MadiganEndoscopic Sinus Surgery Simulator
Changes - Phase 3

Expand the simulator evaluation to address the question: What is the impact
of experience with the simulator on actual operating room performance?"
Upgrade our existing computer hardware at least doubling its processing
power for our application.
Port our real-time software to the new computer and tailor its operation for
that machine.
Increasing the number of polygons to take advantage of the new hardware.

Segmenting additional features including the sphenoid ostium and sphenoid
sinus cavity.
Creating polyps and mucocels that can be inserted into the standard patient
Evaluate the NLM visible female data set.  Considering the outcome of our
evaluation, we will use the NLM data or collect our own data from a suitable
cadaver to create a second patient model.
Make software revisions that the evaluation phase indicates.  Dr. Edmond
will prioritize requirements.  We will implement new requirements based upon
those priorities.
Evaluate the Haptic System.
If the evaluation outcome shows that it would be better to apply forces to
the endoscope than to the dissection instrument we will modify the hardware
 We will attempt to model structures that meet expert expectations of
We will refine our patient model extraction process.  This includes improved
automation in the extraction phase.
The prototype is currently and will continue to be tested as new residents
become availbable.
We will use the original trainer to continue evaluations while we upgrade
the device in parallel.
We will continue to gather information about its usability (human factors
data) and success in training (performance and comprehension data).
We use five standard techniques for gathering information on training
effectiveness; Observation, Performance Tests, Debriefing, Think-Aloud, and
Audit Trails.
For this follow-on effort, we will address three basic evaluation questions:

QUESTION 1 (proposed) -- What is the impact of experience with the simulator
on actual OR performance?
QUESTION 2 (proposed) -- How does experience with the simulator affect
individual components of surgical competence?
QUESTION 3 -- What is the effectiveness of the various training aids and
protocol methods incorporated into the simulator?
The uncinate is displacable; yielding a crease for guiding incision.
The sickle knife must be able to cut in a downward direction.
The endoscope camera and lens shall roll independently.
The instructor can reset the orientation of the endoscope cable feed.
Obsticles shall provide negative scoring in the novice model.
A seeker shall be added that allows one to feel the anterior surface of the
An Inventor viewer should be added showing the entire anatomy from a
"gods-eye" view.
The skull base and its anterior and posterior ethmoid arteries should be
The Lamina Papyracea and its artwork shall be modeled.
The Agger Nasi Cell chall be modeled and be dissectable.
The Carotid Artery indentation in the sphenoid sinus cavity shall be
The Optic Nerve indention in the sphenoid sinus cavity shall be modeled.

The frontal Sinus Cavity shall be modeled.
The mannequin shall constrain the tool shafts to the active nostril.
The Naso-Lacrimal duct shall be modelled.
The Frontal OS shall be modelled and be dissectible.
The Frontal Recess shall be segmented, modelled and be dissectible.
Add Virtual Instructor; containing all current instructor controls in a
voice activated fashion.
Add suggest and identify to the virtual instructor.
Add Xomed Round Bur
Add Xomed Agressive Router Bur
Add Xomed Rad 40 Curved Blade
Add time stamp to frame-based recorded records.
Get closed state of scissors-like grip while the tool is in the calibration
Concha Bullosa should dissect like a membrane.
Add the posterior Choana
Add the Naso-Pharynx
Add the Adnoid Pad
Add the Eustacian Tube
Add the Naso-Pharyngeal Outlet
The rotation speed shall be controlled ONLY by the foot switch
The Agger Nasi Cell shall be placed directly in line with the uncinate (more
forward and inferior than the visible male.)
Add labels for every segmented patient component.
Place each novice-level objective at a location that is identical to the
anatomical component that it dissects.
Base stiffness on Patient Component.
Dissection of arteries should cause massive bleeding.
Add ability to pack nasal passage with forceps.
Remove mode controls from the virtual instructor.
Add "nice" as a null command to the virtual instructor.
Reduce warnings to 1%, 25%, 50%, 75%, and 100%.w3
Turn off audio cues on advanced model.
Extend Lamina to cover the peri-orbital fat.
Move round burr objective to coinside with the lamina.
Place scissors objective at middle of middle turbinate.
Change the sequence so that the knife objective does not follow the burr.

Enlarge the fat to fill area adjacent to the lamina.
Break apart the lamina model into lamina and peri-orbita
Add a score for the agger-nasi cell.
Reduce the weight of the lamina to almost zero; leave warnings.
Dissecting half the obstacle should negate the score for the entire
Reduce the weight for the artery by half.
Move the last hoop of pass 2a to the sphenoid OS.
Increase depth for knife obstacles
Stop dissection timer when all scores are satisfied.
Rotate burr obsatcle more toward line of sight.
Reduce cutting of uncinate so that maxillary sinus is not exposed.
Add "activate" to virtual instructor.
Give verbal confirmation to all VI commands.
Add forces on/off through virtual instuctor.
Add a 45-degree scope
Martin should speak from first-person instead of third-person
Add haptic controls to events record
Announce injection and disseciton progress once, at completion of each
DO NOT limit the number of suggestions

Last Update: 09/21/98