Modular anatomical system

Abstract

The present invention relates to a modular anatomical system for demonstrating, practicing or evaluating medical procedures or techniques.

Description

[0001] This application is an international application, claiming priority to U.S. Provisional Patent Application No. 63 / 347,092 filed on May 31, 2022, U.S. Provisional Patent Application No. 63 / 347,903 filed on June 1, 2022, and U.S. Provisional Patent Application No. 63 / 449,879 filed on March 3, 2023, the entire contents of each patent application are incorporated herein by reference.

[0002] All patents, patent applications, and publications cited herein are hereby incorporated by reference in their entirety. The disclosures of these publications are hereby incorporated by reference in their entirety into this application in order to more fully describe the state of the art as known to those skilled in the art as of the date of the invention described and claimed herein.

[0003] This patent disclosure contains material that is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the U.S. Patent and Trademark Office patent files and records, but otherwise reserves any and all copyrights whatsoever.

[0004] Government interests

[0005] N / A Technical Field

[0006] The present invention relates to a modular dissection system for demonstrating, practicing or evaluating medical procedures or techniques. Background Art

[0007] There are various training simulators with different anatomical accuracy, including cadaver simulators, virtual reality simulators, and various "benchtop" simulators. Cadaver is an ideal training simulator for most surgical tasks, but the high price and low availability of cadaver specimens limit trainees' use of cadaver specimens. Virtual reality simulators generally lack the ability to simulate the interaction between tissues and tools in complex procedures, and enrichment through tactile rendering requires extensive programming and high computational costs; "benchtop" simulators include a variety of tissue substitutes and are primarily provided by SawBones (Vashon Island, Washington). Examples with high anatomical accuracy include products branded "Alex 2" and "Alex 3" for arthroscopic surgery of the shoulder. Simulators with lower anatomical accuracy designed for training tasks are primarily composed of "Dome Rotator Cuff Anchor Training Block" and "MagneFAST". These simulators are expensive, have limited flexibility, and lack the anatomical complexity of virtual reality simulators. Summary of the invention

[0008] In an embodiment, a modular anatomical system for demonstrating, practicing, or evaluating a medical procedure or technique is described herein. In an embodiment, the system includes: an anatomical structure including a base portion and one or more anatomical elements; the base portion including one or more attachment mechanisms, wherein the one or more attachment mechanisms are configured to be removably attached to the corresponding one or more anatomical elements; at least one tracking element; at least one camera for receiving visual information of the anatomical structure and at least one tracking element; and one or more applications running on at least one processor of a computing device, the one or more applications being configured to use information of the at least one tracking element to overlay a three-dimensional virtual feature on a marker in a virtual display of at least a portion of the anatomical structure.

[0009] In an embodiment, one or more anatomical elements are representations of bones, joints, tissues, structures, nerves, blood vessels, or surgical hardware.

[0010] In an embodiment, one or more anatomical elements are constructed based on diagnostic imaging.

[0011] In an embodiment, one or more attachment mechanisms are at different locations on the base.

[0012] In an embodiment, the anatomical structure further comprises a covering portion, wherein the covering portion comprises at least one access port.

[0013] In an embodiment, the at least one access port comprises an anterior side, anterior superior side, anterior inferior side, superior side, lateral side, posterior inferior side, posterior side, or any combination thereof.

[0014] In an embodiment, one or more anatomical elements are configured to removably receive a tissue substitute.

[0015] In an embodiment, the one or more anatomical elements include one or more receiving elements configured to receive a tissue substitute.

[0016] In an embodiment, the one or more receiving elements comprise a container, a pocket, a peg, a hook, a slider, a hole or a socket for receiving a tissue substitute.

[0017] In an embodiment, one or more containment elements are embedded into the anatomical element.

[0018] In embodiments, the tissue substitute comprises cadaveric tissue, synthetic tissue, or animal tissue.

[0019] In an embodiment, the system or portions thereof are manufactured via molding, machining, 3D printing, or any combination thereof.

[0020] In embodiments, the synthetic tissue comprises bone, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, neural tissue, a medical device, or a combination thereof.

[0021] In an embodiment, one or more anatomical elements may be articulated or actuated.

[0022] In an embodiment, one or more anatomical elements may be actuated by a resilient element.

[0023] In an embodiment, the elastic element comprises a rubber band.

[0024] In an embodiment, the system is configured to simulate a medical procedure.

[0025] In an embodiment, the system is configured to assess an operator's proficiency in a medical procedure.

[0026] In an embodiment, the medical procedure comprises a surgical procedure.

[0027] In embodiments, the surgical procedure comprises an otolaryngology procedure, a neurosurgery procedure, a gastroenterology procedure, a urology procedure, cardiovascular surgery, oral surgery, pediatric surgery, plastic surgery, orthopedic surgery, cardiothoracic surgery, dental surgery, podiatric surgery, or any combination thereof.

[0028] In an embodiment, the medical procedure comprises an arthroscopic procedure, a laparoscopic procedure, an endoscopic procedure, a fluoroscopic image-guided procedure, an ultrasound-guided procedure, or an image-guided procedure.

[0029] In an embodiment, the surgical procedures include acromioclavicular reconstruction, rotator cuff repair, anterior labrum repair, posterior labrum repair, superior labrum repair, glenohumeral ligament humeral avulsion repair, shoulder arthroscopy procedures, knee arthroscopy procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, medial collateral ligament reconstruction, lateral collateral ligament reconstruction, autologous osteochondritis dissecans fixation, meniscus repair), hip arthroscopy procedures (CAM resection, femoral osteochondroplasty, labrum repair), ankle arthroscopy procedures (osteochondral fracture fixation, autologous osteochondral transplantation, loose body removal, ankle distraction, ankle fusion), elbow arthroscopy (osteophyte debridement, loose body removal, osteochondral fragment removal, microfracture, autologous osteochondral transplantation, plica resection), wrist arthroscopy, or a combination thereof.

[0030] In an embodiment, one or more anatomical elements are arranged to model an anatomical feature, deformity, or lesion.

[0031] In embodiments, the anatomical feature, deformity or lesion comprises a human anatomical feature, deformity or lesion.

[0032] In an embodiment, the anatomical feature, deformity or lesion is selected from the group consisting of: maxillofacial procedures, neurosurgical procedures, proximal humeral fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric femoral fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus, radial head, olecranon fractures, radial and ulnar shafts, distal radius, posterior malleolus fractures, calcaneal fractures, tarsometatarsal fracture-dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joint, pedicle, subtrochanteric fractures, socket and femoral shaft fractures.

[0033] In an embodiment, at least one tracking element comprises an alphanumeric code, an optical marker, or a chip.

[0034] In an embodiment, at least one tracking element is located within the anatomical structure.

[0035] In an embodiment, at least one tracking element is externally attached to the anatomical structure.

[0036] In an embodiment, at least one camera includes a computing device.

[0037] In an embodiment, a second modular anatomical system identical to the modular anatomical system is positioned remotely from the modular anatomical system.

[0038] In an embodiment, the second modular dissection system is communicatively coupled to the modular dissection system.

[0039] In an embodiment, a trainer using a modular anatomy system performs a medical procedure or technique remotely displayed on a virtual or augmented reality display available to a trainee, who can follow along using a second modular anatomy system.

[0040] In an embodiment, a trainee using a second modular anatomical system performs a medical procedure or technique remotely displayed on a virtual display available to the trainee, wherein the trainer uses the modular anatomical system to perform guided actions visible to the trainee.

[0041] In an embodiment, one or more applications implement artificial intelligence for at least one of: providing virtual instructions to a user of the modular anatomical system and receiving voice command instructions for implementing training tasks in a virtual environment.

[0042] Aspects of the present invention relate to a modular anatomical system for demonstrating, practicing, or evaluating medical procedures or techniques. In an embodiment, the system includes: an anatomical structure including a base portion and one or more anatomical elements; the base portion including one or more attachment mechanisms, wherein the one or more attachment mechanisms are configured to be removably attached to the corresponding one or more anatomical elements; at least one tracking element; at least one camera for receiving visual information of the anatomical structure and at least one tracking element; and one or more applications running on at least one processor of a computing device, the one or more applications being configured to use information of the at least one tracking element to overlay a three-dimensional virtual feature on a marker in a virtual display of at least a portion of the anatomical structure.

[0043] In an embodiment, one or more anatomical elements may be representations of bones, joints, tissues, structures, nerves, blood vessels, or surgical hardware.

[0044] In an embodiment, one or more anatomical elements may be constructed from diagnostic imaging.

[0045] In an embodiment, one or more attachment mechanisms may be at different locations on the base.

[0046] In an embodiment, the anatomical structure may further include a covering portion, wherein the covering portion includes at least one access port.

[0047] In an embodiment, the at least one access port may include an anterior side, anterior superior side, anterior inferior side, superior side, lateral side, posterior inferior side, posterior side, or any combination thereof.

[0048] In an embodiment, one or more anatomical elements may be configured to removably receive a tissue substitute.

[0049] In an embodiment, the one or more anatomical elements may include one or more receiving elements configured to receive a tissue substitute.

[0050] In an embodiment, one or more receiving elements may include a container, a pocket, a peg, a hook, a slider, a hole or a socket for receiving a tissue substitute.

[0051] In an embodiment, one or more containment elements may be embedded into the anatomical element.

[0052] In embodiments, the tissue substitute may include cadaveric tissue, synthetic tissue, or animal tissue.

[0053] In an embodiment, the system or portions thereof may be manufactured via molding, machining, 3D printing, or any combination thereof.

[0054] In embodiments, the synthetic tissue may include bone, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, neural tissue, a medical device, or a combination thereof.

[0055] In an embodiment, one or more anatomical elements may be articulated or actuated.

[0056] In an embodiment, one or more anatomical elements can be actuated by a resilient element. For example, the resilient element can include a rubber band.

[0057] In an embodiment, the system can be configured to simulate a medical procedure. For example, the system can be configured to assess the operator's proficiency in a medical procedure. For example, a medical procedure includes a surgical procedure, and non-limiting examples of surgical procedures include otolaryngology procedures, neurosurgery procedures, gastroenterology procedures, urology procedures, cardiovascular surgery, oral surgery, pediatric surgery, plastic surgery, orthopedic surgery, cardiothoracic surgery, dental surgery, podiatry, or any combination thereof. Non-limiting examples of medical procedures include arthroscopic procedures, laparoscopic procedures, endoscopic procedures, fluoroscopic image-guided procedures, ultrasound-guided procedures, or image-guided procedures. Non-limiting examples of surgical procedures include acromioclavicular reconstruction, rotator cuff repair, anterior labrum repair, posterior labrum repair, superior labrum repair, glenohumeral ligament humeral avulsion repair, shoulder arthroscopy procedures, knee arthroscopy procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, medial collateral ligament reconstruction, lateral collateral ligament reconstruction, autologous osteochondral transplantation, osteochondritis dissecans fixation, meniscus repair), hip arthroscopy procedures (CAM resection, femoral osteochondroplasty, labrum repair), ankle arthroscopy procedures (osteochondral fracture fixation, autologous osteochondral transplantation, loose body removal, ankle distraction, ankle fusion), elbow arthroscopy (osteophyte debridement, loose body removal, osteochondral fragment removal, microfracture, autologous osteochondral transplantation, plica resection), wrist arthroscopy, or a combination thereof.

[0058] In an embodiment, one or more anatomical elements may be arranged to model anatomical features, deformities or pathological changes. For example, anatomical features, deformities or pathological changes may include human anatomical features, deformities or pathological changes. For example, anatomical features, deformities or pathological changes may be selected from the group consisting of the following: maxillofacial procedures, neurosurgery procedures, proximal humeral fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus, radial head, olecranon fractures, radius and ulna shafts, distal radius, posterior malleolar fractures, calcaneal fractures, tarsometatarsal fracture dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joints, pedicles, subtrochanteric fractures, spherical sockets and femoral shaft fractures.

[0059] In an embodiment, at least one tracking element may include an alphanumeric code, an optical marker, or a chip.

[0060] In an embodiment, at least one tracking element may be located within the anatomical structure.

[0061] In an embodiment, at least one tracking element may be located within the anatomical structure.

[0062] In an embodiment, at least one camera may include a computing device.

[0063] In an embodiment, a second modular anatomical system that is identical to the modular anatomical system can be positioned remotely from the modular anatomical system.

[0064] In an embodiment, the second modular dissection system is communicatively coupled to the modular dissection system.

[0065] In an embodiment, a trainer using a modular anatomy system may perform a medical procedure or technique remotely displayed on a virtual or augmented reality display available to a trainee, who may follow along using a second modular anatomy system.

[0066] In an embodiment, a trainee using a second modular anatomical system can perform a medical procedure or technique remotely displayed on a virtual display available to the trainee, where the trainer uses the modular anatomical system to perform guided actions visible to the trainee.

[0067] In an embodiment, one or more applications may implement artificial intelligence for at least one of: providing virtual instructions to a user of the modular anatomical system and receiving voice command instructions for implementing training tasks in a virtual environment.

[0068] Aspects of the present invention also relate to a modular anatomical system for demonstrating, practicing or evaluating medical procedures or techniques, the system comprising: an anatomical structure comprising a base portion and one or more anatomical elements; the base portion comprising one or more attachment mechanisms, wherein the one or more attachment mechanisms are configured to be removably attached to corresponding one or more anatomical elements; a virtual reality controller, wherein the virtual reality controller is attached to a surgical probe; a virtual reality camera device; one or more applications running on one or more processors of at least one of the virtual reality controller and the virtual reality camera device, the one or more applications being configured to: establish a position of the virtual reality controller relative to the virtual reality camera; receive three-dimensional data of the anatomical structure, the anatomical structure comprising one or more anatomical elements within the anatomical structure; use the three-dimensional data to map an xyz position of the controller to an xyz position of the anatomical structure; use the mapped information to track the position of the surgical probe relative to the anatomical elements; and generate a virtual display of the surgical probe within the environment of the anatomical structure.

