SURGICAL SIMULATOR

Description

1 / 59 SURGICAL SIMULATOR FIELD OF THE INVENTION

[001] This invention relates to the field of surgical simulation and, in particular, to a surgical simulator system and a surgical method with haptic force feedback. BACKGROUND OF THE INVENTION

[002] In many parts of the world, people suffer from blindness. Compared to other types of disability, the impact of blindness is particularly destructive and can be economically devastating. Blind people cannot see to work, care for themselves, or care for anyone else. In most cases, they lack access to adequate medical care. In most cases, vision loss due to cataracts occurs gradually over many years and results in reduced quality of life, reduced disposable income for the family, and increased dependence on family caregivers (usually children who should be in school). Overall health is affected as a result of increased risk of injury, inability to see injuries to properly care for them (such as cuts and scrapes that can become infected), and reduced ability to maintain adequate nutrition. Many blind people die as a result of their blindness.

[003] Millions of people with blindness could be cured, because blindness is often caused by cataracts which can be surgically removed from the eye to restore vision. Unfortunately, the resources are simply not available to provide this cure in many parts of the world. Petition 870250090308, dated 03 / 10 / 2025, p. 9 / 110 2 / 59 worldwide. In developing countries, resources for the blind are scarce or nonexistent, white cane policies (providing awareness and safety for the blind) and other disability legislation are often lacking, and the family bears the burden alone. As a result, cataract blindness is also associated with extreme poverty and an increased risk of death.

[004] The fact that cataracts are common also makes blindness an expected disability in developing countries, especially among the poor. It is understood to be part of the aging process and is accepted as such. The information available on cataracts and cataract surgery is generally insufficient or inaccurate. Patients who have gone to traditional healers or poorly trained surgeons often receive poor information and inadequate treatment. Surgical treatment is feared, and many people prefer to remain blind rather than undergo surgery. As a result, blind patients in developing countries often come to believe that their only option is to live blindly, wishing to be free from the bleak world in which they have been forced to live, but unable to do anything about it.

[005] Phacoemulsification (PE) cataract surgery and conventional extracapsular cataract extraction (ECCE) surgery, including their variants, are the two main cataract surgery techniques used universally. Although PE cataract surgery is considered the gold standard for cataract removal, it requires expensive machinery and an uninterrupted power source. The overall cost and maintenance of PE machinery and supplies Petition 870250090308, dated 03 / 10 / 2025, page 10 / 110 3 / 59 makes it prohibitive for regions with inadequate infrastructure. PE also presents a higher rate of intraoperative complications when performed on patients with advanced cataracts.

[006] A popular variant of ECCE surgery that can be performed without sutures is known as manual small-incision cataract surgery (MSICS). A distinct advantage of MSICS over ECCE is that a smaller incision is used to remove the natural cataract lens and implant an intraocular lens (IOL). The smaller incision is also shaped to be self-sealing and sutureless. This translates to shorter healing times, significantly less astigmatism, reduced intraoperative risk, and a shorter overall postoperative recovery. ECCE and MSICS do not rely on any motorized machinery other than an operating microscope.

[007] MSICS and ECCE are widely practiced outside of North America and Europe. When comparing different surgical techniques and application circumstances worldwide, MSICS is often the preferred technique for high-volume cataract surgery. MSICS can be used to restore vision safely and economically in developing countries, where the majority of blind people live, and with the same quality that would be expected in the high-tech world. Although many variations exist in the technique, the basic idea of ​​MSICS revolves around producing and properly utilizing a tunnel large enough to remove even dense cataracts, yet stable enough to be self-sealing and have minimal impact on corneal curvature.

[008] Although MSICS is an alternative Petition 870250090308, dated 03 / 10 / 2025, page 11 / 110 4 / 59 proven to solve the problem of cataract blindness in developing countries, there is a shortage of ophthalmologists skilled in the technique. In some sub-Saharan African countries, for example, there is, on average, one ophthalmologist per million individuals. To address the burden of global cataract blindness, there is an urgent need to train a substantial number of surgeons in the MSICS technique. In modern times, even in developing countries, surgeons are able to provide PE as a care procedure for patients who can afford it. Global rates of cataract blindness can be significantly reduced by increasing the number and skill level of available surgeons capable of performing cataract surgery.

[009] It is also important that surgeons learn how to manage complications when surgical errors occur or when presented with patients with complex conditions. For example, for patients presenting to an emergency ward with ocular trauma, the initial care provided can be a determinant of visual outcomes. Surgeons need to be well-trained for such scenarios, which do not occur frequently but can have a major impact on the outcome.

[0010] A significant portion of the training need can be met by high-quality, high-efficiency simulation-based training without risk to the patient. Therefore, there is a need for a surgical simulator system and method that allows users to master manual small-incision cataract surgery (MSICS), phacoemulsification (PE), and complication management for Petition 870250090308, dated 03 / 10 / 2025, page 12 / 110 5 / 59 Cataract surgery and ocular trauma management. SUMMARY OF THE INVENTION

[0011] One objective of the present invention is to provide surgical simulator systems and methods that provide visual, tactile, and audio cues to a user to simulate eye surgery.

[0012] Another objective of the present invention is to provide simulation systems.

[0013] and methods that model tissues, use of surgical tools and interactions between surgical tools and modeled tissue, and allow a user to practice and become proficient in a surgical procedure.

[0014] Another objective of the present invention is to provide simulation systems and methods that gradually introduce a comprehensive matrix of realistic patient factors and surgical complications so that the learner experiences the live sensation of surgery, including the many variables and errors that can occur.

[0015] Yet another objective of the present invention is to provide simulation systems and methods that allow a student's performance to be monitored and evaluated for feedback, corrective instruction, scoring, and progression.

[0016] Another objective of the present invention is to provide simulation systems and methods that use a mesh model to construct and display visuals using rasterization or ray tracing, while a physical model that influences properties such as collision detection and fabric deformation is run in parallel. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] A deeper understanding of Petition 870250090308, dated 03 / 10 / 2025, page 13 / 110 6 / 59 The invention can be obtained by reference to the embodiments shown in the illustrations of the accompanying drawings. Although the illustrated embodiments are merely exemplary of systems, methods and apparatus for carrying out the invention, both the organization and the method of operation of the invention, in general, together with other objectives and advantages, can be more easily understood by reference to the drawings and the description that follows. Similar reference numbers generally refer to similar features (e.g., functionally similar and / or structurally similar elements).

[0018] The drawings are not necessarily represented to scale; in some cases, various aspects of the material disclosed in this document may be shown exaggerated or enlarged in the drawings to facilitate the understanding of different features. Furthermore, the drawings are not intended to limit the scope of this invention, which is presented in particular in the claims appended to this document or subsequently amended, but only to clarify and exemplify the invention.

[0019] Figure 1a is a representation of a simulated surgical environment according to the present invention.

[0020] Figures 1b-1c depict an exemplary simulated microscope according to the present invention.

[0021] Figures 1d-1e depict an alternative embodiment of a simulated surgical environment according to the present invention.

[0022] Figure 2 is a graph that describes the interaction between a simulated surgical environment and computer components according to the present invention. Petition 870250090308, dated 03 / 10 / 2025, page 14 / 110 7 / 59

[0023] Figure 3a is a diagram illustrating the hardware components of a simulator according to the present invention.

[0024] Figure 3b is a diagram illustrating the software components of a simulator according to the present invention.

[0025] Figure 3c is a graph illustrating the computer components of a simulator according to the present invention.

[0026] Figure 3d is a graphic that illustrates an exemplary connection between a simulator, a central server and instructor clients according to the present invention.

[0027] Figures 4a to 4f depict simulated physical eye models according to the present invention.

[0028] Figures 5A to 5C represent simulated images visible through a simulated microscope according to the present invention.

[0029] Figure 6a is a table of exemplary tools that can be simulated by a haptic right arm according to the present invention.

[0030] Figure 6b is a table of exemplary tools that can be simulated by a haptic left arm according to the present invention.

[0031] Figures 7a and 7b show the steps for performing MSIC surgery and the tools that can be simulated by haptic arms according to the present invention.

[0032] Figure 8 depicts an exemplary simulator user interface according to the present invention. Petition 870250090308, dated 03 / 10 / 2025, p. 15 / 110 8 / 59

[0033] Figure 9 depicts an exemplary simulator user interface according to the present invention.

[0034] Figure 10 depicts an exemplary pedal unit according to the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0035] The invention can be more easily understood by reference to the following detailed descriptions of embodiments of the invention. However, techniques, systems, and operational structures according to the invention can be incorporated in a wide variety of forms and modes, some of which may be quite different from those in the disclosed embodiments. Furthermore, the features and elements disclosed herein can be combined to form various non-exclusive combinations, unless expressly stated otherwise. Consequently, the specific structural and functional details disclosed herein are merely representative. However, in this respect, they are considered to provide the best embodiments for disclosure purposes and provide a basis for the claims contained herein, which define the scope of the invention.It should be noted that, as used in the descriptive report and attached claims, the singular forms a, an, and the include plural references, unless the context clearly indicates otherwise.

[0036] When a range of values ​​is given, it is understood that each intermediate value, up to the tenth of a unit of the lower limit, unless the context clearly states otherwise, between the upper and lower limits of that range is also specifically revealed. Each smaller range Petition 870250090308, dated 03 / 10 / 2025, page 16 / 110 9 / 59 between any stated value or intermediate value in a stated range and any other stated or intermediate value in that stated range is covered by the invention. The upper and lower limits of these smaller ranges may be independently included or excluded in the range, and each range in which one, neither, or both limits are included in the smaller ranges is also covered by the invention, subject to any limit specifically excluded in the stated range. When the stated range includes one or both limits, the ranges that exclude one or both included limits are also included in the invention.

