
  19. 19.
    Huang, D., Tang, W., Ding, Y., Wan, T., Chen, Y.: An interactive 3D preoperative planning and training system for minimally invasive vascular surgery. In: 2011 12th International Conference on Computer-Aided Design and Computer Graphics (CAD/Graphics), pp. 443–449 (2011)Google Scholar
  20. 20.
    Huang, D., Tang, W., Wan, T.R., John, N.W., Gould, D., Ding, Y., Chen, Y.: A new approach to haptic rendering of guidewires for use in minimally invasive surgical simulation. Comput. Anim. Virtual Worlds 22, 261–268 (2011)CrossRefGoogle Scholar
  21. 21.
    Brown, J., Sorkin, S., Bruyns, C., Latombe, J.-C., Montgomery, K., Stephanides, M.: Real-time simulation of deformable objects: tools and application. In: Conference Proceedings on Computer Animation, pp. 228–236 (2001)Google Scholar
  22. 22.
    Chen, D., Gourishankar, V., Rawley, C., Grinstein, G.: The QuickHaptics microAPI: enabling haptic mashups. In: 2010 IEEE Haptics Symposium, HAPTICS 2010, pp. 269–272 (2010)Google Scholar
  23. 23.
    Culbertson, H., Lopez Delgado, J.J., Kuchenbecker, K.J.: One hundred data-driven haptic texture models and open-source methods for rendering on 3D objects. In: 2014 IEEE Haptics Symposium (HAPTICS), pp. 319–325 (2014)Google Scholar
  24. 24.
    Yamaguchi, T., Oshima, K., Hirano, Y., Makishima, A., Harada, T., Richard, P.: Component-based authoring tool for haptic navigation. In: Proceedings of the 10th International Conference on Computer Graphics Theory and Applications (VISIGRAPP 2015), pp. 486–491 (2015)Google Scholar
  25. 25.
  26. 26.
  27. 27.
  28. 28.
  29. 29.
    Müller, M., Chentanez, N.: Solid simulation with oriented particles. In: ACM SIGGRAPH 2011 Papers, British Columbia, Canada, pp. 92:1–92:10. ACM, Vancouver (2011)Google Scholar
  30. 30.
    Chen, X.: Real-time Physics Based Simulation for 3D Computer Graphics,, (2013)
  31. 31.
    Maggiorini, D., Ripamonti, L.A., Panzeri, S.: Follow the leader: a scalable approach for realistic group behavior of roaming NPCs in MMO games. In: Proceedings of the Twelfth European Conference on the Synthesis and Simulation of Living Systems: Advances in Artificial Life, ECAL 2013, Sicily, Italy, 2–6 September 2013, pp. 706–712 (2013)Google Scholar
  32. 32.
    Liu, T., Bargteil, A.W., O’Brien, J.F., Kavan, L.: Fast simulation of mass-spring systems. ACM Trans. Graph. 32, 214:1–214:7 (2013)Google Scholar
  33. 33.
  34. 34.
    Hernandez-Belmonte, U.H., Ayala-Ramirez, V., Sanchez-Yanez, R.E.: A mobile robot simulator using a game development engine. In: Proceedings of the 1st Robotics Summer Meeting, 27–28 June 2011, pp. 5–11 (2011)Google Scholar
  35. 35.
    Craighead, J., Burke, J., Murphy, R.: Using the unity game engine to develop SARGE: a case study. Computer 4552, 366 (2008)Google Scholar
  36. 36.
    Cadavid, A.N., Ibarra, D.G., Salcedo, S.L.: Using 3-D video game technology in channel modeling. IEEE Access. 2, 1652–1659 (2014)CrossRefGoogle Scholar
  37. 37.
  38. 38.
    Qin, J., Chui, Y.P., Pang, W.M., Choi, K.S., Heng, P.A.: Learning blood management in orthopedic surgery through gameplay. IEEE Comput. Graph. Appl. 30, 45–57 (2010)Google Scholar
  39. 39.
    Lin, Y., Wang, X., Wu, F., Chen, X., Wang, C., Shen, G.: Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill. J. Biomed. Inform. 48, 122–129 (2014)CrossRefGoogle Scholar
  40. 40.
  41. 41.
    Nazarov, J.G.R.: Native browser support for 3D rendering and physics using WebGL, HTML5 and Javascript. In: BCI 2013, 19–21 September 2013, Thessaloniki, Greece, pp. 21–24 (2013)Google Scholar
  42. 42.
  43. 43.
  44. 44.
    Mitchell, J.D., Siegel, M.L., Schiefelbein, M.C.F., Babikyan, A.P.: Applying publish-subscribe to communications-on-the-move node control. Lincoln Lab. J. 16(2), 413–430 (2007)Google Scholar
  45. 45.
  46. 46.
    Birr, S., Mönch, J., Sommerfeld, D., Preim, U., Preim, B.: The LiverAnatomyExplorer: a WebGL-based surgical teaching tool. IEEE Comput. Graph. Appl. 33, 48–58 (2013)CrossRefGoogle Scholar
  47. 47.
    Tommaso De Paolis, L., Ricciardi, F., Giuliani, F.: Development of a serious game for laparoscopic suture training. In: Paolis, L.T., Mongelli, A. (eds.) AVR 2014. LNCS, vol. 8853, pp. 90–102. Springer, Heidelberg (2014)Google Scholar
  48. 48.
    Ricciardi, F., De Paolis, L.T.: A comprehensive review of serious games in health professions. Int. J. Comput. Games Technol. 2014, e787968 (2014)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Valerio De Luca
    • 1
  • Antonio Meo
    • 1
  • Antonio Mongelli
    • 1
    Email author
  • Pietro Vecchio
    • 1
  • Lucio T. De Paolis
    • 1
  1. 1.Department of Engineering for InnovationUniversity of SalentoLecceItaly

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