[0069] In an embodiment, mapping may include placing a virtual reality controller in a fixed position relative to the anatomy.

[0070] In an embodiment, the mapping may include a virtual reality camera mapping the environment.

[0071] In an embodiment, mapping may include a virtual reality camera using information from an environment map and the three-dimensional data to map an xyz position of a controller to an xyz position of an anatomical structure.

[0072] In an embodiment, one or more anatomical elements may be representations of bones, joints, tissues, structures, nerves, blood vessels, or surgical hardware.

[0073] In an embodiment, one or more anatomical elements may be constructed from diagnostic imaging.

[0074] In an embodiment, one or more attachment mechanisms may be at different locations on the base.

[0075] In an embodiment, the anatomical structure may further include a covering portion, wherein the covering portion includes at least one access port. For example, the at least one access port may include anterior, anterior superior, anterior inferior, superior, lateral, posterior inferior, posterior, or any combination thereof.

[0076] In an embodiment, one or more anatomical elements may be configured to removably receive a tissue substitute.

[0077] In an embodiment, the one or more anatomical elements may include one or more receiving elements configured to receive a tissue substitute.

[0078] In an embodiment, one or more receiving elements may include a container, a pocket, a peg, a hook, a slider, a hole or a socket for receiving a tissue substitute.

[0079] In an embodiment, one or more containment elements may be embedded into the anatomical element.

[0080] In an embodiment, the system or portions thereof may be manufactured via molding, machining, 3D printing, or any combination thereof.

[0081] In embodiments, the tissue substitute may include cadaveric tissue, synthetic tissue, or animal tissue. For example, the synthetic tissue may include bone, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, neural tissue, medical devices, or combinations thereof.

[0082] In an embodiment, one or more anatomical elements may be articulated or actuated.

[0083] In an embodiment, one or more anatomical elements can be actuated by a resilient element. For example, the resilient element can include a rubber band.

[0084] In an embodiment, the system can be configured to simulate a medical procedure. For example, the system can be configured to assess the operator's proficiency in a medical procedure. For example, a medical procedure can include a surgical procedure, and non-limiting examples of surgical procedures can include otolaryngology procedures, neurosurgery procedures, gastroenterology procedures, urology procedures, cardiovascular surgery, oral surgery, pediatric surgery, plastic surgery, orthopedic surgery, cardiothoracic surgery, dental surgery, podiatry, or any combination thereof. For example, a medical procedure can include an arthroscopic procedure, a laparoscopic procedure, an endoscopic procedure, a fluoroscopic image-guided procedure, an ultrasound-guided procedure, or an image-guided procedure. For example, surgical procedures may include acromioclavicular reconstruction, rotator cuff repair, anterior labrum repair, posterior labrum repair, superior labrum repair, glenohumeral ligament humeral avulsion repair, shoulder arthroscopy procedures, knee arthroscopy procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, medial collateral ligament reconstruction, lateral collateral ligament reconstruction, autologous osteochondritis dissecans fixation, meniscus repair), hip arthroscopy procedures (CAM resection, femoral osteochondroplasty, labrum repair), ankle arthroscopy procedures (osteochondral fracture fixation, autologous osteochondral transplantation, loose body removal, ankle distraction, ankle fusion), elbow arthroscopy (osteophyte debridement, loose body removal, osteochondral fragment resection, microfracture, autologous osteochondral transplantation, plica resection), wrist arthroscopy, or a combination thereof.

[0085] In an embodiment, one or more anatomical elements may be arranged to model anatomical features, deformities or pathological changes. For example, anatomical features, deformities or pathological changes may include human anatomical features, deformities or pathological changes. For example, anatomical features, deformities or pathological changes may be selected from the group consisting of the following: maxillofacial procedures, neurosurgery procedures, proximal humeral fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus, radial head, olecranon fractures, radius and ulna shafts, distal radius, posterior malleolar fractures, calcaneal fractures, tarsometatarsal fracture dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joints, pedicles, subtrochanteric fractures, spherical sockets and femoral shaft fractures.

[0086] In an embodiment, a second modular anatomical system that is identical to the modular anatomical system can be positioned remotely from the modular anatomical system.

[0087] In an embodiment, a second modular dissection system can be communicatively coupled to the modular dissection system.

[0088] In an embodiment, a trainer using a modular anatomy system can perform a medical procedure or technique remotely displayed on a virtual or augmented reality display available to a trainee, who follows along using a second modular anatomy system.

[0089] In an embodiment, a trainee using a second modular anatomical system can perform a medical procedure or technique remotely displayed on a virtual display available to the trainee, where the trainer uses the modular anatomical system to perform guided actions visible to the trainee.

[0090] In an embodiment, one or more applications may implement artificial intelligence for at least one of: providing virtual instructions to a user of the modular anatomical system and receiving voice command instructions for implementing training tasks in a virtual environment.

[0091] Aspects of the present invention also relate to a method of simulating a medical procedure. For example, the method may include simulating a medical procedure using an anatomical system as described herein.

[0092] Furthermore, aspects of the present invention relate to a medical procedure simulation system. For example, the system includes a modular dissection system as described herein; software configured to calculate an operator proficiency score; and a display screen configured to display the operator proficiency score.

[0093] Other objects and advantages of the present invention will become apparent from the ensuing description. BRIEF DESCRIPTION OF THE DRAWINGS

[0094] Figure 1Illustrations of the base (sub-figure a), anatomical elements (sub-figure b) and dome (sub-figure c) are shown.

[0095] Figure 2 Illustrations showing examples of bags (sub-figure a) and pegs (sub-figure b) that may be included in an anatomical element housing a cuboid tissue substitute as shown in (sub-figure c).

[0096] Figure 3 Shown is a diagram of the base, one anatomical element (scapula), the base, and a retaining plate placed at the bottom to restrict movement of the anatomical element.

[0097] Figure 4 Images of an example of a modular system prototype are shown with the hood closed (sub-figure a) and open (sub-figure b).

[0098] Figure 5 A diagram showing an example of a computer setup with predetermined locations of visual markers that can then be placed on a real world model to triangulate the locations.

[0099] Figure 6 An illustration showing (left) an example of a marker placed in a real-world model. The model has slots or peg holes to guide the user in inserting the marker at predetermined locations and angles relative to the virtual model to triangulate the location of the augmented reality structure and (right) the simulated bleeding vessel. This demonstrates an augmented / mixed reality structure that can be placed inside a model for training exercises.

[0100] Figure 7 Shown are examples of (left) a wooden dowel or rod with attached markers and (right) an augmented metal cylinder that simulates a razor device and can interact with augmented reality but provides tactile feedback based on a real-world model.

[0101] Figure 8 An image showing an example of the system augmented with a virtual bursa (left) and printed markings USD (right).

[0102] Fig. 9 Illustrations showing examples of augmented reality (AR) markers in a mask (sub-figure a), on additional posts anchored to anatomical elements (sub-figure b), and composed of a bone substitute (sub-figure c).

[0103] Fig.10 A diagram of the present invention for rotator cuff repair training is shown.

[0104] Fig.11 Pictures of the systems described herein are shown at various viewing angles.

[0105] Fig.12Illustration of a hip arthroscopy-acetabular block and femoral neck block model is shown.

[0106] Fig.13 Illustration of a sacroiliac screw simulator - sacral block and iliac block model is shown.

[0107] Fig.14 An illustration of a posterior pedicle screw simulator with 2 blocks is shown.

[0108] Fig.15 An illustration of a subtrochanteric fracture model with a rubber band is shown.

[0109] Fig.16 A diagram of a camera handle having an open architecture for placing a camera is shown.

[0110] Fig.17 Shown is an illustration of a synthetic arthroscopic camera model that allows the camera to be inserted into a hole at the back and extended out the front to be used as an arthroscopic camera mimic.

[0111] Fig.18 A diagram of a camera mount is shown.

[0112] Fig.19 A diagram of a camera mount is shown.

[0113] Fig. 20 A diagram of a camera mount having a closed architecture is shown.

[0114] Fig.21 A diagram of a camera mount is shown.

[0115] Fig. 22 A diagram showing a camera mount and a camera.

[0116] Fig.23 A diagram showing a camera mount and a camera.

[0117] Fig.24 A diagram showing a camera mount and a camera.

[0118] Fig.25 A diagram of a camera mount is shown.

[0119] Fig.26 An illustration of a synthetic arthroscopic camera model is shown that allows the camera to be inserted into a hole at the back and extended out the front to be used as an arthroscopic camera simulation. In addition, the handle has an illustration of a handle for holding a mold of a joystick and / or game controller that can interact with a computer.

[0120] Fig. 27 An illustration of a handle with a mold for holding a joystick and / or game controller that can interact with a computer is shown.

[0121] Fig.28 A diagram of a handle and a game controller is shown.

[0122] Fig.29 An illustration of a handle having a mold for holding an augmented reality / virtual reality / mixed reality controller with built-in tracking software to track the movement of a camera relative to a real-world simulation training module is shown.

[0123] Fig.30 An illustration of a handle with a mold for holding an augmented reality / virtual reality / mixed reality controller is shown.

[0124] Fig.31 An illustration of a handle with a mold for holding an augmented reality / virtual reality / mixed reality controller is shown.

[0125] Fig.32 An illustration of a synthetic arthroscopic camera model is shown that allows the camera to be inserted into a hole in the back and extended out the front to be used as an arthroscopic camera simulation. Additionally, the handle has a mold that holds a smartphone or other optical tracking device with built-in tracking software to track the movement of the camera relative to the real-world simulation training module. The screen can then face the user to display a picture of the arthroscopic training module or the real-world environment in a mixed reality perspective.

[0126] Fig.33 An illustration of a handle with a mold for holding a smartphone or other optical tracking device is shown.

[0127] Fig.34 An illustration of a handle with a mold for holding a smartphone or other optical tracking device is shown.

[0128] Fig.35 An illustration of a synthetic arthroscopic tool model is shown. The handle has a mold for holding an augmented reality / virtual reality / mixed reality controller with built-in tracking software to track the movement of the tool relative to the real-world simulation training module. In the augmented / mixed reality / virtual reality environment, the tool can then be visualized as a variety of instruments, such as a suture passer, a cautery device, or a razor.

[0129] Fig.36 An illustration of a handle having a mold for holding an augmented reality / virtual reality / mixed reality controller with built-in tracking software to track the movement of the tool relative to a real-world simulation training module is shown.

[0130] Fig.37A schematic diagram of a composite handle with a local tracking handle is shown.

[0131] Fig.38 An illustration of a fracture deformity simulator is shown. The simulated bone is purple, the socket is blue, and the simulated bone block is orange.

[0132] Fig.39 An illustration of a fracture deformity simulator is shown. The simulated bone is purple, the socket is blue, and the simulated bone block that has been inserted into the socket is orange.

[0133] Fig.40 Shown is an illustration of a spherical socket with a base for clamping to a work surface and 6 hooks around the ring at 45 degree intervals.

[0134] Fig.41 An illustration of the 2 cricoid sockets on both ends used to stabilize the two bone ends is shown.

[0135] Fig.42 An illustration of a femoral shaft fracture model is shown in which a ball end and hook are placed to recreate deforming forces at the proximal and distal femur.

[0136] Fig.43 An illustration of the 2 cricoid sockets with a femoral model is shown.

[0137] Fig.44 An illustration showing the top of a semi-circular ring for clamping to a workbench.

[0138] Fig.45 An illustration of the 2 ring top sockets and the ring top is shown with a simulated femoral fracture and a deformed hook attachment.

[0139] Fig.46 An illustration of the annular fossa and annular top is shown with a simulated femoral fracture and a deformed hook attachment.

[0140] Fig.47 A diagram of a femur fracture model is shown.

[0141] Fig.48 Illustration of a tension device attached to the femur and rings is shown. The tension ring extends medially to the distal femur to generate an adduction deforming force (red ring). The tension device located anteriorly and lateral to the proximal femur generates flexion and abduction deforming forces (blue ring).

[0142] Fig.49 An illustration of an arthroscopic camera model is shown with a socket at the end for mounting a small camera (primary camera). Additionally, a socket in the handle is used to mount an additional camera (auxiliary camera). This auxiliary camera can be used to view external markers on the outside of the arthroscopic model to calibrate the position of the simulated camera. This can then be used to combine with real video from the primary camera to create mixed reality.

[0143] Fig.50 An illustration of an arthroscopic camera model is shown.

[0144] Fig.51 An illustration of the primary camera inside the model is shown, with a secondary camera outside the arthroscopic model visualizing the target (red).

[0145] Fig.52 A diagram of an embodiment of a knee simulator is shown.

[0146] Fig.53 A diagram of an embodiment of a knee simulator is shown.

[0147] Fig.54 A diagram of an embodiment of a knee simulator is shown.

[0148] Fig.55 A diagram of an embodiment of a knee simulator is shown.

[0149] Fig.56 A diagram of an embodiment of a knee simulator is shown.

[0150] Fig.57 A diagram of an embodiment of a knee simulator is shown.

[0151] Fig.58 A diagram of an embodiment of a knee simulator is shown.

[0152] Fig.59 A diagram of an embodiment of a knee simulator is shown.

[0153] Fig.60 A diagram of an embodiment of a knee simulator is shown.

[0154] Fig.61 A diagram of an embodiment of a knee simulator is shown.

