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133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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The OpenHELP Project: Heidelberg laparoscopy phantom as an open-source surgical evaluation and training tool

Meeting Abstract

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  • Martin Wagner - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Martin Apitz - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Josephin Wünscher - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Anas Amin Preukschas - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Anna-Laura Wekerle - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Felix Nickel - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Peter Neher - Deutsches Krebsforschungszentrum, Medizinische und Biologische Informatik, Heidelberg, Deutschland
  • Stefan Suwelack - Karlsruher Institut für Technologie, Institut für Anthropomatik und Robotik, Karlsruhe, Deutschland
  • Stefanie Speidel - Karlsruher Institut für Technologie, Institut für Anthropomatik und Robotik, Karlsruhe, Deutschland
  • Dare Oladokun - Deutsches Krebsforschungszentrum, Medizinische und Biologische Informatik, Heidelberg, Deutschland
  • Lena Maier-Hein - Deutsches Krebsforschungszentrum, Medizinische und Biologische Informatik, Heidelberg, Deutschland
  • Rüdiger Dillmann - Karlsruher Institut für Technologie, Institut für Anthropomatik und Robotik, Karlsruhe, Deutschland
  • Hans-Peter Meinzer - Deutsches Krebsforschungszentrum, Medizinische und Biologische Informatik, Heidelberg, Deutschland
  • Beat Peter Müller - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Hannes Götz Kenngott - Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch559

doi: 10.3205/16dgch559, urn:nbn:de:0183-16dgch5594

Published: April 21, 2016

© 2016 Wagner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Surgical evaluation of new laparoscopic technology and training requires animal or artificial phantoms before introduction to the clinic. Besides ethical and economic concerns, the animal model is not completely congruent with human anatomy and artificial phantoms usually lack haptic and motional realism. The aim of the OpenHELP project was to provide a realistic phantom in terms of haptic and anatomy for better evaluations of new laparoscopic technologies and surgical training. The proposed procedure was designed to be cost-effective and easily reproducible.

Materials and methods: The OpenHELP phantom was based on an anonymized computed tomography (CT) scan of a 26-year-old male patient. The patient was hospitalized at the University Hospital of Heidelberg due to a car accident. The CT scan (Siemens Somatom Definition AS 40, Siemens AG, Munich, Germany) was performed with contrast agent in accordance with standard emergency room protocol. The patient was chosen because no pathologies were detectable and anatomical structures were clearly distinguishable. Organs and torso were segmented into digital three-dimensional models with the Medical Imaging Interaction Toolkit (MITK, German Cancer Research Center, Heidelberg). The torso was then 3D-printed using stereolithography. The organs were first printed in gypsum using a 3D-printer (Z 450, Z Corporation, Burlington, USA). Then, with the help of the 3D gypsum organ model, a reusable silicone mold was created with which silicone organs could be produced. Reproducibility was evaluated by comparing the three-dimensional surface of the original rectum in the CT scan with the silicone organs and the gypsum organ. Haptic realism of the different silicone compositions was evaluated by five surgical residents and one consultant on a visual analogue scale (0 to 10).

Results: The root mean square of error between the ten silicone rectum phantoms and the gypsum model was 1.62 mm. The models with three parts of soft silicone (shore 00-30) and one part of softening agent provided the best haptic realism (VAS 7.25; 5.2-9.6). Initial cost of torso and further equipment were calculated an investment of 5,600 € with recurring costs of 200 € per organ set.

Conclusion: The phantom was built and proved its reproducibility and haptic realism that can improve and ensure the translation into human anatomy for laparoscopic, but also for endoscopic and open surgery. In contrast to previous phantoms it is build based on real human anatomy. All data is provided as open-source under creative commons license for the scientific community on www.open-cas.org for further improvements.