TOWARD AN IMMERSIVE VIRTUAL ENDOSCOPIC SLEEVE GASTROPLASTY SIMULATOR

Abstract

Obesity is a pervasive public health concern in the United States. For severe cases of obesity, bariatric surgery reliably achieves lasting weight loss; however, it's rarely prescribed for eligible patients due to its risks and expenses. Endoscopic sleeve gastroplasty (ESG) is one of the many alternative procedures developed as a result. ESG holds great promise with its effectiveness, fast post-operative recovery, and low risk of adverse events, but there has been a lack of virtual ESG simulators that can be used for training as well as evaluation. This thesis proposes the Virtual Bariatric Endoscopic Simulator (ViBE) as an ESG simulator to fill that gap, through the synthesis of two studies, a survey of emerging technologies in endoscopic surgery and a user study of ViBE with a newly added endoscopic control system and immersive virtual reality (VR) display. The first study is a review of recent trends in extended reality (XR), artificial intelligence/machine learning (AI/ML), digital twins, and 3D printing, all fields that have been seeing rapid growth, as they apply to endoscopic surgery. 78 studies have been chosen for review after searching five databases. Results show that advances in extended reality have enabled more realistic and immersive training environments for endoscopic procedures for improving psychomotor skill acquisition and spatial awareness in simulated settings. Digital twin technologies have improved the fidelity of patient-specific anatomical models and instrument tracking for preoperative planning and intraoperative navigation. Artificial intelligence and machine learning approaches support automated tissue segmentation, anomaly detection, and predictive control of robotic endoscopic instruments. Meanwhile, 3D printing advances have allowed for the rapid fabrication of customized endoscopic tools, patient-specific anatomical phantoms, and rehearsal models, which are vital in procedure-specific training and design optimization for each operation and patient. The second study describes ViBE, integrates it with a new controller replicating real endoscopic equipment and an immersive VR display, conducts a user study to test those new features, and integrates the provided feedback to improve the simulator's realism and usability. The user study involved 14 participants of varying expertise levels and focused on validating the control system and VR display. Feedback from the participants indicated that the control system was promising and the VR setup did allow better immersion, and highlighted potential improvements for the control system's realism and usability, which have been largely implemented. These two studies support ViBE's ongoing development into a full-fledged ESG simulator. The first study summarizes recent advancements in applying emerging technologies to endoscopy, revealing trends that can be useful for immersive virtual surgical simulators such as ViBE. The second study discusses ViBE's own recent advancements and the way forward.