[0155] Fig.62 A diagram of an embodiment of a knee simulator is shown.

[0156] Fig.63 A diagram of an embodiment of a knee simulator is shown.

[0157] Fig.64 A diagram of an embodiment of a knee simulator is shown.

[0158] Fig.65 A diagram of an embodiment of a knee simulator is shown.

[0159] Fig.66 A diagram of an embodiment of a knee simulator is shown.

[0160] Fig.67 A diagram of an embodiment of a knee simulator is shown.

[0161] Fig.68 A diagram of an embodiment of a knee simulator is shown.

[0162] Fig.69 A diagram of an embodiment of a knee simulator is shown.

[0163] Fig.70 A diagram of an embodiment of a knee simulator is shown.

[0164] Fig.71 A diagram of an embodiment of a knee simulator is shown.

[0165] Fig.72 Diagram showing examples of portal locations of the present disclosure. Ankle joint - 2 anterior portals, 2 posterior portals, 2 medial incision portals, 2 lateral incision portals.

[0166] Fig.73 Diagrams showing examples of portal locations of the present disclosure. Hip Joint - 5 portals.

[0167] Fig.74 Diagrams showing examples of portal locations of the present disclosure. Knee joint - 3 anterior portals.

[0168] Fig.75 Diagrams showing examples of portal locations of the present disclosure. Lumbar - Midline portal.

[0169] Fig.76 Diagrams showing examples of entry locations for the present disclosure. Neck - Posterior midline incision entry.

[0170] Fig.77 Diagram showing examples of portal locations for the present disclosure. Hand and / or wrist - 3 portals.

[0171] Fig.78 Diagram showing examples of inlet locations of the present disclosure. Elbow - 4 inlets.

[0172] Fig.79 Figures illustrating embodiments of the present disclosure.

[0173] Fig.80 The total number of seconds to complete the arthroscopic shoulder simulator task is shown.

[0174] Fig.81 Shown is a scatter plot of the number of seconds required to complete an arthroscopic simulation task on a novel simulator versus the number of shoulder arthroscopies performed during a career.

[0175] Fig.82Anatomical test scores before and after use of a shoulder arthroscopy simulator are shown for Alex3 and the novel simulator described herein.

[0176] Figures 83 to 97 The steps for creating a surgical training platform as described herein are shown. Fig.83 and Fig.84 ). Schematic diagram of a trapezoid, with two sides formed by two circular arcs, characterized by infinitesimal curvatures when starting to create the training platform. In the default configuration, the dimensions of the trapezoid are similar to a square with a side length of 100 mm. The topology of the base rectangle is enriched by extending arms, which are formed by circles connected to the trapezoid through rectangles that, in the default configuration, are orthogonal to the vertical axis of the trapezoid. The base is then automatically constructed so that this profile is extruded in the direction of the vertical axis. ( Fig.85 ). The outer contour of the containment plate can then be generated by extrusion of an offset contour performed on the outer edge of the base. The offset of the base contour can be made by a first distance, which for FDM printing technology can be 0.4 mm, while the second offset creating the outer wall of the containment plate can have various dimensions, of which 4 mm is a dimension that has been achieved in existing prototypes. ( Fig.86 ). The user can add primitives corresponding to the base through a selection menu available in the user interface (UI). Primitives can be placed in the 3D environment (3DE) by dragging and dropping. Once the elements are inserted into the 3D environment, the system assigns a random unique color to each element. Each element can be listed in a dedicated sidebar window where the user can select individual elements or a group of elements, delete them or indicate to the training system whether the elements are virtual, real or both. For geometries with edges below the base plane, this plane can be used for cutting. The placed geometry can be further manipulated through the "Gizmo" tool (see figure below), which allows operations such as positioning, scaling and stretching. The Gizmo appears on the entity once selected by the user. ( Fig.87 The same tool can be used to move the side arms in a plane for clamping, and appears when the user pointer is in the position corresponding to the center of the arm. ( Fig.88 ). A "drawing tool" may be included for which the system may create a sweep of a circular portion along a path determined by the user via the position of the pointer. In an embodiment, a curve may be determined from the path, ideally creating a single NURBS curve for each successive input received by the user (example: pressing the left mouse button for computer-based modeling, or pressing an index-thumb pinch or hand-held controller button for VR-AR based systems). ( Fig.89). As shown, elements indicated as real will be indicated with a solid color, while virtual elements will be displayed in a transparent manner, and elements indicated as real and virtual will be solid colors and surrounded by a transparent surface created by offsetting the element surface by a preset distance. ( Fig.90 )The user can also use the function menu to add elements such as: pins for anchoring soft tissue substitutes, bags for containing bone substitutes, joints such as sliders and hinges, and hooks for anchoring springs or rubber bands. These elements are different from the geometry when they are positioned in place after user confirmation, and they are merged into the interfering geometry through Boolean operations. When the pin moves corresponding to the geometric element, it is set by default so that its main axis is perpendicular to the surface of the geometric element at the intersection of the main axis and the surface of the geometric element. See the following figure. ( Fig.91 ). When dragging the bag of bone substitute in 3DE, an arrow is displayed to the user, indicating the direction of removal of the bone substitute and the axis along which the user can interact when performing training. ( Fig.92 ). Bags can be incorporated into geometric elements by the following automated steps: a) Fig.93 - Subtract the box defining the pocket from the geometric entity; b) Fig.94 - Two additional Boolean subtractions are performed internally on the parallelepiped created at the window of the bag to ensure that the bone substitute can be used and removed; c) Fig.95 -Merge the bag with the geometric entities to obtain the final configuration. For the bag feature tool, the gizmo allows for Euclidean transformations, and the behavior when scaling is different given the standard dimensions of the bone substitute. When scaling is performed, a fit is performed to the size values ​​of the bone substitute that will be released to the public. In an embodiment, the dimensions can be: 20×20×20mm, 30×30×30mm, 20×20×3mm, 30×30×3mm, 20×20×3mm, 30×30×3mm, 20×20×40mm, 20×20×60mm, 30×30×60mm. Hinges, sliders, and hooks can be introduced similarly in 3DE. ( Fig.96 ). After positioning the element in 3DE, the user has the option to verify the status of the entity with respect to the entity's merging to the base. The merged elements are then included in the list as separate items and indicated with an alphanumeric symbol (*). During this process, in the object view, each isolated element has a "real" green box if it is connected to the base, while elements that are not in contact with the base have a "virtual" green box. This is the default configuration, for which elements marked as real will be physically realized (3D printed), while elements marked as virtual will be saved as 3D models and associated with an augmented reality marker. At this point, the user can accept this realization by the trainer, or select the "real" box to represent the element that they want to be physically realized. ( Fig.97 ).

[0177] Fig.98 Shown are the total seconds required to complete the arthroscopic shoulder simulator task on a 3D printed arthroscopic shoulder simulator (3DPASS) and a commercially available shoulder simulator (CASS).

[0178] Fig.99 The construct validity of the ASSET ratings by expert surgeons and medical students using the CASS and 3DPASS was shown.

[0179] Fig.100 Shown are the total seconds it took a medical student and an expert surgeon to complete the arthroscopic shoulder simulator task using a commercially available simulator and a 3D printed simulator.

[0180] Fig.101 Shown are the anatomy test scores of medical students and expert attending physicians before and after using a shoulder arthroscopy simulator on a commercially available simulator and a 3D printed simulator.

[0181] Fig.102 An image showing an example of a modular system prototype with covers of different hues.

[0182] Fig.103 An embodiment of a 3D printed arthroscopic shoulder simulator is shown.

[0183] Fig.104 Anatomical test scores before and after use of a shoulder arthroscopy simulator are shown for a commercially available simulator (Alex 3) and one embodiment of the simulator described herein.

[0184] Fig.105 The total seconds to complete the arthroscopic shoulder simulator task on 3DPAS S and CAS S are shown.

[0185] Fig.106 An experimental evaluation method of construct validity in medical students and novice and expert orthopedic arthroscopic surgeons was shown.

[0186] Fig.107 Different arthroscopic tasks tested in an experimental evaluation of construct validity in medical students versus novice and expert orthopedic arthroscopic surgeons are shown.

[0187] Fig.108 ASSET on a 3D printed arthroscopic shoulder simulator (3DPASS) and a commercially available shoulder simulator (CASS) is shown.

[0188] Figures 109 to 113Exemplary steps for creating an embodiment of a system for surgical task training and features of a computer-aided design system designed for this purpose are shown. These steps can be performed by a software environment that provides visualization and editing of three-dimensional representations of anatomical structures. Fig.109 The creation of a training platform base is shown. Fig.110 Enriching the training platform base with primitives is shown. Fig.111 Enriching the training platform with anatomical elements is shown. Fig.112 Enriching the training platform base with arbitrary geometry is shown. A "drawing tool" may be included for which the system can create a scan of a circular portion along a path determined by the user through the position of the pointer. Fig.113 Enriching the training platform with features is shown. In addition to the insertion and editing of entities, the user can also use the function menu to add elements such as: pins for anchoring soft tissue substitutes, bags for containing bone substitutes, joints such as sliders and hinges, and hooks for anchoring springs or rubber bands. Fig.90 , the types of elements included in the simulator may be different from each other. Elements indicated as real will be indicated with a solid color, while virtual elements may be displayed in a transparent manner, and elements indicated as real and virtual may be solid colors and surrounded by a transparent surface created by offsetting the element surface by a preset distance. DETAILED DESCRIPTION

[0189] Abbreviations and definitions

[0190] The specific implementation of one or more preferred embodiments is provided herein. However, it should be understood that the present invention can be embodied in various forms. Therefore, the specific details disclosed herein should not be interpreted as limiting, but as the basis of the claims and as a representative basis for teaching those skilled in the art to adopt the present invention in any appropriate manner.

[0191] Unless the context clearly dictates otherwise, the singular forms "a", "an", and "the" include plural referents. In the claims and / or specification, when used in conjunction with the term "comprising", the use of the word "a" or "an" may mean "one", but is also consistent with "one or more", "at least one", and "one or more than one".

[0192] Wherever the phrases "for example," "such as," "including," etc. are used herein, unless expressly stated otherwise, they should be understood to be followed by the phrase "and but not limited to." Similarly, "example," "exemplary," etc. should be understood to be non-limiting.

[0193] The term "substantially" allows deviations from the descriptor that do not adversely affect the intended purpose. Even if the term "substantially" is not explicitly recited, the descriptive term should be understood to be modified by the term "substantially".

[0194] The terms "comprising," "including," "having," and "involving," etc. are used interchangeably and have the same meaning. Specifically, each of these terms is defined to be consistent with the general U.S. patent law definition of "comprising," and thus should be interpreted as open terms meaning "at least the following," and should also be interpreted as not excluding additional features, limitations, aspects, etc. Thus, for example, "a process involving steps a, b, and c" means a process that includes at least steps a, b, and c. Whenever the term "a" or "an" is used, it should be understood to mean "one or more," unless such an interpretation does not make sense in the context.

[0195] The term "about" is used herein to mean approximately, roughly, around, or in the region of. When the term "about" is used in conjunction with a numerical range, the term modifies the range by extending the boundaries above and below the numerical values ​​set forth. Typically, the term "about" is used herein to modify the numerical values ​​above and below the stated value by a variation of up or down (higher or lower), such as 20%.

[0196] For purposes of this disclosure, note that spatially relative terms, such as "upward," "downward," "right," "left," "below," "under," "lower," "above," "upper," and the like are used herein for ease of description to describe the relationship of one element or feature to another element or feature, as shown in the accompanying drawings. It should be understood that spatially relative terms are intended to include different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device in the figure is flipped or rotated, elements described as being "below" or "below" other elements or features will be oriented as being "above" the other elements or features. Thus, the exemplary term "below" can include both above and below orientations. The device can be oriented in other ways (rotated 90 degrees or in other orientations), and the spatially relative descriptors used herein are interpreted accordingly.

[0197] As used herein, the term "standard of care" may refer to the diagnostic and / or therapeutic process that a clinician follows for a certain type of patient, disease, or clinical situation. For example, the standard of care may refer to the common skills and level of care that a clinician should achieve when providing clinical care to a patient. In an embodiment, the standard of care may vary depending on the patient, disease, or clinical situation. As used herein, "standard nursing practice" may refer to the practice as standard care.

[0198] As used herein, the term "clinician" may refer to a person who is qualified to practice medicine, psychiatry, or psychology clinically. As used herein, the terms "clinician" and "physician" may be used interchangeably. For example, a "clinician" may refer to a physician, surgeon, veterinarian, physician's assistant, nurse, or a person practicing under his or her supervision.

[0199] As used herein, the term "credentialed" may refer to a professional whose credentials have been approved by an official body or regulatory agency. For example, this person is a physician who has graduated from medical school, completed residency, trained under professional supervision, and passed a medical specialty board certification exam.

[0200] As used herein, the terms "subject" and "patient" include all members of the animal kingdom, including, but not limited to, mammals, beasts (eg, cats, dogs, horses, pigs, etc.), and humans.

[0201] Modular dissection system

[0202] Aspects of the present invention are directed to a modular dissection system configured to simulate medical procedures as described herein.

[0203] Embodiments as described herein may be configured to represent specific tissues, organs, and / or cavities in mammalian anatomy, such as human anatomy.

[0204] Embodiments may include a base portion, one or more three-dimensional anatomical elements, at least one tracking element, and a processing unit.

[0205] A "base portion" may refer to any support structure capable of supporting components of an anatomical model as described herein, including but not limited to one or more anatomical elements and / or a cover portion. In an embodiment, the base portion may be planar, and components of the anatomical model may be positioned directly on top of the planar base portion. Fig.56 and Fig.58 , for example, the base may be upright and the components of the anatomical model may be positioned perpendicular to the upright base.