[0037] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention pertains. Although any methods and materials similar or equivalent to those described herein may be used in the practice or testing of the present invention, some potential and preferred methods and materials are now described. All publications mentioned herein are incorporated herein by reference to disclose and describe the methods and / or materials in connection with which the publications are cited. It is understood that this disclosure supersedes any disclosure of an incorporated publication to the extent that there is a contradiction.

[0038] The present invention is described in the context of eye surgery, such as MSICS surgery or PE surgery. However, the present invention can be used to simulate other types of surgical procedures performed on the human eye or other parts of the human body. The present invention also Petition 870250090308, dated 03 / 10 / 2025, page 17 / 110 10 / 59 can be used to simulate veterinary surgery. The present invention can also be used to assess the skills required to perform general surgery or a specific type of surgery when, for example, a medical student is considering whether to pursue a career in surgery, including a career in a specialized field of surgery, or shortly before a practicing surgeon performs surgery.

[0039] The present invention can stem the tide of cataract blindness worldwide by significantly increasing the number of highly skilled ophthalmological surgeons. The surgical simulator of the present invention can be used to provide the necessary skills training on a large scale. The training provided is comprehensive, the learner's progress is performance-based, and successful completion of the training allows the learner to become part of the global network of cataract surgeons. The training can be administered to individuals with no prior knowledge or experience in ophthalmological care. Success in the training program is performance-based—each learner proves they possess the basic language, intellect, motor skills, and depth perception necessary to master the applicable surgery by demonstrating the required performance to progress in the training program.The data collected during admission can be compared with performance during training to refine admission tests and establish standardized criteria.

[0040] By using the surgical simulator systems and methods of the present invention, the user can Petition 870250090308, dated 03 / 10 / 2025, page 18 / 110 11 / 59 progress methodically and efficiently through the learning process, so as to experience a spectrum of surgical challenges and variations in a relatively short period of time, without ever putting a patient at risk. After successful completion of simulator-based training, the trainee can return to surgical facilities in their own country to begin live surgical training under the supervision of a mentor surgeon. Normally, live surgical training can take years to complete and often leaves gaps in experience. But due to the advanced simulation experience, users of the present invention can progress rapidly to high-quality independent work. The approximate transition to independent surgical care is expected to take one to six months.

[0041] The surgical simulator and method of the present invention can gradually introduce, through simulation, a comprehensive matrix of realistic patient factors and surgical complications associated with each step, so that the learner experiences the live sensation of surgery, including the many variables, complications, and errors that can occur during live surgery. Simulator-assisted training provides a safe and efficient means of preparing for live surgical experience. The training experience presents a wide variety of surgical situations to develop confidence and surgical intuition for live surgery without risk to patients. The learner's performance on simulator assignments can be monitored and evaluated for feedback, corrective instruction, scoring, and progression. Each student can practice and learn until a desired level of proficiency is demonstrated in the Petition 870250090308, dated 03 / 10 / 2025, p. 19 / 110 12 / 59 simulator.

[0042] For MSICS or PE surgery to be successful, the following five tasks must be completed sequentially during simulation: (1) completing patient preparation, (2) creating a self-sealing tunnel in the eye, (3) removing the cataract, (4) inserting the intraocular lens (IOL), and (5) restoring conditions that optimize the healing process.

[0043] The eye surgery simulator comprises the hardware and software to display an eye, both visually and haptically. The simulator provides visual, tactile, and audio cues to the user to simulate a realistic MSICS / PE / Complication Management / Ocular Trauma surgery. Parameters based on haptic and visual rendering can be derived from live surgical force data. Alternatively, the eye surgery models presented in the simulator can be based on subjective evaluation by expert surgeons and / or objective validation of the models. Haptic rendering can provide the student with virtually the same instrument forces that are experienced during live surgery. Visual rendering can reproduce the images in a non-pixelated stereoscopic display with photorealistic quality, so as to mimic what a surgeon would see during live surgery under a binocular surgical microscope.Modeling can include: (1) tool-tissue interaction, (2) tissue-to-tissue interactions, (3) tissue connections, (4) tissue dissection, (5) alteration of tissue properties, (6) intraocular pressure, (7) fluid injection and aspiration, (8) fluid propagation, (9) sound reproduction in response to events, and (10) movement of the model patient's head. Petition 870250090308, dated 03 / 10 / 2025, page 20 / 110 13 / 59

[0044] The eye surgery simulator may include the following simulation elements: (a) a simulator with haptic arms, (b) a physics-based computer model, and (c) a visual image generator. The eye surgery simulator may also include an instructor / student operator station. SIMULATOR WITH HAPTIC ARMS

[0045] With reference to Figures 1a and 2, the simulator (101) may comprise the body of the stretcher (103) from which a simulated model of a patient's head (105) is projected. The simulator (101) may additionally include a simulated microscope (107) through which the user may perceive a simulation. The right haptic arm (109) and the left haptic arm (111) may be connected and controlled by the right haptic mechanism (113) and the left haptic mechanism (115), respectively. The simulator (101) may additionally include a touch screen (117) and a simulated aspiration syringe instrument (119).

[0046] Figures 1d-1e depict an alternative and compact version of a simulator (401).

[0047] The simulator (401) may include a truncated stretcher body (403) from which the head of a simulated patient (405) projects. The simulator (403) may additionally include a simulated microscope (407), right and left haptic arms (409, 411) and right and left haptic mechanisms (413, 415) that can be connected to and control the haptic arms (409, 411). The simulator (401) may additionally include one or more legs (425) that can be used to position the simulator (401) on a horizontal surface, such as a tabletop (not shown). The legs (425) can be extended and / or Petition 870250090308, dated 03 / 10 / 2025, p. 21 / 110 14 / 59 retracted to ensure that the simulator (401) is level with the ground and / or to position the simulator at a height that is ergonomically correct for the surgeon using the simulator. Tabletop simulators can be placed on height-adjustable platforms for similar functions.

[0048] A surgeon's hands and fingers are too large to directly manipulate the small and delicate tissues of the eye. As such, to perform ophthalmic surgery, a surgeon uses certain instruments or tools. In the present invention, these instruments are simulated by the haptic right arm (109) and the haptic left arm (111). Haptic arms (109, 111) are provided in the workspace and held in the user's right and left hands to simulate surgery. For example, haptic arms (109, 111) are used to perform actions on a virtual eye while looking through the viewer of the simulated microscope (107). A user can select instruments for simulation and move the instruments to the operating area of ​​the simulator under the simulated microscope (107). The user can use these instruments to simulate various surgical tasks.

[0049] The simulator (101) may additionally include a camera with a field of view that includes the operating area. Figures 1b-1d depict an alternative embodiment of the simulated microscope (207) which may have a camera (217) facing downwards, towards the operating area. While the user positions and manipulates the right haptic arm (109) and the left haptic arm (111) during a simulated surgery, the camera (217) may capture still images, including video, of the haptic arms (109, 111) and / or hands. Petition 870250090308, dated 03 / 10 / 2025, page 22 / 110 15 / 59 of the user. Additional applications of these systems may include providing resources for remote training.

[0050] The haptic arms (109, 111) provide tactile realism in the form of force feedback when working in the virtual eye model. Haptic arms (109, 111) are motion control devices that provide a realistic sense of the forces on the user's fingers, hands, and arms that hold the instruments while the instruments interact with the virtual eye. The virtual eye is programmed to accurately simulate a response or behavior that would be caused by interactions between an eye and selected instruments. For example, to simulate holding an eye and increasing pressure on the eye by pressing the eye with a Colibri clamp, one of the haptic arms (109, 111) can simulate a Colibri clamp that can be used to restrict eye movement in the simulated microscope viewfinder (107).The resistance of the corresponding haptic mechanism (113, 115) can be increased to simulate an increase in the hardness of the eye that would be felt by the Colibri forceps or other tool as the tool collides with the eye. Similarly, simulating interaction with a crescent blade would result in the cutting of the virtual eye's ocular tissues according to the edge, angle, force, nature of the movement, etc. of the simulated blade. The simulator can also simulate interactions between two or more tools.

[0051] Haptic arms (109, 111) provide simultaneous, bimanual use to represent tools that can be used in actual surgery. Preferably, haptic arms (109, 111) are representative of actual surgical instruments. In one embodiment, haptic arms (109, Petition 870250090308, dated 03 / 10 / 2025, page 23 / 110 16 / 59 111) allow the exchange of handles that are representative of real surgical instruments. In another embodiment, the haptic arms (109, 111) include permanently mounted handles that are representative, but may not be exact replicas of real surgical instruments. In both cases, the visual appearance of the instrument under the simulated microscope (107) may change for each instrument type.

[0052] The simulator can also simulate other tools, such as, for example, a Simcoe Cannula syringe. Figures 6a-6b are exemplary lists of tools that can be simulated by the simulator. Each tool can have three translational degrees of freedom. The haptic point of interest for these translations is at the tip of the tool. Three passive rotational degrees of freedom are also provided and measured. Their rotations are centered on this same point of interest. The haptics are based on the use of admittance control, with the use of a force sensor as input.

