A Da Vinci Open Spina Bifida Suturing Simulator with Continuum Tools for Surgeon Skills Training

Abstract

Open Spina Bifida (OSB) is a congenital neural tube defect that affects approximately 1 in 1000 births worldwide. Robotic in-utero OSB repair provides a minimally invasive alternative to open-surgery, which places significant strain on both baby and mother. Recent advancements in da Vinci miniature continuum tools reduce port sizes through the uterus for access to the fetus with lower maternal risk. However, idiosyncrasies in continuum tool behaviour further complicate an already difficult procedure. Consequently, a high-fidelity da Vinci OSB repair simulator is presented featuring continuum tools for surgeon skills training. The simulator incorporates a plugin for suture physics handling, soft body physics for deformable tissues and implements haptic virtual fixtures for improved situational awareness during suturing. Quantitative validation demonstrated virtual tool accuracy, with a mean-squared continuum backbone error of 0.64 mm<sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> and system-level end-effector trajectory errors averaging 3.25 mm for a helix tracing task. During suturing, high-fidelity performance was maintained. Four expert surgeons from relevant specialties provided positive qualitative feedback, reporting that the simulator accurately replicates real tool control and offers a realistic and valuable training experience. Ultimately, the simulator shows promise as a training platform for safer robotic in-utero OSB repair and facilitating the adoption of novel continuum wristed tools in clinical settings.