[0206] In an embodiment, the base portion includes one or more attachment mechanisms configured to be removably attached to corresponding anatomical elements. The term "attachment mechanism" can refer to a mechanism for combining, joining, or securing a first material to a second material. For example, the attachment mechanism can be used to secure an anatomical element to a base portion, a first anatomical element to a second or more anatomical elements, a cover portion to a base portion, and the like. Non-limiting examples of attachment mechanisms can be hooks, snaps, clips, retainers, loop fasteners, magnets, latches, adhesives, or any other mechanism capable of permanently or removably attaching a first element to a second element.

[0207] In an embodiment, one or more attachment mechanisms (and their corresponding anatomical elements) can be arranged at different locations of the base portion to model anatomical features, deformities, or lesions (such as anatomical features, deformities, or lesions of mammals). In an embodiment, anatomical elements can be arranged on the base portion to simulate human anatomical features, deformities, or lesions.

[0208] Non-limiting examples of anatomical features include the humerus, tibia, femur, fibula, ankle, radial head, hip, pelvis, sacroiliac joint, spine, thorax, skull, and the like.

[0209] Non-limiting examples of anatomical deformities include dislocations, dislocations, dysplasia, fractures, spondylosis, curvature abnormalities, limb anomalies, craniosynostosis, and the like.

[0210] Non-limiting examples of anatomical conditions include fractures, osteoporosis, polymyalgia rheumatica, cancer, arthritis, osteoarthritis, rheumatoid arthritis, rickets, fibrous dysplasia, graft-versus-host disease, lateral epicondylitis, Paget's disease of bone, multiple myeloma, metabolic bone disease, osteogenesis imperfecta, gout, neurological syndromes, marble bone disease, osteomyelitis, and the like.

[0211] For example, the anatomical condition can be a fracture. Non-limiting examples of such fractures include maxillofacial procedures, neurosurgical procedures, proximal humerus fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric femoral fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus fractures, radial head fractures, olecranon fractures, radial and ulnar shaft fractures, distal radius fractures, posterior malleolus fractures, calcaneal fractures, tarsometatarsal fracture dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joint, pedicle, subtrochanteric fractures, socket, and femoral shaft fractures.

[0212] An "anatomical element" may refer to a three-dimensional representation of a portion of a mammalian anatomy, such as a human anatomy. For example, an anatomical element may represent a particular bone, joint, ligament, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, etc. In embodiments, an anatomical element may include a non-mammalian anatomical element previously introduced into the body, such as an implant or hardware associated with a previous medical procedure, such as surgery.

[0213] In an embodiment, the anatomical elements can be constructed from diagnostic imaging of the subject's body. "Diagnostic imaging" can refer to any visual display of the structure or functional pattern of an organ or tissue for diagnostic evaluation. It can include measuring physiological and metabolic responses to physical or chemical stimuli. Medical diagnostic and imaging systems have a variety of modes, including ultrasound systems, optical imaging systems, computed tomography (CT) systems, x-ray systems (including conventional and digital or digitized imaging systems), positron emission tomography (PET) systems, single photon emission computed tomography (SPECT) systems, and magnetic resonance imaging (MRI) systems.

[0214] In an embodiment, one or more anatomical elements can be articulated or actuated to simulate the relative movement, migration, rotation of natural tissue. For example, the relative migration of bones caused by joint instability. For example, one or more anatomical elements can be actuated by elastic elements such as rubber bands.

[0215] In an embodiment, the anatomical element comprises a tissue substitute. "Tissue substitute" may refer to a material that can replace or represent natural tissue and simulate the properties of natural tissue in situ. For example, the term "bone substitute" may refer to any material that can simulate the characteristics of natural bone in situ, including synthetic hydroxyapatite and sol-gel systems containing Ca and / or Si. Similar to natural tissue, a tissue substitute may be drilled, implanted, sawn, ablated or excised.

[0216] In an embodiment, the tissue substitute can be a synthetic tissue. The synthetic tissue can be made of materials such as wood, PEEK, polyethylene, high-density polyethylene, polyurethane, ABS, PLA, PVA, polystyrene, silicone rubber, nylon, neoprene, modacrylic, olefin, acrylic, polyester, rayon, nylon, spandex, vinylon, mucus, aramid, Kevlar, twaron, modal, dyneema / spectra, polybenzimidazole, sulfur, lyocell, M-5 (PIPD fiber), orlon, zylon (PBO fiber), vectran (TLCP fiber), derclon fiber, silk, plasticine, natural rubber, paint, cellulose, cotton, wool, epoxy resin, polytetrafluoroethylene, rubber, isoprene, keratin, acetylglucosamine, glucose, phenolic compounds, D-galacturonic acid products, fibroin, and the like.

[0217] In embodiments, the anatomical element may include cadaveric tissue, animal tissue, or portions thereof.

[0218] In an embodiment, the components of the system can be made via molding, machining, 3D printing, or any combination thereof. For example, the components of the system can be shaped, manufactured, or 3D printed according to shapes or objects stored on a server and downloaded through a website.

[0219] For example, the anatomical element itself can be integrally made of the entire tissue substitute, or the anatomical element can be made of one material but configured to removably hold and / or anchor the tissue substitute therein. For example, the anatomical element can have a pocket, staple, or other attachment mechanism to removably hold and / or anchor the tissue substitute. In this way, the operator attempting the surgical method sacrifices only the tissue substitute and not the entire anatomical element. After completing the training exercise, the tissue substitute can be removed and replaced with a new tissue substitute for additional practice.

[0220] In embodiments, the anatomical element may include one or more "receiving elements". For example, a receiving element may be configured to receive a tissue substitute. Non-limiting examples of a receiving element include a container, a bag, a pin, a hook, a slide, a hole, or a socket. For example, a receiving element may be designed so that a tissue substitute can be slid into the receiving element, such as into a socket or a container. In embodiments, the insertion / extraction direction of the tissue substitute is perpendicular to the direction of instrumentation, compression, implantation described in surgical training, so that when a force is applied to the substitute, the substitute will not be pulled out (e.g., see Fig. 9 , Panels B and C). In an embodiment, there may be a hole connected to the socket or container so that a user can push or pull the tissue substitute out of the containing element (eg, socket or container).

[0221] The containing element may be embedded into the system, such as into an anatomical element.

[0222] "Tracking elements" may refer to elements that identify or track anatomy, structures, and activities in a training surgical environment. For example, tracking elements may include markers placed within a surgical task training environment to enable display of virtual elements in an augmented or mixed reality environment. These augmented reality markers include images or objects that can be recognized by a processing unit and camera recognition system equipped with augmented reality. The images or objects are used to trigger augmented reality features. These markers can be used to track elements and activities in a surgical training environment associated with a user to provide tactile feedback for surgical task training performed in virtual reality. In addition, the tracking element may include an alphanumeric code printed on an anatomical element in the surgical training environment. As yet another example, the tracking element may include an RFID tag or chip embedded in an anatomical element. The RFID tag or chip is capable of broadcasting information identifying the anatomical element.

[0223] A "processing unit" may refer to a unit or system that includes any collection of processor-based devices or computing devices operating together, or components of a processing system or device. For example, a processing system may include one or more personal computers, workstations, servers, mainframe computers, laptop computers, mobile computers, smartphones, tablet computers, or combinations thereof. A processing system may include components within a larger computer system.

[0224] In an embodiment, the processing unit may be communicatively linked to the tracking element. A "communication link" may refer to a communication path coupling these components. A communication path includes any medium for communicating or transferring files between components. Communication paths include wireless connections, wired connections, and hybrid wireless / wired connections. Communication paths also include coupling or connection to networks, including local area networks (LANs), metropolitan area networks (MANs), wide area networks (WANs), proprietary networks, inter-office or back-end networks, the Internet, mobile networks, and cellular networks. In addition, communication paths include removable fixed media, such as floppy disks, hard drives, and CD-ROM disks, as well as flash RAM, universal serial bus (USB) connections, RS-232 connections, telephone lines, buses, and email messages.

[0225] The modular dissection system may also include a "cover portion" or "hood" that includes at least one access port. An "access port" may refer to a physical opening that provides an operator with access to an area beneath the cover portion that contains system components, including one or more anatomical elements. In an embodiment, the access port may be covered with a softer, elastic material that mimics human skin to allow an incision to be made with a surgical scalpel. Depending on the desired medical procedure and anatomical structure, the access ports may be dispersed throughout the hood. For example, at least one access port includes an anterior side, an anterior superior side, an anterior inferior side, an superior side, an lateral side, a posterior inferior side, a posterior side, or any combination thereof.

[0226] Medical Procedure Simulation System

[0227] Aspects of the invention relate to a medical procedure simulation system. In an embodiment, the system comprises a modular dissection system, software, and a display screen as described herein.

[0228] In an embodiment, the software is configured to calculate an operator proficiency score and / or determine an elapsed time, and the display screen is configured to display the operator proficiency score and / or elapsed time.

[0229] The medical protocol simulation system may also include a microcontroller. A "microcontroller" may refer to a small computer on a single metal oxide semiconductor (MOS) integrated circuit (IC) chip. A microcontroller contains one or more CPUs (processor cores) as well as memory and programmable input / output peripherals.

[0230] In an embodiment, the microcontroller may include a timer, an interface to a processing unit, an output to a display, or a combination thereof.

[0231] Using a systematic approach

[0232] The embodiments described herein may be used to simulate a medical procedure, thereby allowing a user to demonstrate, practice, or evaluate a medical procedure or technique.

[0233] The term "medical procedure" may refer to any clinical or diagnostic procedure performed by a medical practitioner (e.g., including but not limited to a physician or physician assistant, a nurse or nurse practitioner, or a veterinarian). Non-limiting examples of medical procedures include arthroscopic procedures, laparoscopic procedures, endoscopic procedures, fluoroscopic image-guided procedures, ultrasound-guided procedures, or image-guided procedures.

[0234] In embodiments, a medical procedure comprises a "surgical procedure." A "surgical procedure," "surgical procedure," and the related terms "surgery," "surgical procedure," or "surgical intervention" may refer to any medical procedure that involves cutting open tissue. For example, a surgical procedure comprises an otolaryngology procedure, a neurosurgery procedure, a gastroenterology procedure, a urology procedure, a cardiovascular surgery procedure, an oral surgery procedure, a pediatric surgery procedure, a plastic surgery procedure, an orthopedic surgery procedure, a cardiothoracic surgery procedure, a dental procedure, a podiatric surgery, or any combination thereof. For example, a surgical procedure comprises an acromioclavicular reconstruction, a rotator cuff repair, an arthroscopic shoulder procedure, an arthroscopic knee procedure, an anterior labrum repair, or a combination thereof

[0235] Simulated medical procedures can be used to assess the operator's proficiency in medical procedures. For example, the method described herein can be used to determine the total amount of time required for an operator to complete a surgical procedure. Similarly, the embodiments described herein can be used to determine the execution accuracy, repeatability, trajectory and speed of tools (including cameras), the envelope volume of tool movement, the extension of the contact surface between the tool and the anatomical structure, the applied force, the effective contact pressure, the expansion of the changes made to perform surgical operations (the invasiveness of the procedures), the number of times of contact with certain anatomical structures, the direction of contact, the consistency between the tool path executed and the reference path, the number of gestures to complete the task, the number of errors, the number of dangerous movements on important structures (nerves, blood vessels, cartilage), the smoothness of movement and camera movement, etc.

[0236] Thus, aspects of the present invention may be used to provide an operator proficiency score.In an embodiment, the operator proficiency score is inversely proportional to the total amount of time required to complete a surgical procedure.

[0237] Other Implementations

[0238] While the invention has been described in conjunction with specific embodiments thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages and modifications are within the scope of the appended claims.

[0239] The present invention will be further described in the following examples, which do not limit the scope of the invention described in the claims.

[0240] Example

[0241] Examples are provided below to facilitate a more complete understanding of the present invention. The following examples illustrate exemplary modes for preparing and practicing the present invention. However, the scope of the present invention is not limited to the specific embodiments disclosed in these examples for illustrative purposes only, because similar results can be obtained using alternative methods.

[0242] Example 1 - Modular system for training with surgical tasks

[0243] In embodiments, the disclosure described herein relates to training equipment for performing surgical tasks.

[0244] There are various training simulators with different anatomical accuracy, including cadaver simulators, virtual reality simulators, and various "benchtop" simulators. Cadaver is an ideal training simulator for most surgical tasks, but the high price and low availability of cadaver specimens limit the use of cadaver specimens by trainees. Virtual reality simulators generally lack the ability to simulate the interaction between tissues and tools in complex procedures, and enrichment with tactile rendering requires extensive programming and high computational costs; "benchtop" simulators include a variety of tissue substitutes and are mainly provided by SawBones (Vashon Island, Washington). Examples with high anatomical accuracy include products branded "Alex 2" and "Alex 3" for arthroscopic surgery of the shoulder. Simulators with lower anatomical accuracy designed for training specific tasks are mainly composed of "Dome Rotator Cuff Anchor Training Block" and "MagneFAST". These simulators are expensive, have limited flexibility, and although they can provide tactile feedback during the performance of tasks, they lack the anatomical complexity of virtual reality simulators. Therefore, there is a need for a training tool that can overcome the limitations of existing devices in anatomical fidelity, flexibility, and integration with computer graphics.

[0245] In one embodiment, a modular system for surgical task training consists of a base that holds anatomical elements in predefined locations, individual anatomical elements that can be swapped in various shapes to represent various lesions and deformities, and a cover that optionally covers the anatomical structure for training in arthroscopic, laparoscopic, endoscopic, or simulated fluoroscopic / ultrasound / image-guided procedures. (See, e.g., Figure 1 ).