[0053] The surgical simulator may also include a foot pedal unit that can be used to perform various functions. The foot pedal unit can be connected to the surgical simulator's computer hardware by a wired or wireless connection. Figure 10 depicts an exemplary foot pedal unit (1100). The foot pedal unit (1100) may include a foot pedal (1200) with an upper surface (1220) adapted for contact with the user's foot. The foot pedal unit (1100) may additionally include one or more switches (1240, 1250, 1260, 1270). As shown in Figure 10, each switch (1240, 1250, 1260, 1270) can be located next to the pedal (1200). The switches (1240, 1250, 1260, 1270) can also be adapted for contact by the user's foot. The functions Petition 870250090308, dated 03 / 10 / 2025, page 24 / 110 17 / 59 executed by the pedal (1200) and by the switches (1240, 1250, 1260, 1270) can be predetermined and / or programmed, for example, by the user. Pressing the foot pedal (1200) and / or the switches (1240, 1250, 1260, 1270) so that the pedal (1200) and / or the switches (1240, 1250, 1260, 1270) move from a first position to a second position can, for example, change one of the tools represented in the surgical simulation from a first tool (e.g., a scalpel) to a second tool (e.g., forceps). As another example, pressing the pedal (1200) and / or switches (1240, 1250, 1260, 1270) can simulate the injection or aspiration of a fluid. As another example, pressing the pedal (1200) and / or switches (1240, 1250, 1260, 1270) can adjust the physical configuration of the surgical simulator, such as increasing or decreasing the height of the simulator above the ground, increasing or decreasing the height of the simulated microscope, changing the simulated ultrasound energy level provided by a virtual tool in the simulator, and / or controlling the simulated fluid pressure level for irrigation or vacuum pressure for aspiration. The foot pedal can also be programmed to provide an option to advance to the next step of the simulated surgical procedure. Additionally, a second or third foot pedal can be added that can perform one or more of the functions described above.

[0054] As described above, haptic rendering provides the user with virtually the same forces on the instruments that are experienced during live surgery. Table 1 below lists the surgical steps that can be simulated by the simulator, the instrument that can be simulated for each step, and a direction of movement of the instrument. Petition 870250090308, dated 03 / 10 / 2025, page 25 / 110 18 / 59 during surgery and maximum and minimum force values ​​for each surgical step. TABLE 1 Surgical Stage / Maneuvers Instrument Direction of movement Horizontal (Fx gms) Vertical (Fy gms) Anterior-posterior (Fz gms) Scleral tunnel pocket Crescent blade H + AP Max 48.8 Min 21.7 Average 31.9 Max 63.6 Min 35.4 Average 47.0 Max 62.5 Min 24.4 Average 45.6 Lateral extension of the scleral tunnel Crescent blade H Max 115.8 Min 61.9 Average 91.3 Max 87.1 Min 41.0 Average 60.8 Max 95.4 Min 43.5 Average 66.2 Paracentesis port and 15-degree blade AP Max Min Average Max Min Average Max 55.6 Min 13.3 Average 23.4 AC entry through main incision Keratome H + AP Max 82.2 Min 35.4 Average 55.6 Max Min Average Max 52.0 Min 2.1 Average 22.9 Capsulotomy Cystome V Max Min Average Max 42.0 Min 10.9 Average 22.5 Max 48.0 Min 13.6 Average 23.6 Expression of lens Vectis Lens AP Max Min Average Max Min Average Max 6 6.3 Min 7.8 Average 35.1 IOL Repositioning Sinskey Hook AP + H + V Max insignificant Min Average Max insignificant Min Average Max 7.4 Min 1.6 Average 4.7

[0055] In Table 1, all forces are shown Petition 870250090308, dated 03 / 10 / 2025, page 26 / 110 19 / 59 in grams (g) and the directions of movement are represented as follows: H - horizontal, AP - anteroposterior, V - vertical. Fx represents the forces in the x-plane that designate the left-to-right movement, Fy represents the forces in the y-plane that designate the up-and-down movements, and Fz represents the forces in the z-plane that designate the inward and outward movements. The primary force during the paracentesis stabbing is Fz inward, while during the slicing maneuver using the crescent blade, the Fx forces (to the right or left) dominate.

[0056] Force values ​​define the level of force that the simulator reproduces to give the operator a realistic feel of the procedure. A minimum force establishes the upper limit of noise in the electronics and friction in the robotic mechanism, beyond which the surgeon can no longer adequately experience surgical forces. A maximum force sets the standard for motor size and robotic mechanism rigidity. The force curve characteristics provide an objective baseline for testing the realism of simulated live tissue interaction.

[0057] The most critical step in the MSICS procedure is the creation of the scleral tunnel. It is also the most difficult step to learn. The crescent blade's Fx during the back-and-forth movements when creating the scleral tunnel pocket averages 31.9 grams, with a maximum (max) of 48.8 g and a minimum (min) of 21.7 g. During the same movement, the surgeon also follows the contour of the globe upwards and inwards. The crescent blade's Fy swing movements during the scleral tunnel pocket stage (which is an upward-oriented force) average 47.0 g (max 63.6 g, min 35.4 g). Fz (which is a force Petition 870250090308, dated 03 / 10 / 2025, page 27 / 110 The force exerted by the 20 / 59 blade (oriented inwards) averages 45.6 g (max. 62.5 g, min. 24.4 g) during this same step. All three degrees of freedom exert significant forces during this maneuver. It is important for the surgeon to recognize that as the blade moves left and right, it also advances inward and follows the contour of the globe upwards, all to similar average forces.

[0058] The greatest force encountered during the simulation is when slicing the crescent blade to the right or left during the lateral extension step of the scleral tunnel. Fx of the crescent blade during the right or left slicing maneuver in the lateral extension step of the scleral tunnel averages 91.3 g (max. 115.8 g, min. 61.9 g). The eye surgery simulator reproduces forces from zero to at least 115.8 g. The y-force value for this step changes depending on whether the surgeon would slice to the right or to the left. When slicing to the right, Fy is oriented downwards as the left-handed surgeon follows the contour of the globe. When slicing to the left, Fy is oriented upwards as the right-handed surgeon extends the tunnel to the left while holding the outer tunnel with Colibri forceps. The z-forces encountered are oriented outwards during the crescent slice, regardless of the cutting direction.In Fy max, when slicing to the right, which is a downward-oriented force, it has an average of 31.3 g (max 50.2 g, min 12.0 g). Fy, when slicing to the left, is an upward-oriented force with an average of 60.8 g (max 87.1 g, min 41.0 g). The force Fz (Fz max) during the increasing slicing maneuver is an outward-oriented force with an average of 66.2 g (max 95.4 g, min 43.5 g).

[0059] The incisional forces of knife stabs are Petition 870250090308, dated 03 / 10 / 2025, p. 28 / 110 21 / 59 predominantly z forces during corneal entry (i.e., paracentesis gate). Fz during stabbing incision formation, or paracentesis gate, using the 15-degree paracentesis blade is inward in orientation with an average force of 23.4 g (max. 55.6 g, min. 13.3 g).

[0060] Although it is often taught to float in the center of the tunnel in order to slice the keratome to the right or left, a novice surgeon would recognize that significant Fx forces can still be encountered, reaching an average of 55.6 g, especially at the end of the maneuver. When entering the anterior chamber using the 3.0 mm keratome (i.e., AC entry through the main incision), the Fz max (inward) averages 22.9 g (max 52.0 g, min 2.1 g). When slicing with the keratome to open the internal wound, the Fx (right or left) averages 55.6 g (max 82.2 g, min 35.4 g).

[0061] Cystome can opener forces are given in degrees of freedom y and z. There are no significant forces when cutting the anterior capsule during each stroke. The actual cutting stroke of the cystotome has minimal forces—a surgeon cannot feel the cystotome when cutting the anterior capsule. However, a significant signature of the repositioning force (Fy upward and Fz outward) is given immediately after each cutting stroke. Fy, for the capsulotomy step, is an upward-oriented force that averages 22.5 g (max. 42.0 g, min. 10.9 g) and Fz, an outward-oriented force, averages 23.6 g (max. 48.0 g, min. 13.6 g).

[0062] The Fz (outward-oriented) during vectis expression of the crystalline lens averages 35.1 g (max. 66.3 g, min. 7.8 g). Sinskey forces are minimal at Petition 870250090308, dated 03 / 10 / 2025, page 29 / 110 22 / 59 rotate the IOL, highlighting that to correctly rotate an IOL under viscoelastic control, minimal forces are required. The maximum forces in any degree of freedom when rotating the IOL with the Sinskey hook at the 9 o'clock position are negligible, averaging 4.7 g (max. 7.4 g, min. 1.6 g). The basic model of the simulated eye can be further adjusted using feedback from surgeons and / or may not depend on live surgical force measurements. Computational model based on physics.

[0063] Figure 2 is a graph illustrating an exemplary data flow between the simulator components during a simulation. A physical modeling application (202) can model the tissue and fluid properties of the simulated eye and the interaction of the tools with the eye, including the forces applied by the tools to the eye. Information regarding the visual appearance of the eye and the tools can be processed by a visual image processing application (204) and delivered, for example, to a graphics card (206) for rendering 3D models. The 3D image of the eye is transmitted to the simulated microscope (107) and can be viewed by a user during a simulation.

[0064] The haptic control unit (208) receives simulation modeling information from the physical modeling application. The haptic control unit (208) also receives surgical input information (216) from the haptic arms (109, 111) regarding the position and orientation of the haptic arms (109, 111). The haptic control unit (208) controls the amount of force and resistance applied by the Petition 870250090308, dated 03 / 10 / 2025, page 30 / 110 23 / 59 haptic mechanisms (113, 115) to haptic arms (109, 111).

[0065] The simulator may additionally include a simulator interface application (210) that manages the simulation. The simulator interface application (210) may allow instructors to assign surgical scenarios to users and / or monitor, evaluate, provide feedback and report on users regarding the operation of the simulator.