[0246] To reduce supply costs, the anatomical elements may have bags (see e.g. Figure 2 Subgraph a) or nail (see e.g. Figure 2 b) to accommodate and anchor the tissue substitute so that the user sacrifices only the substitute rather than the entire anatomical element when attempting a surgical approach (see Figure 2 Subfigure c). These tissue substitutes can be drilled, have implants inserted therein, be sawn, ablated or excised. After completing the training exercise, the tissue substitute can then be removed and replaced with a new tissue substitute for additional exercises. In addition, in order to simulate the relative migration of bones due to joint instability, individual anatomical elements can be hinged or can be hinged to the base, and this articulation can be actuated by elastic elements such as rubber bands. The anatomical elements can also include reinforcing structures to form articulated joints or to accommodate the accommodation of tissue substitutes. These structures can ultimately be represented by different colors or textures to indicate to the user the deviation from the surface reconstructed according to the diagnostic imaging.

[0247] The anatomical elements are anchored to the base by a press fit, or are simply positioned and restrained in place by an additional plate that limits the anatomical element from disengaging from the base. In a preferred embodiment, the base has a flange to allow it to be anchored to the workbench by using a clamp. The flange is placed so that the trained working area can avoid contacting the surface of the workbench. Each anatomical element is ideally derived from a computed tomography image and is characterized by a unique contour at the base so that it can be securely positioned in a uniquely specified position (see, for example, Figure 3 ).

[0248] The hood may be hinged to the base to facilitate exposure of the internal anatomy and may also have holes and openings at predetermined locations for training in specific tasks (see, e.g., Figure 4 ). While the cover may be characterized by high rigidity and contain alphanumeric characters referenced in the training instructions, the opening may be covered with a softer elastic material that mimics human skin to allow for incision with a scalpel.

[0249] Such a modular system can be connected to a processing unit for tracking the various elements involved in the training, such as the user ID, the time the task was performed, the anatomical elements used. For this last purpose, each anatomical element used is identified by an alphanumeric code that can simply be printed on the element, represented by a tag, communicated through an embedded chip using radio frequency identification (RFID) technology.

[0250] Tracking of elements relevant to the user is integrated into the system to display virtual elements in augmented reality and mixed reality competitions or simply to provide tactile feedback for surgical task training performed in virtual reality. The dome and anatomical model can have unique relief or raised areas identifying the location of the tracking elements / markers. The tracking elements can be positioned in an area visible to a camera looking through one of the access ports. In addition, the entire anatomical structure and dome can be custom printed with unique patterns to provide unique markings for augmented or mixed reality for surgical training (see, e.g., Figure 5 ). Additionally, the entire dome and anatomical model can be scanned, or the model used to make them can be utilized to create a unique model for augmented or mixed reality tracking. Additional markers can also be placed on real surgical instruments or other objects (such as wooden dowels) to include visualization of virtual tools such as razors or cauterizers in the scene and operate like a razor or cauterizer in the augmented environment. This real-world system combined with augmented reality tracking provides mixed reality exercises that simulate surgical steps such as scraping tissue, cauterizing blood vessels, and so on. These augmented reality surgical steps receive tactile feedback from the real-world model, dome portals, and tissue surrogates. See, for example, Figure 6 Examples of enhanced bleeding vessels in , and e.g. Figure 7 Example of an enhanced metal razor. Figure 8 is an example of a reinforced bursa in a shoulder model.

[0251] Augmented reality presents information in the correct real-world context. In order to do this, the system needs to know where the user is and what the user is looking at. Typically, the user explores the environment through a display showing camera images and augmented information. Therefore, in practice, the system needs to determine the position and orientation of the camera. Using a calibrated camera, the system is then able to render virtual objects in the correct position. The term tracking means calculating the relative pose (position and orientation) of the camera in real time. This is one of the fundamental components of augmented reality.

[0252] In marker-based tracking, the system needs to detect the markers, recognize them, and then calculate the pose.

[0253] A good marker is one that is easily and reliably detected in all circumstances. Using machine vision techniques, differences in brightness (luminance) are easier to detect than differences in chrominance (color). This is due to poor automatic white balance of the camera: colors are not recorded correctly, and objects may, for example, change their color in the image depending on what else is in view. In addition, lighting changes the perceived color of an object, so color detection is challenging. Of course, the greater the contrast in brightness, the easier the object is to detect. In this sense, black and white markers are optimal.

[0254] The system should also be able to use the detected markers to calculate the pose of the camera. Four known points are sufficient to uniquely calculate the pose of the camera, and the simplest shape they can be obtained is a square. In addition, the positions of corner points are relatively stable because they can be estimated as the intersection of edge lines. Therefore, many marking systems use black and white square markers, but the implementation is not limited to this.

[0255] The first goal of the marker detection process is to find the outline of a possible marker and then infer the location of the corners of the marker in the image. Furthermore, the detection system needs to confirm that it is indeed a marker and decrypt its identity. Finally, the system uses information from the detected marker positions to calculate the pose.

[0256] Before actually detecting the marker, the system needs to obtain an intensity image (grayscale image). If the captured image format is in other formats, the system converts it, such as converting an RGB image into an intensity image. From now on, it will be assumed that the marker detection system operates with grayscale images.

[0257] The first task of the landmark detection process is to find the boundaries of potential landmarks. Detection systems take two approaches: either they first threshold the image and search for landmarks from a binary image, or they detect edges from a grayscale image. These lower-level image processing tasks (thresholding, edge detection, line fitting, etc.) are well known.

[0258] The pose of a calibrated camera can be uniquely determined by at least four coplanar but non-colinear points. Therefore, the system can use the four corner points of the marker in image coordinates to calculate the pose of the marker in 3D coordinates (relative to the camera).

[0259] In the ideal pinhole camera model, all light rays pass through the infinitesimal optical center of the camera and the image of the object is recorded on the image plane. This is called the ideal image. In a digital camera, the image is recorded on the image sensor and the coordinates of its elements differ from the ideal coordinates. The camera image depends on the physical properties of the camera, such as focal length, image sensor orientation and size. The transformation matrix transforms world coordinates into ideal camera coordinates.

[0260] Of course, the main principle of augmented reality is to present virtual objects in a real environment as if they were part of the real environment. Camera pose is used to render virtual objects in the correct scale and perspective. The virtual camera of the computer graphics is moved to the same pose as the real camera, and the virtual objects are rendered on top of the real image.

[0261] There are a variety of software systems and development frameworks that can use markers to provide augmented reality (AR). Here are some examples:

[0262] Vuforia: Vuforia is a popular AR development platform that provides marker-based AR capabilities. It provides robust marker detection, tracking, and rendering functionality. With Vuforia, developers can create AR experiences that recognize and track various types of visual markers, including images, QR codes, and 3D objects. Vuforia supports multiple platforms, including iOS, Android, and Unity.

[0263] Unity3D with AR Foundation: Unity3D is a popular game development engine that also provides AR functionality through its AR Foundation package. AR Foundation supports marker-based AR by combining marker detection, tracking, and rendering capabilities. Developers can take advantage of Unity's robust game development tools and use AR Foundation to combine AR experiences with marker-based tracking.

[0264] Additional software systems include Wikitude and EasyAR, but the implementation scheme is not limited thereto.

[0265] Tracking can be performed by shape recognition technology, optical or magnetic markers, and can include tracking of fine hand or arthroscopic instrument movements. To this end, in addition to the internal camera that constitutes the arthroscope, an external camera can also be included in the setup. In the case of augmented reality, the system can also provide real-time visualization of computer-generated images rendered as x-ray images to simulate the use of intraoperative fluoroscopy. Videos from external cameras and 3d trajectories of hands and tools can be recorded by a processing unit to extract performance indicators or for display in a training session in augmented reality. Markers dedicated to each instrument and implant can then be placed, which are unique and can be recorded. Then, when the trainer performs the task, these markers and their three-dimensional positions relative to the training model can be recorded. Subsequently, the trainee can watch the augmented reality / mixed reality video of the surgical training later or in person, where the virtual augmented instruments and implants on the trainee's model correspond to the exact position in the space where the trainer recorded them. For example, the steps and movements of the instrument can be recorded during a simulated rotator cuff repair. Then, another user can play back the augmented reality or virtual reality video at another time and place, while the secondary user is watching the augmented reality video in their separate surgical simulator.

[0266] In another embodiment, multiple users can interact simultaneously in real time in an augmented reality environment. This is very useful for training, and a teacher can use a separate surgical simulator with similar size to remotely demonstrate surgical procedures from different locations. For example, user A (teacher) may be in a different location from user B (trainee). For example, user B and user A are both using a surgical simulator, and user A is teaching user B how to perform a rotator cuff repair. User A can use instruments with markers that can record the position and angular position of the instrument. The trainee will then see the teacher's instrument in the trainee's augmented reality environment.

[0267] In yet another embodiment, the augmented reality environment may have augmented reality instructions with animations to guide the trainee through the task. For example, the tracking software may locate a marker associated with a screwdriver. An animated arrow may then show the trainee where in the augmented reality environment the screwdriver should be inserted, corresponding to where the screwdriver would need to be inserted in real life.

[0268] In one embodiment, the simulator can be used for standardized testing of users. This can be accomplished by providing a consistent, standardized simulator with the same anatomy to all test takers. The system can then be used to assess the user's skills with objective criteria.

[0269] In an embodiment, tracking may be used to simulate the use of a fluoroscopic imaging system: a processing unit renders a simulated x-ray image by substituting a set of relative positions between fluoroscopic and anatomical elements.

[0270] Each part of the system has a dedicated slot to accommodate the printed mark, and such slot can be made into an arcuate portion concentric with the opening in the cover (see, for example, Fig. 9 , sub-figure a), columns anchored to anatomical elements (e.g., see Fig. 9 , sub-figure b), or using bone substitutes as markers (see, for example, Fig. 9 , sub-figure c).

[0271] An example of an application of the system is its use for training arthroscopic surgeries of the shoulder: the modular device mimicking the human shoulder anatomy consists of a cover (representing the skin covering the shoulder) covering modular components representing the clavicle, scapula and humerus.

[0272] The cover contains multiple arthroscopic portals, including A (anterior), AS (anterosuperior), AI (anteroinferior), S (superior), L (lateral), PI (posteroinferior), and P (posterior). The cover also contains a slightly larger oval opening over the distal clavicle and coracoid process, which simulates the small incisions made by surgeons during acromioclavicular reconstruction procedures.

[0273] 3D reconstructions of CT scans can be used to accurately generate the bony anatomy of the shoulder and realistically render the anatomical relationships during shoulder arthroscopy. The humerus has a pocket at the anatomical location of the greater tuberosity and the supraspinatus coverage area. For example, an appropriately sized bone substitute with a density of 10 PCF can be used to simulate the insertion of an anchor into the greater tuberosity, as is done in a rotator cuff repair.

[0274] The scapular element contains two separate compartments, which preferably receive a 20 PCF bone substitute piece. One compartment is within the distal tip of the coracoid process, allowing for drilling and deployment of sutures and suture fixation devices when simulating acromioclavicular reconstruction repair. The other compartment on the scapula is located on the articular surface of the glenoid. This compartment extends medially and is located within the scapular body to allow for placement of anchors when simulating labral repair. Four pegs or wedges are arranged around the 2, 4, 7, and 11 o'clock positions of the glenoid rim, which act as anchors to secure the artificial labrum when simulating labral repair. A disposable labral substitute has been recreated using polyisoprene strips removed from an orthopedic sterile glove and hooked onto the four pegs around the glenoid rim.

[0275] The clavicle contains a compartment for accommodating a bone substitute, which is located just above the compartment within the coracoid process. This compartment allows for drilling and suture placement when simulating acromioclavicular reconstruction. The clavicle is hinged to the base by its medial connection to a portion that accommodates a hinge, which connects the hood to the base of the simulator. A rubber band is attached to the bottom of the hinge on the clavicle and tensioned to displace the clavicle upward (thus demonstrating a torn coracoclavicular ligament). This requires the trainee to pull the clavicle downward when simulating acromioclavicular reconstruction, just as would be done on an actual patient in the operating room.

[0276] An example of an application of the device is a simulated rotator cuff repair. A polyisoprene strip is cut to resemble a torn supraspinatus tendon and secured to the scapula via surgical tape (e.g., see Fig.10). An arthroscopic camera is inserted through the posterior (P) portal to view the shoulder joint and perform a diagnostic shoulder arthroscopy. The arthroscope is then inserted into the lateral (L) portal while the awl is inserted into the superior (S) portal and a guide hole is made in the anteromedial position on the greater tuberosity. The suture anchor is then inserted into the superior (S) portal and into the guide hole in the anteromedial position. The process is repeated for the second medial anchor. The surgical awl is inserted through the superior (S) portal and a guide hole is made in the medial posterior position on the greater tuberosity. The second suture anchor with suture is then inserted through the superior (S) portal (while viewing from the arthroscope of the lateral (L) portal) and inserted into the medial posterior position. Attention is then turned to the placement of the two lateral anchors. The arthroscope is placed in the postero-inferior (PI) portal and the surgical awl is placed in the lateral (L) portal. The awl is used to make a guide hole for the lateral row of anterior anchors. Once the guide hole is made, the awl is removed from the lateral (L) portal. The suture anchor is then inserted into the lateral portal under direct supervision of the arthroscope in the postero-inferior (PI) portal. The same process is repeated for the contralateral row of posterior anchors. This example describes a double-row rotator cuff repair in detail. It is also possible to simulate a single-row rotator cuff repair with this device by simply performing the first half of the above technique.

[0277] Another example of an application for this device is a simulator for an anterior labrum repair (or Bankart repair). Orthopedic sterile surgical gloves are cut only and fit over the 4 pegs / wedges around the glenoid rim in order to simulate the labrum. A variety of portal and labrum fixation devices can be used depending on user preference and device availability. Replaceable sawbones 20PCF sheets enable trainees to practice drilling and anchor placement without damaging the 3D printed scapula.

[0278] The third application of the device is to simulate acromioclavicular joint (AC) reconstruction. AC reconstruction is performed by drilling holes on the clavicle and coracoid process and performing sutures and suture buttons to reduce the displaced clavicle and restore the stability of the acromioclavicular joint. Two compartments (one in the clavicle and one in the coracoid process on the scapula) receive sawbone sheets that allow drilling and sutures to pass through to simulate the steps taken in actual AC reconstruction. Once completed, the sawbone sheets can be removed and disposed of, and new sheets can be reinserted to allow multiple attempts to practice AC reconstruction as desired. The device of the present invention allows the process to be simulated by arthroscopic and micro-opening methods. The oval opening above the clavicle simulates the small incision that the surgeon cuts when resetting the clavicle and tightening the sutures to complete the AC repair. As with rotator cuff repair and labrum repair, any repair device can be used according to the availability of the device.

[0279] Embodiments of the present disclosure are directed to a shoulder arthroscopy training simulator for orthopedic surgery trainees.

[0280] There are currently a variety of arthroscopic training simulators, including cadaveric simulators, virtual reality simulators, and various "benchtop" simulators with varying degrees of anatomical accuracy. Cadaveric specimens are ideal training simulators for shoulder arthroscopy training, but the high price and limited availability of cadaveric specimens limit the use of cadaveric specimens by orthopedic trainees. Virtual reality simulators lack the ability to simulate more complex procedures. "Benchtop" simulators include a variety of simulators produced by SawBones (Vashon Island, Washington). Examples include the "Alex 2" and "Alex 3" arthroscopic simulators, which replicate the human shoulder and allow for training of specific arthroscopic procedures. However, these simulators are expensive, ranging from $786 to $1000, and require the purchase of replacement parts depending on the specific procedure being simulated. Other simulators sold by SawBones include the "Dome Rotator Cuff Anchor Training Block" and the "MagneFAST Shoulder Kit". These simulators do not provide anatomical accuracy, but are intended to provide simulations of various arthroscopic surgical tasks to improve trainees' surgical skills before entering the operating room. Although these simulators have been shown to improve trainees' specific arthroscopic skills, they lack anatomical precision.

[0281] Embodiments as described herein include a modular device simulating the shoulder anatomy of a person, which has multiple components that allow simulation of various specific shoulder arthroscopy procedures. A cover (representing the skin covering the shoulder) covers the 3D printed modular components representing the clavicle, scapula, and humerus. The cover includes multiple arthroscopic entrances, including A (front) entrance, AS (front upper) entrance, AI (front lower) entrance, S (upper) entrance, L (outer) entrance, PI (rear lower) entrance, and P (rear) entrance. The cover is also included in a slightly larger oval opening above the distal end of the clavicle and the coracoid process, which simulates the small incisions that surgeons cut in the acromioclavicular reconstruction procedure.

[0282] 3D reconstructions of CT scans can be used to accurately generate the bony anatomy of the shoulder and realistically render the anatomical relationships during shoulder arthroscopy. The humerus contains a 30mm x 30mm x 30mm cube insert in the anatomical location of the greater tuberosity and supraspinatus coverage. A sawbones 10PCF block corresponding to the above dimensions can be inserted into the humeral pocket, providing the operator with a disposable bone simulation block that can be used to simulate the insertion of an anchor into the greater tuberosity as done in a rotator cuff repair.

[0283] The scapula contains two separate compartments that house 20 PCF sawbone sheets. One compartment is within the distal tip of the coracoid process, allowing for drilling and deployment of sutures and suture fixation devices when simulating acromioclavicular reconstruction repair. The other compartment on the scapula is located on the articular surface of the glenoid. The glenoid compartment is and can accept a similar 20 PCF sawbone sheet. This compartment extends medially and is located within the body of the scapula to allow for placement of anchors when simulating labral repair. Four pegs or wedges are arranged around the 2, 4, 7, and 11 o'clock positions of the glenoid rim, which serve as anchors to secure the artificial labrum when simulating labral repair. Latex orthopedic sterile gloves provided in the operating room were used and cut to create an inexpensive, disposable artificial labrum that can be hooked onto the four pegs around the glenoid rim.

[0284] The clavicle contains a compartment that is positioned just above the compartment within the coracoid process. The compartment receives sawbone sheets of the same size and density (20 PCF) to allow drilling and suture placement via the two compartments when simulating acromioclavicular reconstruction. The medial end of the clavicle is incorporated into a hinge that connects the cover to the base of the simulator. A rubber band is attached to the bottom of the hinge on the clavicle and tensioned to displace the clavicle upward (thus demonstrating a torn coracoclavicular ligament). This requires the trainee to pull the clavicle downward when simulating acromioclavicular reconstruction, just as would be done on an actual patient in the operating room.

[0285] An example of the application of the device is to simulate a rotator cuff repair. Orthopedic sterile surgical gloves are cut into a shape similar to a torn supraspinatus tendon and fixed to the scapula by surgical tape. An arthroscopic camera is inserted through the posterior (P) portal to view the shoulder joint and perform a diagnostic shoulder arthroscopy. The arthroscope is then inserted into the lateral (L) portal, while the awl is inserted into the superior (S) portal, and a guide hole is formed in the anteromedial position on the greater tuberosity. The suture anchor with suture is then inserted into the superior (S) portal and inserted into the guide hole in the anteromedial position. Repeat the process for the second medial anchor. The surgical awl is inserted via the superior (S) portal, and a guide hole is formed in the medial posterior position on the greater tuberosity. The second suture anchor with suture is then inserted via the superior (S) portal (while observing from the arthroscope of the lateral (L) portal) and inserted into the medial posterior position. Attention is then turned to the placement of the two lateral anchors. The arthroscope is placed in the posterior inferior (PI) portal, and the surgical awl is placed in the lateral (L) portal. An awl is used to create a guide hole for the lateral row anterior anchor. Once the guide hole is created, the awl is removed from the lateral (L) portal. The suture anchor is then inserted into the lateral portal under direct supervision of the arthroscope in the posteroinferior (PI) portal. The same process is repeated for the lateral row posterior anchor. This example describes a double row rotator cuff repair in detail. It is also possible to simulate a single row rotator cuff repair with this device by simply performing the first half of the technique described above.

[0286] Another example of an application of the device is a simulator for an anterior labrum repair (or Bankart repair). Orthopedic sterile surgical gloves can only be cut and fitted over 4 pegs / wedges around the glenoid rim to simulate the labrum. Various portal and labrum fixation devices can be used depending on user preference and device availability. Anatomical elements including tissue substitutes (such as replaceable drillable blocks or sheets) allow trainees to practice drilling and anchor placement without damaging the 3D printed scapula.

[0287] The third application of the device is to simulate acromioclavicular joint (AC) reconstruction. AC reconstruction is performed by drilling holes on the clavicle and coracoid process and performing sutures and suture buttons to reduce the displaced clavicle and restore the stability of the acromioclavicular joint. Two compartments (one in the clavicle and one in the coracoid process on the scapula) receive sawbone sheets that allow drilling and sutures to pass through to simulate the steps taken in actual AC reconstruction. Once completed, the sawbone sheets can be removed and disposed of, and new sheets can be reinserted to allow multiple attempts to practice AC reconstruction as desired. The device of the present invention allows the process to be simulated by arthroscopic and micro-opening methods. The oval opening above the clavicle simulates the small incision that the surgeon cuts when resetting the clavicle and tightening the sutures to complete the AC repair. As with rotator cuff repair and labrum repair, any repair device can be used according to the availability of the device.

[0288] Example 2 - Fracture Deformity Simulator

[0289] Fracture Deformity Simulator: A system used to simulate the deformity forces of a fracture, dislocation, or separation using blocks and sockets to simulate bone for drilling and screw placement. This simulation system allows the user to practice reducing bones or straightening them using simulated deforming forces that resist reduction. These forces are generated by attaching an elastic device to the simulated bone and attaching the other end to a ring with a hook every 45 degrees.

[0290] Anatomically modeled synthetic bones can be created. Simulated fractures of transverse, oblique, or comminuted nature can be made on the body. A rectangular socket can be placed in the bone on one side of the fracture, and another set of sockets can be made on the other side of the fracture. A hook can then be placed on each side of the fracture to attach an elastic material (rubber or spring). It can then be attached to a fracture ring to produce a deformation force that simulates human muscle, tendon, or ligament.

[0291] Below are implementations of various models and configurations. The sockets into which the simulated bones can be inserted are all orange.

[0292] 1. Proximal Humerus Fracture Model

[0293] a. Humeral shaft: Anteromedial hook to which elastic material may be attached.

[0294] a. Simulation: pectoralis major

[0295] i. Deformation force: anterior and medial sides of the shaft

[0296] b. Humeral head: Lateral posterior hook with elastic material can be attached.

[0297] a. Simulation: supraspinatus, infraspinatus, teres minor

[0298] i. Deformation force: external rotation of the head / greater tuberosity

[0299] c. Simulated Surgery (Blue) - Plates and Screws

[0300] 2. Humeral Shaft Fracture Model

[0301] a. Proximal humeral shaft: Lateral hook with elastic material can be attached.

[0302] a. Simulation: deltoid muscle

[0303] i. Deformation force: abduction

[0304] b. Distal humeral shaft: Medial hook with elastic material may be attached.

[0305] a. Simulation: Biceps and Triceps

[0306] i. Deformation forces: shortening and medial displacement

[0307] c. Simulated Surgery (Blue) - Plates and Screws

[0308] 3. Distal Humerus Intra-articular T-type Fracture Model

[0309] e. Proximal humeral shaft: Lateral hook with elastic material can be attached.

[0310] a. Simulation: deltoid muscle

[0311] i. Deformation force: abduction

[0312] f. Distal fragment: Expand the medial and lateral hooks of the fragment.

[0313] a. Simulation: Biceps and Triceps

[0314] i. Deformation forces: shortening and medial displacement

[0315] g. Simulated surgery (blue) - medial and lateral plates with screws 4. Subtrochanteric fracture

[0316] i. Proximal femur: Anterolateral hook to which elastic material may be attached.

[0317] a. Simulation: Iliopsoas and gluteus medius

[0318] i. Deformation forces: abduction and flexion

[0319] j. Distal humerus: Medial hook to which elastic material may be attached.

[0320] a. Simulation: adductor muscles

[0321] i. Deformation forces: shortening and medial displacement

[0322] k. Simulated Surgery - Nail with Locking Screw

[0323] 5. Tibial plateau fracture

[0324] a. Multiple fossae in the proximal tibia with simulated fractures in the metaphysis and fossae in the diaphysis.

[0325] b. Simulated Surgery - Plates and Screws

[0326] 6. Tibial shaft fracture - intramedullary nail

[0327] a. Medial and lateral fossa in the proximal tibia

[0328] b. Simulate transverse fracture of mid-shaft

[0329] c. Distal socket for placement of locking screws

[0330] d. Simulated surgery - nails with locking screws

[0331] 7. Distal fibula fracture - side plate placement

[0332] a. Proximal fossa

[0333] b. Distal fossa

[0334] c. Oblique simulated fracture

[0335] d. Simulated surgical procedure - plates and screws

[0336] 8. Inner ankle

[0337] a. Oblique simulated medial malleolus fracture

[0338] b. Fossa in the distal metaphysis

[0339] c. Fossa in the medial malleolus

[0340] 9. Radial head-plate can be blue

[0341] a. Transverse radial neck simulated fracture

[0342] b. Fossa in the radial head

[0343] c. Fossa in the proximal radial shaft

[0344] d. Simulated surgery (blue) - plates and screws

[0345] 10. Olecranon fracture

[0346] a. Transverse simulated fracture

[0347] b. Proximal socket for the tip of the olecranon

[0348] c. Fossa in the coronoid region and vertebral body region

[0349] d. Simulated surgery (blue) - plates and screws or tension bands

[0350] 11. Radius and ulna shaft

[0351] a. Simulation of distal ulna transverse fracture

[0352] b. Simulated fracture of distal ulnar fossa

[0353] c. Proximal ulnar fossa fracture

[0354] d. Simulated fracture of the radius in the diaphysis

[0355] e. Fossa proximal and distal to the fracture

[0356] f. Simulated Surgery (Blue) - Plates and Screws

[0357] 12. Distal radius

[0358] a. Distal radius fracture

[0359] b. Distal ulnar end of radius with fossa

[0360] c. Radial styloid process with fossa

[0361] d. Fracture proximal metaphysis with fossa

[0362] f. Simulated surgery (blue) - palmar plate and screws

[0363] 13. Posterior ankle fracture

[0364] a. Simulated vertical posterior ankle fracture

[0365] b. Fossa in the distal tibial plateau and metaphysis

[0366] c. The fossa in the posterior ankle

[0367] d. Simulated surgical procedure (blue) - posterior plate and screws

[0368] 14. Calcaneus fracture

[0369] a. Simulate fracture of the middle part of the body

[0370] b. Front and rear sockets for side panel applications (blue)

[0371] d. Simulated surgery (blue) - side plate and screws

[0372] 15. Metatarsophalangeal fracture dislocation

[0373] a. Second metatarsal base fossa

[0374] b. Medial cuneiform fossa

[0375] c. Simulated Surgery (Blue) - Medial Screw Placement or Button and Cord Placement

[0376] 16. Acetabular fracture

[0377] a. Simulated transverse acetabular fracture

[0378] b. Fossa above the fracture

[0379] c. The fossa below the fracture

[0380] d. Simulated surgery (blue) - placing the plate with screws

[0381] Example 3 - Camera and Tool Rack

[0382] - Camera handle with open frame for placing camera ( Fig.16 ).