[0066] Figure 3a is a diagram illustrating the interrelationship of the simulator's hardware components. Haptic components (2.1) may include gimbal mechanisms (2.1.1.1, 2.1.2.1), motors and drives (2.1.1.2, 2.1.2.2), and handpiece interfaces (2.1.1.3, 2.1.2.3). The visualization 3D (2.2) of the simulated microscope (107) may include one or more LCDs (2.2.1), optics (2.2.2) and a microscope housing (2.2.3). Figures 1b-1d depict a microscope housing (223). The camera (217) may be located on the underside (224) of the housing (223). The camera (217) may be positioned so that its field of view includes at least part of the haptic arms (109, 111) and / or at least part of the user's hands while a simulated surgery is performed.

[0067] The computer hardware (2.3) used by the simulator sending information to or receiving information from the simulator may include a real-time PC (2.3.1), a graphics PC (2.3.2), a panel PC (2.3.3), a database server (2.3.4) and / or a teaching station (2.3.5). The computer hardware (2.3) may be used to record images, which may include video, captured by the camera (217). In addition, or alternatively, the images captured by the camera (217) may be displayed on a display screen, such as a display screen on the teaching station (2.3.5). Petition 870250090308, dated 03 / 10 / 2025, page 31 / 110 24 / 59 while the user performs a simulated surgery and / or after the completion of a simulated surgery.

[0068] A simulated head (2.4.1) — represented in Figure 1 by the reference element (105) — and a patient stretcher / bed (2.4.2) — represented in Figure 1 by the reference element (103) — can also be provided. VISUAL IMAGE GENERATOR

[0069] The simulator can represent a visual graphic model of a body part on which surgery can be practiced, such as a graphic model of the eye to simulate realistic MSIC surgery. A physics-based model of the eye can be programmed to simulate the eye's behavior in response to surgical actions. The 3D visual model of the eye can change according to these actions in real time to provide the experience of working with a real eye. The virtual eye can have customizable parameters that allow changing not only the appearance (e.g., iris color, skin, sclera) but also other anatomical and technical parameters, such as its shape and / or type of cataract, to allow a user to practice with a wide variety of patient conditions that a surgeon may encounter.

[0070] Figures 4a-4f illustrate the physics model representation. As shown in Figures 4a-4f, a mesh model can be used to construct and display visuals using rasterization, while a physical model that influences properties such as collision detection and tissue deformation runs in parallel. The eye model can include all structures involved in eye surgery. The eye model can include high detail for the cornea and limbus to obtain a realistic reflection of its Petition 870250090308, dated 03 / 10 / 2025, page 32 / 110 25 / 59 surface. Figure 4D shows a vector rendering of the eye from the side, illustrating that the high level of detail can overlap the limbus. Figure 4e shows the main tunnel as it enters the eye, and Figure 4f illustrates a vector diagram of the main section.

[0071] The simulator may contain two visual displays with which a user can work, including (1) the microscope view and (2) an external display screen. Figures 5a-5c illustrate simulated images within the microscope view. Objects in the simulation are perceived as moving and deforming with physical realism. The learner is presented with an image of the visual model via a 3D visual display that resembles a stereoscopic microscope. Using the microscope, the learner sees the virtual eye model and interacts with it using haptic arms (physical forms representing surgical instruments) to perform tasks while looking through the microscope eyepieces.

[0072] The visual display can represent a stereoscopic 3D image of the eye, as it would be seen under a surgical microscope with 5X magnification, showing everything within a circular surgical field of 34 mm to 35 mm. The field image is preferably surrounded by a black ring approximately 5 mm wide, making the total visual image approximately 4 cm in diameter. Other microscope zoom settings, as required by the surgeon, can also be provided in the simulator. Controls to change the zoom levels of the simulated eye can be activated by, for example, controls displayed on a touch-sensitive panel display screen or by one or more Petition 870250090308, dated 03 / 10 / 2025, page 33 / 110 26 / 59 pedals. In a preferred mode, rasterization can be used to render the visuals of the eye model. In other modes, ray tracing can be used, or a combination of rasterization and ray tracing.

[0073] The external display allows the student and instructor to communicate with the simulator. Communications include, but are not limited to, the following: selection of the surgical task to practice, review of task-related information on the screen before starting the execution, viewing of feedback content (multimedia - text, audio, video, animations, etc.) and parallel display of the microscope view, for example, when a task is being performed, etc. The external display screen may include a control panel through which the student and / or instructor exercises control over the simulations.

[0074] Figure 8 depicts an exemplary image (800) within the microscope view according to the present invention. The image (800) may include one or more visual cues and / or information relevant to the simulated procedure that may help guide the learner and indicate the extent to which the learner performs the surgical technique with sufficient proficiency. The image (800) may include a three-dimensional rendering of an eye (810) and one or more three-dimensional renderings of surgical instruments (820) as controlled by haptic arms (109, 111). The image (800) may include the guideline (830) showing the path along which an incision should be made or the desired path of any instrument. The guideline (830) may be black, white, or a color such as yellow. The guideline (830) may be any type of line, including solid, dotted, or Petition 870250090308, dated 03 / 10 / 2025, p. 34 / 110 27 / 59 dashed line.

[0075] The guideline (830) can be displayed while the surgical instrument (820) is moved by the user and / or when a part of the surgical instrument (820) is displayed in the image (800) or when the surgical instrument (820) touches the virtual tissue. Alternatively, the guideline (830) can be displayed in the image (800), but then deleted when the surgical instrument (820) is moved by the user and / or when a part of the surgical instrument (820) is displayed in the image (800). Alternatively, the guideline (830) can be generated but not displayed. Alternatively, the color or colors of the guideline (830) can match the eye color or colors so as not to be perceptible to the user.

[0076] When the guideline (830) and one or more surgical instruments (820) are displayed simultaneously in the image (800), the guideline (830) may be displayed above (i.e., in front of) the surgical instrument (820) so that it is visible regardless of the position of the surgical instrument (820). Alternatively, the guideline (830) may be displayed below (i.e., behind) the surgical instrument (820) so that a portion of the guideline (830) is not shown when the surgical instrument (820) is positioned over the surgical instrument (820). Alternatively, the color, weight, and / or other characteristic of all, part, or portions of the guideline (830) may be altered as the surgical instrument (820) passes above the guideline (830).For example, if the guideline (830) is a solid black line, when the surgical instrument (820) passes over the guideline (830), the part of the guideline (830) covered by the surgical instrument (820) may be changed to a dashed line and / or may. Petition 870250090308, dated 03 / 10 / 2025, page 35 / 110 28 / 59 change to gray.

[0077] As the learner uses the displayed tool (820) to make a virtual incision, the image (800) may display an incision line (840) indicating the path of the incision. The incision line (840) may be black, white, or a color. The color of the incision line (840) may be the same color or a different color from the guideline (830), if the guideline (830) is shown. The incision line (840) may be shown while the incision is being made, may be shown immediately after the incision is completed, or may be shown later, including during assignment review with a trainer.

[0078] If the incision line (840) deviates beyond a predetermined acceptable distance from the guideline (830), either at the time the incision is made or after the incision is completed, the system can provide feedback to the learner that the incision is not sufficiently similar to the guideline (830). The deviation can be measured, for example, by the distance between the incision line (840) where the surgical instrument (820) makes an incision at a given time and the nearest point on the guideline (830). Different acceptable deviations can also be defined for each side of the guideline (830). For example, the acceptable deviation might be up to one centimeter on one side of the guideline (830), but it might be only three millimeters on the other side of the guideline (830).

[0079] Feedback to indicate to the user that the deviation is beyond an acceptable distance may include, for example, vibration in one or more tool handles, a haptic force on a tool handle in the direction the tool would need to be moved to reduce the deviation, a sound Petition 870250090308, dated 03 / 10 / 2025, page 36 / 110 29 / 59 audible and / or visual indication on the display. The system can also simulate a noise emitted by the simulated patient if the deviation exceeds a certain limit.

[0080] In addition, as shown in Figure 8, one or more gauges may be shown in the image (800). One or more gauges may provide information about the performance of the procedure and / or a simulated eye condition. For example, gauge (850) may indicate the intraocular pressure (IOP) of the eye and may show changes in intraocular pressure as the simulated surgery progresses. If the trainee causes a tool to press against the eye (810), gauge (850) may indicate an increase in intraocular pressure. One or more gauges may be shown on the eye and / or adjacent (below, above, or beside) the eye.

[0081] Also as shown in Figures 8 and 9, a two-dimensional view (860) showing the surgical instrument (920) and the eye (910) can be provided in the image (800). The two-dimensional view (860) can be displayed in a window and / or can be shown above the eye (810) (as shown in Figure 8) or adjacent to the eye (810). The two-dimensional view (860) can show the angle of the surgical instrument (920) relative to the eye (910) and the relative distance between the tip of the surgical instrument (920) and the eye (910). The two-dimensional view (860) can help the learner assess the orientation of the surgical instrument (820, 920).

[0082] with regard to the eye (910) and the spatial relationship between the surgical instrument (820, 920) and the eye (910).

[0083] The angle of the surgical instrument (920) can be measured, for example, as the angle between the line Petition 870250090308, dated 03 / 10 / 2025, page 37 / 110 30 / 59 tangential to the nearest point on the eye surface (910) to the tip of the surgical instrument (920), and the angle of the nearest portion of the surgical instrument (920) to the eye (910). In addition, or alternatively, the angle of the surgical instrument (920) can be measured relative to a reference plane generated by the system.

[0084] The two-dimensional view (860) can show a variety of preferred or necessary angles for the surgical instrument (820, 920). As shown in Figure 9, a range of preferred or required angles may be shown by one or more range lines (970). The range lines (970) may be any type of line, including solid, dotted or dashed. The area (980) of the two-dimensional view (860) between the range lines (970) and / or the area of ​​the two-dimensional view (860) outside the range lines (970) may be highlighted with a color.