[0383] - A synthetic arthroscopic camera model that allows the camera to be inserted into the hole at the back and extended out the front to be used as an arthroscopic camera mimic ( Fig.17 ).

[0384] A synthetic arthroscopic camera model that allows a camera to be inserted into a hole in the back and extended out the front to be used as an arthroscopic camera mimic. The arthroscopic camera can actually detect markers. However, a fixed camera can be placed on the anatomical structure to view internal anatomical elements. The fixed camera can be used in conjunction with the arthroscopic camera. In this embodiment, one camera can detect markers and the other camera is used for tracking, i.e., viewing the environment.

[0385] In one embodiment, an arthroscopic analog may include Fig.49The two cameras shown in . A first camera at the distal end of the arthroscopic simulation device observes the internal environment of the anatomical structure. A second camera can be used to observe externally placed markers. The second camera detects the externally displayed markers and uses the positions of the markers to orient the first camera and the second camera to the space of the rendered structure. The modular anatomical system can then use this information to render a virtual representation of elements within the anatomical structure and track the position of the arthroscopic analog within the structure. In this embodiment, the second camera can provide more accurate tracking capabilities. However, it should be noted that an arthroscopic camera may not be required for training of procedures that do not require an arthroscopic view. For example, in the case of spinal surgery, there may be a camera to reference the relative position of the anatomical structure tracking tool, but the surgery is not performed through the camera view.

[0386] Joystick inserted into the camera mount

[0387] A synthetic arthroscopic camera model that allows the camera to be inserted into a hole at the back and extended out the front to be used as an arthroscopic camera simulation. In addition, the handle has an illustration of the handle of a mold for holding a joystick and / or game controller that can interact with a computer.

[0388] - VR controller( Fig.29 )

[0389] - A synthetic arthroscopic camera model that allows the camera to be inserted into a hole in the back and extended out the front to be used as an arthroscopic camera simulator. Additionally, the handle has a mold for accommodating an augmented reality / virtual reality / mixed reality controller with built-in tracking software to track the movement of the camera relative to the real world simulation training module.

[0390] Smartphone

[0391] - A synthetic arthroscopic camera model that allows the camera to be inserted into the hole at the back and extended out the front to be used as an arthroscopic camera simulation. Additionally, the handle has a mold that holds a smartphone or other optical tracking device with built-in tracking software to track the movement of the camera relative to the real-world simulation training module. The screen can then face the user to display a picture of the arthroscopic training module or the real-world environment in a mixed reality perspective.

[0392] Arthroscopic tools

[0393] Synthetic arthroscopic tool model. The handle has a mold for accommodating an AR / VR / MR controller with built-in tracking software to track the tool's motion relative to the real-world simulation training module. In the AR / MR / VR environment, the tool can then be visualized as a variety of instruments, such as a suture passer, cautery device, or razor.

[0394] In one embodiment, the VR / MR / AR controller includes an Oculus Quest 2 (now Meta) controller that communicates with the headset (see Figure 29 to Figure 31 and Figure 35 to Figure 37 ). If the VR headset allows to see the virtual world, then the controller allows to interact with it. The controller registers the movements of the user's hands and fingers in the virtual environment. The controller translates the physical or mechanical movements of the hands (and / or body) into digital movements inside the chosen virtual world.

[0395] Most VR controllers come with a set of buttons, triggers, and often thumbsticks that allow for grabbing, pushing, throwing, and moving virtual objects. Using a thumbstick can help with walking around in a virtual world, for example. To achieve this, the VR headset needs to know the position of the controller in relation to its own position. The two most common controller tracking systems today are lighthouse tracking and inside-out tracking.

[0396] Oculus Quest 2 (now called Meta Quest 2) uses an inside-out tracking system. Each controller has a set of infrared LEDs located on the ring of the controller. A camera located on the headset detects the LEDs and continuously takes images of them. Based on these images, the so-called constellation tracking system then triangulates the position of the controller in space.

[0397] In the case of the modular anatomical system described herein, the controller must also be oriented to the space of the anatomical structure. In one embodiment, the controller is placed in an adapter for a hand tracking controller. Fig.71 As shown, the controller 7100 is located in an adapter attached to a rendering of a human knee joint. The controller and headset then undergo a calibration process. During the process, the controller is oriented to the three-dimensional layout of the anatomical rendering. The three-dimensional model of the anatomical rendering (including three-dimensional coordinate data) is known to the headset. In addition, the headset knows the position of the controller that was placed in the adapter during calibration (i.e., placed in a fixed position in space relative to the rendered structure). The headset understands the position of the controller in space relative to the anatomical rendering of the knee joint. In other words, the xyz of the controller is mapped to the xyz of the rendered structure.

[0398] The controller can then be removed and attached to an arthroscopic analog (such as Figure 29 to Figure 31 ). The user can then insert the arthroscopic analog into the rendered knee joint and interact with elements within the structure. The headset knows the position of the controller in space relative to the anatomy and knows the position of the distal end of the arthroscopic analog. Thus, the headset can render a virtual image of the arthroscopic device within the knee joint.

[0399] In an alternative embodiment, the first controller can remain within the adapter. The second controller can then be attached to the arthroscopic analog. The user can then use the second controller as an arthroscopic analog to manipulate elements within the anatomical structure.

[0400] In an embodiment, the VR headset can independently map out the environment. As an example, Oculus Quest 2 (now Meta Quest 2) can use simultaneous localization and mapping (SLAM). In this method, while tracking the camera pose, a map of the unknown environment is also built.

[0401] When mapping an environment, the headset needs to know where it is at any given point. The starting position of the headset is the origin of the coordinate system. The headset then moves around and needs to estimate its trajectory as it moves. This is done by observing landmarks in the environment. If the headset is moving around a room, these landmarks may be features of the room (e.g., corners) or furniture. What SLAM does is that the headset estimates the position of the landmarks relative to itself, and then because it knows that the landmarks have not moved, it also estimates its position relative to fixed landmarks. When the headset is estimating the position of the landmarks, it is mapping the world. When the headset is estimating its position, it is localizing according to the map, and the headset can do both at the same time. This mapping method can then identify markers in the environment. If the orientation of the markers relative to elements within the anatomy is known, the headset can track the position of the controller (attached to the arthroscope handle) relative to those elements.

[0402] Although tracking is described above with respect to the Oculus Quest 2 (now Meta), embodiments may employ other VR headsets that detect active or passive light.

[0403] In one embodiment, the controller can be attached to a universal synthetic handle. Fig.37 As shown, the headset can render the handle as a razor, suture passer, or cautery. In an alternative embodiment, the handle may actually include a razor, suture passer, or cautery tool.

[0404] Example 4 - Fracture Deformity Simulator

[0405] Overview: Fracture Deformity Simulator: A system used to simulate the deformity forces of fractures, dislocations or separations, using blocks and sockets to simulate bones for drilling and screw placement. This simulation system allows the user to practice reducing bones or straightening them using simulated deforming forces that resist reduction. These forces are generated by attaching an elastic device to the simulated bone and attaching the other end to a ring with a hook every 45 degrees.

[0406] Anatomically modeled synthetic bones can be created. Simulated fractures of transverse, oblique, or comminuted nature can be made on the body. A rectangular socket can be placed in the bone on one side of the fracture, and another set of sockets can be made on the other side of the fracture. A hook can then be placed on each side of the fracture to attach an elastic material (rubber or spring). It can then be attached to a fracture ring to produce a deformation force that simulates human muscle, tendon, or ligament.

[0407] Here is an example of a subtrochanteric fracture simulation ( Fig.55 ).

[0408] Fracture Deformity Simulator: A system used to simulate the deformity forces of a fracture, dislocation, or separation, using blocks and sockets to simulate bone for drilling and screw placement ( Fig.38 ). The simulated bone is purple, the socket is blue, and the simulated bone block is orange.

[0409] The simulated bone is purple, the socket is blue, and the simulated bone that has been inserted into the socket is orange ( Fig.39 ).

[0410] Ball socket with base for clamping to work surface and 6 hooks around the ring at 45 degree intervals ( Fig.40 ).

[0411] The two ring top sockets at both ends are used to stabilize the two bone ends ( Fig.41 ).

[0412] Femoral shaft fracture model in which a ball tip and hook were placed to reproduce deforming forces at the proximal and distal femur ( Fig.42 ).

[0413] 2 cranioplasty sockets with femoral model ( Fig.43 ).

[0414] Top of semicircular ring for clamping to workbench ( Fig.44 ).

[0415] 2 ring top sockets and ring top with simulated femoral fracture and deformed hook attachment ( Fig.45 ).

[0416] 2 ring top sockets and ring top with simulated femoral fracture and deformed hook attachment ( Fig.46 ).

[0417] The tension device is attached to the femur and rings. The tension ring extends medially to the distal femur to produce an adduction deforming force (red ring). The tension device located anteriorly and laterally to the proximal femur produces flexion and abduction deforming forces (blue ring). Fig.48 )

[0418] A preferred embodiment of the arthroscopic camera simulator has an additional camera for external marker tracking.

[0419] Arthroscopic camera model with a socket at the end for mounting a small camera (primary camera). Additionally, a socket in the handle is used to mount an additional camera (auxiliary camera). This auxiliary camera can be used to view external markers on the outside of the arthroscopic model to calibrate the position of the simulated camera. This can then be used to create mixed reality (combined with real video from the primary camera) Fig.49 ).

[0420] The main camera is located inside the model, and the auxiliary camera outside the arthroscopy model visualizes the target (red) ( Fig.50 ).

[0421] Example 5 - Development of surgical training tools: the role of tactile feedback

[0422] In surgical training, there are a variety of simulators with varying degrees of complexity, but their systematic adoption in training programs is currently limited by the cost of existing solutions and their geographic availability. Simplified low-cost models have been proposed previously, but their popularity has been limited due to low fidelity in replicating human anatomy. Virtual reality surgical simulators and 3D printed anatomical models have been developed that rely on cloud technology or common fused deposition modeling (FDM) printing technology, making them low-cost and easy to share. The educational effectiveness of a novel 3D printed arthroscopic shoulder simulator (PASS) was validated relative to widely adopted and commercially available shoulder simulators. The study conducted was a prospective randomized controlled trial that recruited medical students and expert surgeons. The study was centered around surgical tasks that included inserting screws, exploring different locations, placing suture anchors, pulling sutures through portals, and measuring anatomical structures. Subjects completed anatomy tests and a questionnaire before and after a given task. Educational value was determined by anatomy test scores before and after performing the simulated task, user feedback, and construct validity was determined by measuring completion time. Tools such as PASS can lay the foundation for a widespread training technique that overcomes economic and geographic barriers. Improved anatomical knowledge and consistency in duration have been demonstrated to be critical to the adoption of these tools within a structured educational program.

[0423] Example 6 - Effectiveness of 3D printed arthroscopic shoulder simulator for arthroscopic experience assessment and educational value sex

[0424] Current arthroscopic shoulder simulators can range in price from $1000 to $30,000. A 3D printed shoulder simulator was developed that can be printed with a standard 3D printer, cost less than $100.00 to supply, and can be easily deployed worldwide, providing educational value at a lower cost. The purpose of this study was to validate the effectiveness of a novel 3D printed arthroscopic shoulder simulator and compare it to commercially available shoulder simulators.

[0425] Methods: This study was a prospective randomized controlled trial approved by the local IRB. Subjects were recruited and divided into 2 groups: medical students and expert surgeons. Medical students were 3rd or 4th year medical students who had completed a surgical rotation. Expert surgeons were attending orthopedic surgeons who had completed a sports medicine or shoulder and elbow fellowship or had performed at least 250 shoulder arthroscopic procedures. Each subject was randomly assigned to undergo arthroscopic tasks on either a novel 3D printed shoulder simulator or a commercially available shoulder simulator, the Alex 3 (Sawbones, Vashon Island, WA). Subjects underwent 4 arthroscopic tasks, including exploring different locations, placing suture anchors, pulling sutures through portals, and measuring anatomical structures. Subjects also completed shoulder anatomy tests before and after the tasks, as well as questionnaires after completing the tasks.

[0426] Construct validity was confirmed by empirically measuring the difference in time to complete the task between the two groups. Educational value was determined by the scores of anatomy tests before and after performing the simulation task. Numerical data between the two groups were compared using Student's 2-sample t-test.

[0427] result :

[0428] On average, the medical student group took 729 seconds to complete the simulation task on the business model and 385 seconds to complete the simulation task on the 3D model (p = .01, see Fig.80 The expert surgeon group took 295 seconds and 248 seconds to complete the arthroscopic task on the commercial model and 3D model, respectively (p = .51). The medical student group took longer to complete the arthroscopic task than the expert surgeon group on both the commercial simulator (p = .003) and the 3D-printed simulator (p = .046).

[0429] There was a moderate negative correlation between the number of shoulder arthroscopies performed by the user and the time to complete the simulation task on both the commercial simulator (r = -.60) and the 3D-printed simulator (r = -.43). Fig.81 ). After the subjects performed four tasks on a commercial simulator, their anatomy test scores (see Fig.82) improved from 62% to 80% (p = .022), and their anatomy test scores improved from 62% to 84% (p = .049) after performing the 4 tasks on the 3D printed model.