[0085] A highlight color in the area (980) and / or outside the range lines can be applied or changed depending on whether the angle of the surgical instrument (820, 920) is within a preferred range. For example, if the angle of the surgical instrument (820, 920) is between the range lines (970), the area (980) can be highlighted with the color green. If the angle of the surgical instrument (820, 920) deviates from the preferred range, the area (980) and / or the area outside the range lines (970) can be highlighted in a different color (e.g., red) so as to provide an indication to the student that the angle of the surgical instrument (820, 920) should be adjusted to within the preferred range. Alternatively, the entire two-dimensional view (860) or another subpart of the two-dimensional view (860) can be highlighted in a color (e.g., red) if Petition 870250090308, dated 03 / 10 / 2025, page 38 / 110 31 / 59 the angle of the surgical instrument (820, 920) extends beyond a preferred angle or range of angles.

[0086] The two-dimensional view (860) may also include an indication (990) on the outer surface of the eye (910) showing a preferred or required location where the surgical instrument (820, 920) should make contact with the eye (e.g., where an incision should be made). The system may measure the number of times the surgical instrument (820, 920) is placed at a predetermined distance from the eye (810, 910) and / or indication (990) before the surgical instrument (820, 920) makes contact with the eye (810, 910). The system may require that this number of times be below a predetermined value to constitute a successful procedure. For example, if the trainee brings the tip of a virtual scalpel within two centimeters of the eye surface (810, 910) more than three times before initiating an incision, the system may indicate that the trainee made a mistake and / or failed the assignment.The trainee may be allowed to continue the attempt or may be required to start the procedure from the beginning.

[0087] The system can usually provide an indication at any time that the learner is deviating from a predetermined standard or requirement, or if an error has occurred. The indication can be visual, auditory and / or tactile. For example, one or more parts of the surgical instrument (820, 920) (e.g., the handle, a part of the surgical instrument near the tip) may change color (e.g., red, yellow). The type and / or variation of the indication may depend on the severity of the error.

[0088] Although the examples described above are Petition 870250090308, dated 03 / 10 / 2025, page 39 / 110 32 / 59 referring to MSICS, the system according to the present invention can be used to train a user to perform any type of surgery. The system can also be used to quickly test whether surgeons or other physicians have the manual dexterity and spatial or depth perception necessary to perform a surgical procedure, immediately before performing the procedure or at any time before the procedure. For example, an elderly surgeon may not recognize that their manual dexterity has deteriorated or that a decrease in their vision has impaired their depth perception until after starting the procedure, or even after failing the procedure. A system according to the present invention could quickly test physicians to determine whether they should not perform a procedure at a given time.For example, a physician scheduled to perform an MSICS might perform a simulated MSICS, a simulated subset of the steps required to perform an MSICS, or one or more other simulated exercises that can assess the physician's performance. For example, the physician might be required to guide a simulated scalpel at a specific angle (or at an angle within a given range of angles) and to a specific location on the surface of a simulated patient. The physician might only be allowed a set number of attempts to bring the scalpel to within a predetermined distance of the patient's surface at that location and angle to pass the test. A similar test might be used by medical students considering whether to specialize in medical areas requiring a high degree of dexterity before deciding which field they intend to practice in. A similar test might also be used for people in other fields. Petition 870250090308, dated 03 / 10 / 2025, page 40 / 110 33 / 59 For example, the system can be used by people in the jewelry manufacturing field. COMPUTER SOFTWARE AND COMPONENTS

[0089] Figure 3b illustrates the software components of the simulator, which include components to simulate (1) the tunnel, (2) capsulotomy (or capsulorhexis) and lens replacement with complete zonules, (3) anterior chamber dynamics management, (4) capsulotomy (or capsulorhexis) and lens replacement with incomplete zonules, and (5) vitreous loss management. Each of these components has a visual, simulation, and haptic subcomponent.

[0090] The simulator software can be programmed to support the execution of the entire MSICS procedure on the eye surgery simulator, as well as some modules in complication management, PE. The software can be built around models based on the physics of the eye, surgical instruments, and the forces experienced during live surgery. In particular, the software can contain graphic eye models, haptic models, and didactic material / user interface. Haptic and visual responses to interaction with the model can be almost indistinguishable from real surgery. This model can reproduce precise tool-tissue contact, realistic tissue resistance, stiffness, flexibility, and texture, so as to provide a realistic feel of handling the instruments with the simulator handpieces. The simulator provides sufficient degrees of freedom of movement to allow for adequate simulation and force feedback.

[0091] As used in this document, the Petition 870250090308, dated 03 / 10 / 2025, page 41 / 110 34 / 59 The term computer may refer to a stand-alone computer that may include one or more processors and may include memory, or the term computer may refer to one or more computer processors. As shown in Figure 3c, the simulator consists of a plurality of computers, including the Simulator computer, the Learning Material or Simulator Interface Application (SIA) computer, and the Application Programming Interface (API). A simulator computer, or graphics and / or real-time PC, hosts and runs the simulator software (3D eye model and physics) and related code. The simulator computer (300) includes components for eye models (302), instrument models that include cues and guidelines (304), statistical algorithms used for assessments (306), event generation for critical time response (308), and real-time video (310).

[0092] A teaching materials computer (Panel PC) (350) runs the Simulator Interface Application (SIA). The teaching materials computer (350) may include components for a simulator control panel (352), generate reports (354, 380), save task evaluations to the data service (356), voice recognition (358), task content (360), and task evaluation (362). Learner results may be saved to a learner results database (382). The supervisory station (370) includes a video display (372) and may include a computer (not shown). The teaching materials computer (350) and / or the supervisory station (370) may be remote from the simulator, such as located in a different room, located in a different building, or located in a different country. The main function of the SIA is to communicate with the simulator to deliver Petition 870250090308, dated 03 / 10 / 2025, page 42 / 110 35 / 59 Training. The SIA allows you to monitor, interact with, and manage the specific student practicing in the simulator, as well as record that student's performance data. To do this, the SIA interacts with the Simulator-Based Learning System (SBLS), as described below, to allow the student to view active Assignments (allowed based on prerequisite conditions) and download specific Assignment files and content / learning resources corresponding to the Assignment selected by the student. After completing the Assignment performance, the SIA uploads the student's performance data at the end of each attempt and session. When the student meets the proficiency criteria in an Assignment, the list of active Assignments is updated.The SIA may include modules similar to those described below in relation to SBLS, which include: Assignment Database, Learning Experience Logic, Assignment Information Screens, Simulator Communication, Performance Logs, SBLS Interface, Video encoding, streaming and storage, Reports, and Data / Code Update. The simulator communication module allows the SIA to communicate with the Simulator using the simulator API to manage Assignment performance. This communication is based on standard Assignments received from SBLS, as described below. To track the performance of each Assignment, learners authenticate access to identify them and store their performance data in their respective logs.

[0093] A Simulation Application Programming Interface (API) (middleware layer) interfaces the simulator computer with the SIA. The middleware layer (330) may include components for loading Petition 870250090308, dated 03 / 10 / 2025, p. 43 / 110 36 / 59 eye models (332), select instruments (334), receive statistics (336), and receive events (338). The API can be hosted and run on the graphics PC or the dashboard PC. An interface is provided for Ethernet communication between the learning materials and the simulator in order to initiate simulations, trigger events, obtain metrics, and other necessary communications. The communication requirements between the SIA and the Simulator Middleware include: Assignment parameters, Eye model configuration and state, Performance data - event-based, Performance data - General (ongoing), Event triggers, Audio commands, Video feed, Calibration and pre-session checks, Performance logs and guidelines, Guidance visualization and real-time feedback.

[0094] The main elements of communication between the SIA and the simulator include:

[0095] 1. Surgical conditions:

[0096] a. Surgical Starting Point (a step within the MSICS surgical procedure).

[0097] b. Surgical Endpoint (a step within the MSICS surgical procedure).

[0098] c. Common anatomical variations (e.g., iris color, skin color, anterior chamber depth, etc.).

[0099] d. Surgical variations (right / left eye, intraocular pressure, type of cataract).

[00100] e. Select intraoperative challenges (pupil constricts during capsulotomy or

[00101] increase in IOP after core removal).

[00102] 2. Training conditions. Petition 870250090308, dated 03 / 10 / 2025, page 44 / 110 37 / 59

[00103] a. Specific Objective(s) of Learning the technique for assignment (e.g., making the scleral sulcus with the required shape and size).

[00104] b. Performance parameters and metrics (e.g., Incision size, parameters related to incision shape).

[00105] c. Evaluation standards corresponding to metrics (e.g., Range, not higher or lower than, event (Yes / No) etc.).

[00106] d. Scoring logic - Points and / or weights and conditions related to each metric for calculating the score(s).

[00107] e. Selected training tools - guidelines / guidance visualization / real-time feedback alerts / auditory cues (setting to communicate whether these training tools will be available or not during the presentation).

[00108] 3. Assignment performance data:

[00109] a. Receive data on attribution performance parameters, metrics, alerts, triggers, etc.

[00110] b. Receive video feed.

[00111] 4. Commands:

[00112] a. Start assignment (transfer and upload of assignment files).

[00113] b. Terminate / Abort Assignment (mark the end of the assignment and request to start the transfer of assignment data).

[00114] c. Verbal commands - for limited purposes (e.g., requesting instruments (to be carried, etc.).

[00115] d. To trigger certain challenges Petition 870250090308, dated 03 / 10 / 2025, page 45 / 110 38 / 59 intraoperative (e.g., microscope bulb failure, patient complaints of pain, etc.).

[00116] The text above is not an exhaustive description, but a fairly comprehensive overview.

[00117] There may be some limited additional communication requirements.

[00118] To deliver training in the most effective way, the SIA contains the following important features. It breaks down the procedure into smaller segments for unit practice. This allows for repeated practice with segments to help focus on specific tasks or groups of tasks. For example, assuming the procedure is broken down into 10 tasks, one should be able to start with task 5 and stop after completing task 6. When starting at task 5, all actions from tasks 1 to 4 would already have been completed, and this updated state of the eye should be carried over to performance. The SIA also collects data on performance metrics (data generated in the simulator related to the performance activity) to compare them with standards and thus provide formative and summative feedback. Formative feedback helps improve learning.For example, the force applied to a task was greater than necessary, resulting in poor performance, or an incision made much larger than necessary. Summative feedback means evaluating performance in line with objectives. Summative feedback also involves evaluating performance between trials. The SIA sets up real-life scenarios to adequately prepare learners to manage them effectively. These scenarios may include intraoperative challenges, such as excessive bleeding in response to a... Petition 870250090308, dated 03 / 10 / 2025, page 46 / 110 39 / 59 action, weak zonules holding the capsule, and other challenges arise even when the task is performed accurately. Errors or suboptimal performance in previous tasks can also lead to intraoperative challenges later in surgery. To present such scenarios without requiring a student / trainer to recreate them every time they need to be practiced, the SIA saves the eye state so the learner can begin practicing with that state.

[00119] As shown in Figure 3d, SIA (500) is part of the simulator and manages communication and data exchange with the eye surgery simulator for each student and each task and their performance on the simulator assignments. In a preferred embodiment, the simulator is connected via an intranet to a central server (510). A network server or application, called Simulator-Based Learning System (SBLS) (520), is hosted on the central server (510) and is used to manage the delivery of training to a plurality of learners. The SBLS (520) manages learning management in all instructional delivery simulator modes. This involves managing multiple students, simulators, training delivery methods, etc. For example, the SBLS (520) can manage more than 50 to 100 simulators. When simulators are in simultaneous operation, a large amount of rich data in the form of video feed, etc.Data will be generated and exchanged between the simulators and the centralized server application (SBLS (520)). The SIA (500) communicates with the Simulation API (Figure 3c) to manage simulation practice units, i.e., assignments, and exchange necessary information. The SBLS (520) manages the delivery of assignments to each learner. Petition 870250090308, dated 03 / 10 / 2025, page 47 / 110 40 / 59 identifies learners, controls access to assignments, records performance data from assignment attempts, and provides other training management features. Communication between SIA (500) and SBLS (520) includes: an interface to enable user authentication, synchronization with SBLS (520) to maintain a local copy of the assignment database (static files and codes related to assignment evaluation and scoring), transfer of performance data, video, etc. to SBLS (520) to update learner records in SBLS (520), and communication related to instructor functionalities.

[00120] The SBLS (520) can include a plurality of modules, and these include the modules listed below. Preferably, a copy of the selected modules or specific code from the SBLS (520) is maintained in the SIA (500). This ensures that simulator practice can be started or continued without any dependency on the SBLS (520). As such, the SIA (500) can include the same modules listed below as the SBLS (520).The SIA (500) communicates with the SBLS (520) for data such as the following: user authentication, learner status information (previous records, permitted assignments, access to assignment-related content), data synchronization with the SBLS (520) (uploading learner performance data stored in the local system to the SBLS (520) on the network), communication with the instructor client (530), video feed transfer, download and update of the latest version of the SIA (500), and upload transfer of calibration and simulator test reports and issues. The central server (510) and / or the instructor client (530) may be remote from either location. Petition 870250090308, dated 03 / 10 / 2025, page 48 / 110 41 / 59 more simulators. INSTRUCTOR / STUDENT OPERATION

[00121] A module can be used to manage multiple users (e.g., superuser, administrator, instructor (trainer), learner) and provide access control functionality.

[00122] The same module or a different module can be used to create assignments that can be assigned to students for practice and assessment in the simulator. A learner will be guided to practice a set of assignments that will be designed to provide sufficient practice for the learner in various segments of the procedure and then throughout the entire procedure. The complexity and difficulty levels of each of these assignments will increase with the progress made by the learner. Learners are exposed to a wide variety of cataract cases and complications through the use of assignments. Assignments are created based on selections of various conditions, training tools, performance parameters, triggers / alerts, scoring, prerequisites, assignment metadata, etc.

[00123] Each unit of practice in the eye surgery simulator is referred to in this document as an Assignment. Each Assignment may have a starting point and an ending point (within the surgical procedure), each indicating the state of the eye and related parameters (e.g., color, size, type of cataract, etc.). An Assignment may be a segment of a procedure in which some tasks would already have been completed (e.g., eye with scleral sulcus has been done). An Assignment may also include complications to be presented. The SBLS may support a database of Petition 870250090308, dated 03 / 10 / 2025, page 49 / 110 42 / 59 a large number of surgical assignments using a user-friendly interface and a series of steps to capture and define all the data to define a typical assignment.

[00124] Each Assignment may include all the information required by the simulator to: (1) initiate the simulation (using possible selections for surgical conditions, training conditions, i.e., appropriate ocular model variables, patient parameters, standard / custom starting point in the surgical procedure); (2) define access to training tools - providing guidelines, orientation vision and feedback (in real time); apply other settings and tolerances per level for errors and alerts etc., possible complications and corresponding action; (3) determine the end of the simulation based on the triggering of certain conditions, such as vision-threatening complications in specific assignments (level 2), Assignment abort by the learner, completion of Assignment performance, instructor intervention etc.(4) allow communication of alerts and performance metrics - in real time and at the end of the Assignment (facilitates feedback related to errors, calculation of the score for the attempt, provision of details of the scores assigned for each parameter, etc.); (5) intervention by instructors to change / trigger certain modifiable conditions; and / or (6) validation of the instruments to be used in each part of the simulation Assignment. Each Assignment may also include reference data corresponding to each specified performance parameter to allow evaluation. Corresponding to each level, there may be a specified value, range, or setting with which the parameters will be. Petition 870250090308, dated 03 / 10 / 2025, pp. 50 / 110 43 / 59 compared to assign a score or pass / fail status.

[00125] An assignment database can store assignments and corresponding data that can be communicated to the simulator using, for example, XML messages / commands. Assignment files can include one or more of the following details: (1) associated performance metrics that should be monitored and / or recorded in real time and after the Assignment attempt is completed; (2) guidelines, guidance visualization, and real-time feedback requirements (includes audio feedback and other auditory requirements); (3) complication scenarios that can be triggered by the instructor; (4) triggers for events; (5) parameters (metrics) linked to feedback corrective content resources; (6) name of the reference starting point and data files corresponding to a custom starting point (saved after a learner or instructor's performance); and (7) assignment metadata: Group of Tasks / Task / Subtask / Movement Number according to the standard proficiency definition for MSICS, Title, description, tags - level, task group, etc.

[00126] A simulation course might include, for example, several modules that allow students to achieve a set of perhaps 30 to 40 learning objectives. Each module might have around 8 to 10 unique Assignments, some with 2 to 3 slight variations. In these variations, the base assignment files can be leveraged for customization in terms of metrics to be used for scoring, and alerts and triggers can be altered to emphasize certain aspects. Petition 870250090308, dated 03 / 10 / 2025, page 51 / 110 44 / 59 specific learning objectives related to the Assignment. For example, an Assignment related to “making the scleral groove” may have as one of its variants an emphasis on the learner getting the groove shape right, and its metrics may have greater weight when scoring. Other metrics collected, such as groove length, groove depth, etc., may have low or no weight. Therefore, the weight applied to each metric for scoring may vary accordingly to provide appropriate emphasis corresponding to the learning objective(s).

[00127] Assignment Information Screens may include a set of screens that provide information for each Assignment, including graphics, videos, animations, etc. The screen may have links that can load more details in pop-up screens. These screens will present standard information about the assignment, such as Assignment Description, Steps to be Performed, Surgeon Tips, Best Practices to Follow, Specialist Performance Video, Actual Surgery Video, etc.

[00128] The Logic of the Learning Experience can evaluate each unique Assignment, determine Assignment completion based on proficiency requirements, determine the flow or order in which Assignments will be made available to users, etc. The learner's experience in the simulator can be determined by a number of features. One of the most important among them may be individualization. One of the features related to individualization may be managing a learner's progress through a list of assignments. This can be computer-controlled or controlled by a trainer. Petition 870250090308, dated 03 / 10 / 2025, page 52 / 110 45 / 59

[00129] A learner can be expected to progress through Assignments in a defined order in computer-controlled mode. While the learner may view the list of Assignments, only those that they are qualified to access according to this predefined order can be displayed as active Assignments. Active Assignments mean those assignments that are enabled for practice. Inactive Assignments can become Active when prerequisite Assignments are completed by the learner. The instructor can give each student access to any assignment (in any order) or enable / disable access to each assignment based on their individual judgment. Furthermore, instructors may be authorized to modify selected conditions (specifications provided in the Assignment) referred to as modifiable conditions.Modifiable conditions refer to a selection of conditions for surgical simulation that any trainer can alter to enhance the training experience.

[00130] An Open Assignment is available to the instructor in instructor control mode. It can be configured with default simulation conditions. The default conditions are the most basic settings for simulator practice. The trainer may be able to make changes using modifiable conditions (e.g., within these default conditions and some others) and surgical starting point before allowing the learner to begin the open assignment attempt. The purpose of the open assignment may be to allow the learner to familiarize themselves with the simulator setup and assignment conditions before beginning formative or summative assessment of the attempts. Parameters Petition 870250090308, dated 03 / 10 / 2025, page 53 / 110 Standard 46 / 59 and performance video can be recorded for each attempt. However, attempts for this assignment may not be evaluated and scored by the system. The coach can enter attempt feedback notes into the system.

[00131] A computer control mode may also be provided where predefined algorithms govern access to assignments in the assignment library and progression between assignments. However, an instructor may have the ability to override a learner's configuration for selected assignments and allow access. In this mode, learners can continue to practice assignments without requiring instructors to closely monitor and determine access. However, instructors may be required to review performance data and provide real-time or later feedback on attempts.

[00132] A Free Play feature in computer control mode may allow a predefined number of attempts corresponding to each assignment as Free Play. The purpose of Free Play mode may be to allow the student to familiarize themselves with the simulator setup and assignment conditions before beginning formative or summative assessment of the attempts. However, performance data may still be recorded for monitoring simulator usage.

[00133] Each Assignment may require formative and summative assessment. For assessment, several parameters may be monitored and stored during and after the execution of the Work. Summative assessment may require the use of selected metrics and comparing them to defined performance standards to assign a score and / or classify an attempt as a successful or “failed” attempt. A Petition 870250090308, dated 03 / 10 / 2025, page 54 / 110 A composite score of 47 / 59 can be calculated from these metrics. This may be necessary to compare performance and facilitate comparison with other attempts by the same user (or other users using the same patterns). A simplified example to demonstrate this requirement is presented in the following table: TABLE 2 Performance Parameter Parameter A Parameter B Parameter C Composite Score Standard 5.00 mm 5.00 mm 5.00 mm 80 Actual 4.70 mm 4.62 mm 4.2 mm 16 Range 1 - Score 4.70-5.30 (40) 4.70-5.30 (40) 4.70-5.30 (40) Range 2 - Score 4.40-4.69 or 5.31-5.50 (15) 4.40-4.69 or 5.31-5.50 (15) 4.40-4.69 or 5.31-5.50 (15) Critical Errors No Yes No Result ✓ XX Actual Performance Score 40 / 40 FAILED 0 / 40 16 Weight 40% 30% 30% FAILED

[00134] An Assignment may be considered complete when a desired level of proficiency is demonstrated with consistent performance recorded across a series of attempts. The completion requirement may also require a certain amount of practice in the form of a minimum number of attempts required, a minimum number of attempts well. Petition 870250090308, dated 03 / 10 / 2025, page 55 / 110 48 / 59 successful attempts and minimum number of consecutive successful attempts.

[00135] Free play may include a predefined number of attempts allowed to each learner for each assignment before the performance data from those attempts is considered for scoring and progression. This may allow them to familiarize themselves and become comfortable with the task at hand before being monitored and evaluated. Such a requirement for each assignment may be defined as part of the progression and / or evaluation logic.An example of a completion requirement for a typical assignment might include: (1) Minimum required attempts (e.g., 80 to ensure sufficient practice); (2) Minimum successful attempts (e.g., 40 to ensure a certain minimum success rate); (3) Minimum number of consecutive successful attempts (e.g., 37 to ensure consistency in successful performance); and / or (4) Free-Play (e.g., 15 to allow familiarization with the assignment without any pressure related to review or performance evaluation). Depending on the modality, during Free-Play, no score can be assigned and no feedback can be provided. However, performance data may still be recorded for monitoring purposes.

[00136] A simplified example of recorded attempts is illustrated in the table below: TABLE 3 Assignment No. 1 Free Play: 4 Attempts Minimum successful attempts: > 3 Minimum number of consecutive successful attempts: At least 3 of Petition 870250090308, dated 03 / 10 / 2025, page 56 / 110 49 / 59 The last 5 (3 / 5) attempts should be successful. Result of the attempt score No. Requirement Status (Successful Attempts) | Consecutive Successful Attempts 1 16 Failed (NA) NA 2 40 Failed (NA) NA 3 55 Failed (NA) NA 4 81 Passed (NA) NA 5 64 Failed (0 / 5) | 0 Continue practicing 6 69 Failed (0 / 5) | 0 Continue practicing 7 87 Passed (1 / 5) | 1 Continue practicing 8 75 Failed (1 / 5) | 0 Continue practicing 9 96 Passed (2 / 5) | 1 Continue practicing 10 95 Passed (3 / 5) | 2 Continue practicing 11 97 Passed (4 / 5) 3 Completed

[00137] A Performance Records Database can be used to store a record of all student attempts for each assignment, storing scores, metrics, videos, etc. Each learner's attempt can be recorded and stored. The generated data can be stored in SIA / SBLS. It may include video recording, time spent on each attempt, performance parameter values, scores, attempt count (successful, unsuccessful, aborted), count of the last Petition 870250090308, dated 03 / 10 / 2025, page 57 / 110 50 / 59 consecutive successful attempts, etc. These can be used for reporting, analysis, and can also be used within the logic of progression between assignments, as shown above. The SIA can transfer the assignment attempt records / data to the SBLS for each learner immediately after each attempt. In addition, other data such as login time, logoff time, time spent on attempts, and session duration can also be collected and stored for each learner.

[00138] The system may allow the transmission of simulator images, including simulated images displayed in the microscope viewport and / or images or video captured by the camera (217) to a remote computer or monitor during a simulation. In addition, or alternatively, the system may allow the export of collected performance data, including video recordings, to cloud-based systems for long-term storage. Raw 3D model parameter records may be stored in predefined stages of Assignment performance or on demand. Such raw 3D model snapshots may be exported from SBLS for review and used by a teaching material design team. It may be used to configure unique eye model states when creating assignments.

[00139] An Instructor Module can allow an instructor to monitor and manage simulator practice sessions, either at the same location as the simulator or from a remote location. The instructor can connect to SBLS using a desktop / laptop PC and, preferably, a tablet computer. The instructor module can have the following Petition 870250090308, dated 03 / 10 / 2025, pp. 58 / 110 51 / 59 functionalities to access SBLS and manage training delivery: (1) View a simulator lab activity dashboard - simulators and current user activity; (2) Monitor Assignment performance using video data streams, where the instructor can view a set of video streams together or select one and switch between views; (3) Receive real-time and event-based updates / messages; (4) View reports; (5) Add subjective comments to each Assignment attempted by a learner; (6) Add or reduce scores for an Assignment attempt based on subjective evaluation and observation; (7) Review the learner's performance history; and / or (8) Replace the learning experience logic to allow learners to progress or prevent progression due to subjective evaluation or other reasons. An Instructor can also log on to the simulator Dashboard PC to access these resources and use it to perform Assignments, just like the learners.

[00140] Reports can be generated and viewed. The presentation of each report can be filtered, changed in the views, sorted, and customized. Reports can include:

[00141] · Status Report of the Assignment for a group of apprentices.

[00142] · Individual apprentice progress report for each assignment and across all assignments.

[00143] • Training activity report (for a trainee or group - for a selected time period / days).

[00144] • Learning analysis (graphs and Petition 870250090308, dated 03 / 10 / 2025, pp. 59 / 110 52 / 59 tables) - for assignments (individual, group and comparison) - some examples are given here:

[00145] Trend - successful, failed and aborted attempts.

[00146] Average time to success (another state) or all attempts.

[00147] Number of proficiency attempts.

[00148] Performance trend - for selected metrics in an assignment (one or more selected metrics).

[00149] Instructor comments for an assignment.

[00150] · Number of attempts and time spent on each attempt for each assignment.

[00151] · Number and sequence of failed attempts during an assignment (failure means that assignments end due to an error that threatens the view).

[00152] · Number of failed attempts per simulation level (2 or 3).

[00153] · Number and sequence of aborted attempts during an assignment.

[00154] · Number of aborted attempts per level.

[00155] • Number and sequence of attempts successfully completed during each assignment.

[00156] • List the number and description of vision-threatening errors for each assignment by attempt date. • Report of selected metrics by assignment and date (as per the list of interface requirements metrics above) after every 10 attempts. Petition 870250090308, dated 03 / 10 / 2025, pp. 60 / 110 53 / 59

[00157] The simulation software, which may include the main simulation and the simulator API code, may be updated periodically to, for example, fix problems and update functionality. Additionally, to allow the use of simulators independent of SBLS, certain code and data may be maintained locally in SIA. This may include data such as the Assignment Library and code, such as logic for progressing assignments, etc. If updates are needed, the data / code update module may be authorized to send them to each of the simulators periodically or on demand. A check may be run periodically to confirm the latest version installed and update the simulators as needed.

[00158] The following table provides a Use Case Scenario that connects various activities with the simulator's functions and associated components and resources, including the Simulator-Based Learning System (SBLS): TABLE 4 Typical progression of training activity in the simulator: Turning on the simulator: It turns on the Dashboard PC which runs the simulator interface application (SIA) automatically on startup. The login screen is displayed on the adjacent screen. The trainee logs in using their ID and password / code. The instructor can also log in using the same screen. A list of assignments is displayed on the adjacent screen. The list will also be present if the assignment is active, meaning enabled to start or continue the practice. The simulator can restrict access to assignments to manage the order in which they should be practiced. However, the instructor will always have unrestricted access to start any assignment at any time. This data is loaded from SBLS. Petition 870250090308, dated 03 / 10 / 2025, pp. 61 / 110 54 / 59 The trainee / instructor selects the assignment to begin the practice. The instructor can disable the access restriction and change all assignments so that they are active. The Assignment description screen will be displayed with a Start button. The description content includes text supported by media elements such as images, videos, and animations, which can be viewed by the user. The content can be layered (one level) – links are provided to load pop-up screens. The learner begins the presentation by tapping the Start button on the screen. A record of the assignment attempt is created in SBLS. After the attempt is completed, it will be updated with the corresponding data received from SIA. An instructor can log on to the network application (SBLS) at any time to view a dashboard that lists all simulators on the network, ongoing learner activity, their status, etc. The SIA communicates with the simulator via the simulator API – files related to the selected assignment are transferred to the simulator. The assignment files define the starting point, the ending point of the surgical procedure to be practiced, the eye model configuration(s), the list of parameters to be tracked in real time, and the metrics to be provided at the end of the execution. Alternatively, these files are received from SBLS upon selection and forwarded to the Simulation API. The simulator uses the assignment files to load the eye model, and the simulation activity can begin. The learner grasps the instrument handles (haptic arms) and looks through the microscope to start. The learner gives verbal commands to request instruments - left and right hand. The SIA has voice recognition capability for various verbal commands - these trigger the sending of commands (using XML files) to the simulator for the corresponding action. The simulator will emit an audible alert if the incorrect instrument is selected. The apprentice brings the instruments into the field of vision. Petition 870250090308, dated 03 / 10 / 2025, pp. 62 / 110 55 / 59 (microscope viewer) and starts the performance. The real-time parameters required by the SIA are monitored, and alerts are provided if the alert conditions are met. All other necessary metrics are logged during the assignment attempt. Guidelines, orientation visualization, and real-time feedback are available (according to assignment settings). Guidelines and orientation visualization are artificial objects (lines, arrows, etc.) displayed in the microscope view to support learner performance. Feedback is an audible alert about learner errors and a short text message that appears with the student for a few seconds to communicate the nature of the error. They can be enabled / disabled by a toggle switch in the SIA or by a verbal command. Any error or specific condition classified as a complication may result in the interruption of performance according to the assignment settings. The simulator will display a message communicating the event to the learner. These conditions are predefined in the simulator software. An alert to keep this condition active for monitoring is set or logged when assignment files are transferred to the simulator. The instructor client will also be able to view the alerts for which the triggers were configured as part of the exercise specifications. The instructor / learner can switch between real-time video on the attached screen OR keep the Panel PC interface - SIA displayed. Essentially, the attached screen can be used to connect to one of two display feeds: 1. PC Panel - SIA application interface or 2. HDMI video feed directly from the simulator's visual display. The video feed via HDMI is also transferred to the SIA via the simulation API and will be encoded and stored as part of the assignment attempt data. The instructor client will allow viewing of the simulator video stream(s) via SBLS - a limited set of simulator videos simultaneously. The learner or instructor (on hold) can give a verbal command or use an on-screen button to abort or indicate completion of the practice unit. Petition 870250090308, dated 03 / 10 / 2025, pp. 63 / 110 56 / 59 End-of-assignment performance metrics are reported to SIA. The SIA receives the performance metrics and calculates the scores corresponding to the predefined rubric for each Assignment. Or it transfers the metrics to the SBLS for calculations. The SIA / SBLS calculates a composite performance score. The SIA / SBLS provides a success / failure result for performance based on the evaluation rubric. The SIA / SBLS updates the assignment status using a pre-configured proficiency requirement (Not started, In progress, or Completed). Each assignment may have a different completion requirement in terms of performance scores across attempts or trend of continuous successful performances (i.e., at least 10 successful attempts out of the last 15 attempts). The assignment performance report is displayed on the screen for the learner and instructor to review. The reports are represented visually. Some visual representations may be made available via pop-up links. This will allow the instructor to use the performance data along with their observations for trial evaluation and to provide feedback to the learner. Closing the Assignment Attempt report will display a screen that provides a summary of the user's performance history for the Assignment. The performance report for each attempt can be viewed by selecting any attempt from the list (a drill-down report). More options / resources are made available to users. They can go to the Reports screen to select and view other available reports. You can jump to the Assignments list to select another active Assignment to continue practicing, or log off and close the simulator session. Logging off will update SBLS with the corresponding data, namely the time. Immediately after the assignment attempt is completed, and at any time thereafter, the instructor may review the attempt data and add (type) a subjective evaluation comment and / or edit the score on the assignment. Such comments and changes will be stored with the identity Petition 870250090308, dated 03 / 10 / 2025, pp. 64 / 110 57 / 59 from the instructor. Two of these notes / edits can be made, with the second allowing the expert instructor to provide their comments and contributions. The learner can also add comments or notes related to each attempt after completion.

[00159] Verbal commands can be incorporated into the simulator to increase the realism of instrument changes and intraoperative handling. A verbal command requesting an instrument change can be given, and the visual appearance of the instrument under the microscope can change accordingly. If the handles are not the same, the learner may need to manually change the handles, which will be designed to resemble the actual instrument chosen for use. Voice recognition is also provided as part of the teaching material to support instrument selection by voice command and other commands by the learner.

[00160] In some scenarios, there may be interactions with a scrub nurse that require the surgeon to communicate with other people. The simulator may be restricted to what can be seen under the microscope and what can be felt by the user's hands. Any other interactions or higher-level communication will be handled by the teaching material, and the simulator will provide an interface to the teaching material to make any changes to the simulated scene based on any interaction performed at a higher level. For example, the simulator may indicate that the microscope bulb has burned out. In this scenario, the microscope bulb burns out and the microscope view darkens. The surgeon's response is to ask the nurse to change the microscope bulb, and when this is done, normal light is restored. The sequence between the Petition 870250090308, dated 03 / 10 / 2025, pp. 65 / 110 58 / 59 simulator and teaching material is as follows: (1) the teaching material sends a command to the simulator that informs it that the lamp should burn out, (2) the simulator responds by making the view appropriately dark, (3) the teaching material identifies any sequence of events necessary for the lamp to be changed, for example, a voice command to tell the nurse to change the lamp, (4) the teaching material sends a command to the simulator that informs it that the lamp should work correctly again, and (5) the simulator restores the light in the microscope view.

[00161] Heart rate monitor sounds can also be provided. Heart rate is linked to events in the simulator and can also be set on the course side. In addition, patient sounds, requests, and other sounds are incorporated where the teaching material can define sounds to be played at certain events or directly.

[00162] Although the invention has been described in detail with reference to embodiments for purposes of full disclosure of the invention, such embodiments are merely exemplary and are not intended to limit or represent an exhaustive enumeration of all aspects of the invention. It will be evident to those of common skill in the art that numerous changes can be made to such details, and the invention is capable of being embodied in other forms without departing from the spirit, essential features, and principles of the invention. Furthermore, benefits, advantages, solutions to problems, and any elements that may enable or facilitate any benefit, advantage, or solution should not be interpreted as critical, necessary, or essential to the invention. The scope of the invention should be limited only by Petition 870250090308, dated 03 / 10 / 2025, pp. 66 / 110 59 / 59 attached claims. Petition 870250090308, dated 03 / 10 / 2025, pp. 67 / 110

Claims

1 / 3 CLAIMS 1. SURGICAL SIMULATOR characterized by comprising: a simulated microscope comprising a viewfinder and a camera; a first haptic arm representative of a real surgical tool; a first haptic mechanism in mechanical communication with the first haptic arm, wherein the haptic arm and the haptic mechanism are configured to provide real-time haptic force feedback to a system user during the simulation of a surgery; a haptic control unit configured to signal to the first haptic mechanism a level of haptic force feedback; and a first computer in electronic communication with the haptic control unit and comprising a software module with a physics-based model of a human body part and configured to calculate the haptic force feedback to be provided by the first haptic arm and the first haptic mechanism;where the display is configured to show a simulated three-dimensional image of the human body portion and a three-dimensional image showing a first simulated surgical tool corresponding to the actual surgical tool, based on the current orientation and position of the first haptic arm under the simulated microscope.

2. SURGICAL SIMULATOR, according to claim 1, characterized by the camera having a downward-pointing field of view. Petition 870250090308, dated 03 / 10 / 2025, p. 68 / 110 2 / 3 3. SURGICAL SIMULATOR, according to claim 2, characterized in that a part of the first haptic arm is within the camera's field of view.

4. SURGICAL SIMULATOR, according to claim 3, characterized in that the system is configured to record an image of a portion of the first haptic arm.

5. SURGICAL SIMULATOR, according to claim 3, characterized by an image captured by the camera being transmitted to a remote computer.

6. SURGICAL SIMULATOR, according to claim 3, characterized by an image captured by the camera being displayed on a display screen.

7. SURGICAL SIMULATOR, according to claim 1, characterized in that a part of the first haptic arm is within the camera's field of view.

8. SURGICAL SIMULATOR, according to claim 7, characterized in that the system is configured to record an image of a portion of the first haptic arm.

9. SURGICAL SIMULATOR, according to claim 7, characterized by an image captured by the camera being transmitted to a remote computer.

10. SURGICAL SIMULATOR, according to claim 7, characterized by an image captured by the camera being displayed on a display screen.

11. SURGICAL SIMULATOR, according to claim 1, characterized by additionally comprising a foot pedal unit.

12. SURGICAL SIMULATOR, according to claim 11, characterized by the pedal controller comprising a pedal and a switch. Petition 870250090308, dated 03 / 10 / 2025, page 69 / 110 3 / 3 13. SURGICAL SIMULATOR, according to claim 11, characterized by the visual display being modified according to the position of the pedal.

14. SURGICAL SIMULATOR, according to claim 13, characterized by the visual display being modified to simulate the injection of a fluid.

15. SURGICAL SIMULATOR, according to claim 13, characterized by the visual display being modified to simulate the aspiration of a fluid.

16. SURGICAL SIMULATOR, according to claim 11, characterized in that the visual display shown on the screen is modified depending on the position of a switch.

17. SURGICAL SIMULATOR, according to claim 16, characterized by the visual display being modified to simulate the injection of a fluid.

18. SURGICAL SIMULATOR, according to claim 16, characterized by the visual display being modified to simulate the aspiration of a fluid. Petition 870250090308, dated 03 / 10 / 2025, pp. 70 / 110

Images