[0430] Additionally, expert surgeons perceived the 3D simulator to be more portable and more likely to improve suture management skills than the commercial simulator (p = .004 and p = .04, respectively).

[0431] Conclusions: The 3D printed arthroscopic shoulder simulator had comparable construct validity and educational value to commercially available simulators. Additionally, medical students were able to complete arthroscopic tasks faster using the 3D printed shoulder simulator compared to the commercial simulator.

[0432] Example 7

[0433] The steps for creating an embodiment of a surgical task training system and features of a computer-aided design system for this purpose are described herein. These steps can be performed by a software environment that provides visualization and editing of three-dimensional representations of anatomical structures.

[0434] In this environment, when a user wants to create a new surgical trainer, they need to choose from three scenarios:

[0435] ●Use basic graphics elements to create training platforms.

[0436] ●Create a training platform based on customized CT / MRI-based 3D data.

[0437] ●Create training platforms using standard anatomical models

[0438] Using basic primitives to create a training platform

[0439] The user is prompted in a 3d environment showing a platform centered in the world coordinate system. Such a platform may consist of a base, a receiving plate and an extension arm for clamping the platform to a workbench. The "base" is created flat and consists of a trapezoid enriched by a rectangle to accommodate the text. The two sides of the trapezoid consist of two arcs that, at the beginning of the project, are characterized by an infinitesimal curvature. In the default configuration, the dimensions of the trapezoid are similar to a square with a side length of 100 mm.

[0440] The topology of the base rectangle is enriched by extending arms consisting of circles connected to a trapezoid via a rectangle that, in the default configuration, is orthogonal to the vertical axis of the trapezoid. The base is then automatically constructed so that this profile is extruded in the direction of the vertical axis.

[0441] Illustration of the geometric composition of the base

[0442] The outer contour of the containment plate is then generated by extrusion of an offset profile performed on the outer edge of the base plate. The offset of the base profile is made at a first distance, which for FDM printing technology can be 0.4 mm, while the second offset that creates the outer wall of the containment plate can have various dimensions, of which 4 mm is the one that has been achieved in existing prototypes.

[0443] How to automatically generate a schematic diagram of a holding plate

[0444] The user can add primitives corresponding to the base through a selection menu available in the user interface (UI). Primitives are placed in the 3D environment (3DE) by dragging and dropping. Once the elements are inserted into the 3DE, the system assigns a random unique color to each element. Each element is also listed in a dedicated sidebar window, where the user can select individual or a group of elements, delete them, or indicate whether the elements in the training system are virtual, real, or both. For geometry with edges below the base plane, this plane is used for cutting. Further manipulation of the placed geometry can be performed through the "Gizmo" tool, which allows operations such as positioning, scaling, and stretching. The Gizmo appears on the entity once selected by the user.

[0445] The same tool is also used to move the side arm in plane for clamping, and occurs when the user pointer is at the corresponding position in the center of the arm.

[0446] Also included is a "drawing tool" for which the system can create a sweep of a circular portion along a path determined by the user via the position of the pointer. For the latter, a curve is determined from the path, and ideally a single NURBS curve is created for each successive input received by the user (example: pressing the left mouse button for computer-based modeling, or pressing an index-thumb-tip pinch or hand-held controller button for VR-AR-based systems).

[0447] In this system, elements indicated as real will be indicated with a solid color, while virtual elements will be displayed in a transparent manner, and elements indicated as real and virtual will be solid colors and surrounded by a transparent surface created by offsetting the element surface by a preset distance.

[0448] In addition to the insertion and editing of entities, the user can also use the function menu to add elements such as: pins for anchoring soft tissue substitutes, bags for containing bone substitutes, joints such as sliders and hinges, and hooks for anchoring springs or rubber bands.

[0449] These elements are different from the geometry when they are positioned in place after user confirmation, they are merged into the interfering geometry by Boolean operations. When the pin is moved corresponding to a geometric element, it is set by default so that its main axis is perpendicular to the surface of the geometric element at the intersection of the main axis and the surface.

[0450] When dragging the bag of bone substitute in 3DE an arrow is displayed to the user indicating the direction of removal of the bone substitute and an axis along which the user can interact when performing training.

[0451] The merging of bags and geometric elements is done automatically in the following steps:

[0452] ●Subtract the box defining the pocket from the geometric entity.

[0453] - Two additional Boolean subtractions are performed internally on the parallelepiped created at the window of the pocket to ensure that the bone substitute can be used and removed.

[0454] ●Merge the bag with the geometric entity to obtain the final configuration

[0455] For the bag feature tool, the gizmo allows for Euclidean transformations, and given the standard sizes of bone substitutes, the behavior when scaling is different, and when scaling is performed, a fit is performed to the size values ​​of the bone substitutes that will be released to the public. In an embodiment, the sizes can be: 20×20×20mm, 30×30×30mm, 20×20×3mm, 30×30×3mm, 20×20×3mm, 30×30×3mm, 20×20×3mm, 30×30×3mm, 20×20×40mm, 20×20×60mm, 30×30×60mm.

[0456] Hinges, sliders and hooks are introduced similarly in 3DE.

[0457] These features can also be manipulated via gadgets and performing the fitting of their functional axes to existing elements in the 3DE (e.g., orthogonal axes). The functional axis can be the axis of rotation of a hinge or the sliding direction of a slider. When placed to interfere with geometric elements, internal Boolean operations are performed to merge these features. Their bounding boxes are subtracted from the geometric entities. If both parts of a hinge or slider are in contact with the same geometric element, an error message is displayed to the user so the user can reposition the hinge to allow functionality of the mechanism.

[0458] After positioning the element in 3DE, the user has the option to verify the state of the entity with respect to the merging of the entity to the base.

[0459] The merged elements are then included in the list as separate items and indicated with an alphanumeric symbol (*).

[0460] During this process, in the object view, each isolated element has a "real" green box if it is connected to the base, while elements that are not in contact with the base have a "virtual" green box. This is the default configuration, for which elements marked as real will be physically realized (3D printed), while elements marked as virtual will be saved as 3D models and associated with an augmented reality marker.

[0461] At this point, the user can either accept the trainer's implementation, or select the "real" box to indicate that the element is desired to be physically implemented.

[0462] Example 8 - Construct Validity of the 3D Shoulder Simulator: Medical Students, Novice Surgeons, and Expert Surgeons Compare

[0463] Purpose: To validate the construct validity and educational value of an implementation of a 3D-printed arthroscopic shoulder simulator (3D-PASS) compared to a widely adopted and commercially available shoulder simulator (CASS).

[0464] Methods: This study was a prospective randomized controlled trial approved by the local Institutional Review Board (IRB). Twenty-four subjects were recruited and divided into 3 groups: 8 medical students, 8 novice arthroscopic orthopedic surgeons, and 8 expert arthroscopic orthopedic surgeons. Each subject was equally randomized to perform the arthroscopic task on either the 3D-PAS S or the CAS S. All subjects completed a timed assessment of the 4 arthroscopic tasks. All subjects completed a shoulder anatomy test before and after completing a given task to assess educational value. Construct validity was determined by the time to complete the task. Data were compared using analysis of variance and post hoc tests.

[0465] result :

[0466] like Fig.98 As shown, the time to complete the simulation task differed between the three training levels for CASS and 3D-PASS (p = .002 and p = .014, respectively). On 3D-PASS, expert surgeons and novice surgeons performed faster than medical students (p = .004 and p = .046, respectively). On CASS, expert surgeons and novice surgeons performed faster than medical students (p = .001 and .013, respectively).

[0467] There was a moderate negative correlation between the number of previous shoulder arthroscopies and task completion times on the CASS (r = -.46) and 3D-PASS (r = -.46). Across all participants, anatomy test scores improved from 55% to 72% after performing 4 tasks on the CASS (p = .005) and from 48% to 73% after performing 4 tasks on the 3D-PASS (p = .01).

[0468] Conclusions: The 3D printed arthroscopic shoulder simulator has construct validity, can be performed faster by experienced arthroscopic surgeons, and has educational value comparable to commercially available shoulder simulators.

[0469] Example 9 - Effectiveness Evaluation of a 3D Printed Arthroscopic Shoulder Simulator: Demonstration of Construct Validity and Educational Value Test Evaluation

[0470] Introduction: Currently, the adoption of arthroscopic shoulder simulators in training programs is limited by the cost of existing solutions ($1000 to $30,000) and their geographic availability. A 3D-printed anatomical shoulder simulator has been developed that is low-cost and globally deployable because it relies on the common fused deposition modeling (FDM) printing technology. The purpose of this study was to validate the educational effectiveness of an embodiment of a 3D-printed arthroscopic shoulder simulator (3D-PASS) and compare it to a commercially available shoulder simulator (CAS S).

[0471] Methods: This study was a prospective randomized controlled trial approved by the local Institutional Review Board (IRB). Twenty subjects were recruited and divided into 2 groups: 10 medical students and 10 expert surgeons. Medical students were 3rd or 4th year medical students who had completed a surgical rotation. Expert surgeons were attending orthopedic surgeons who had completed a sports medicine or shoulder and elbow fellowship or had performed at least 250 shoulder arthroscopic procedures. Each subject was randomly assigned to perform the arthroscopic task on either the 3D-PASS or CASS. After randomization, there were 5 medical students in the 3D-PASS group, 5 medical students in the CASS group, and 5 expert surgeons in the 3D-PASS group and 5 expert surgeons in the CASS group. All subjects completed a timed assessment of the arthroscopic tasks on a designated shoulder simulator. The four arthroscopic tasks included exploring different locations, inserting a suture anchor into the greater tuberosity, pulling a suture through the portal, and measuring anatomical structures. All subjects completed a shoulder anatomy test and a questionnaire before and after completing a given task.

[0472] Educational value was determined by anatomy test scores before and after performing the simulation task, while construct validity was determined by empirically measuring the difference in time to complete the task between the two groups. Numerical data between the two groups were compared using the Student 2-sample t-test.

[0473] result :

[0474] On average, the medical students took 729 seconds to complete the simulation task on CASS and 385 seconds on 3D-PASS (p = .01). The expert surgeons took 295 seconds and 248 seconds to complete the arthroscopic task on CASS and 3D-PASS, respectively (p = .51). The medical students took longer to complete the arthroscopic task than the expert surgeons in both CASS (p = .003) and 3D-PASS (p = .046).

[0475] There was a moderate negative correlation between the number of shoulder arthroscopies performed by the user and the time to complete the simulation tasks on both the CASS (r = -.60) and 3D-PASS (r = -.43). Subjects' anatomy test scores improved from 62% to 80% after performing 4 tasks on the CASS (p = .022) and from 62% to 84% after performing 4 tasks on the 3D-PASS (p = .049).

[0476] Additionally, expert surgeons rated the 3D-PASS as more portable and more likely to improve suture management skills than the CASS (p = .004 and p = .04, respectively).

[0477] Conclusions: The 3D printed arthroscopic shoulder simulator had comparable construct validity and educational value to a commercially available shoulder simulator. Additionally, medical students were able to complete arthroscopic tasks faster using the 3D printed shoulder simulator compared to the commercial simulator.

[0478] introduction :

[0479] Surgical simulators have been shown to be an important tool for surgical training. Training on surgical simulators has been shown to improve surgical skills in the operating room. 1 Arthroscopic training requires extensive practice to achieve proficiency. Many experts believe that a minimum of 50 arthroscopies are required to perform basic arthroscopic tasks and 150 arthroscopies are required to perform complex arthroscopic tasks. 2,3 The number of arthroscopies that residents actually perform may be decreasing due to work schedule constraints, making it more challenging to achieve these proficiency levels. 4,5 New challenges such as the COVID-19 pandemic and nursing shortages may place additional constraints on the number of cases that residents can accept. 6 Finally, financial pressures and reduced autonomy for resident trainees may place additional pressure to reduce resident caseloads and training. 5

[0480] All of these factors may increase the need for simulation-based training. Most stakeholders in residency training believe that simulators should be an essential component of training. Recently, 84% of surgical trainees and 86% of program directors believed that surgical simulation should be a mandatory part of surgical training. 7,8 Additionally, 100% of residents surveyed believed that simulators were an essential component of their surgical training. 7 Despite this agreement between program directors and residents, 80% of residents reported that their program did not have a surgical skills lab for arthroscopic training. 9 This may be reflected in the fact that most residents (93%) did not feel comfortable performing an arthroscopy for the first time. 9

[0481] There are multiple factors that may contribute to the lack of arthroscopic simulation training becoming a standard in orthopedic residency training. Without being bound by theory, factors contributing to the lack of simulation-based training include lack of interest from faculty, lack of dedicated space, and lack of interest from residents. However, the majority of program directors (87.3%) believe that the main barrier is lack of available funding. Most programs believe that it would cost $1000 to $15,000 to create a simulation lab, while only 15% of programs are willing to spend more than $30,000. 8 This poses a significant challenge when the price of simulators ranges from $3,500 to $114,000. 10 In order to eliminate the financial barriers to arthroscopic simulation training, a low-cost 3D-printed anatomical shoulder simulator was developed. Because it relies on the common fused deposition modeling (FDM) printing technology, it can also be deployed globally. The purpose of this study was to validate the educational and construct effectiveness of an embodiment of a 3D-printed arthroscopic shoulder simulator (3D-PASS) and compare it to a commercially available shoulder simulator (CAS S).

[0482] method

[0483] This study was a prospective randomized controlled trial approved by the local Institutional Review Board (IRB). Twenty subjects were recruited and divided into 2 groups: 10 medical students and 10 expert surgeons. Medical students were 3rd or 4th year medical students who had completed a surgical rotation. Expert surgeons were attending orthopedic surgeons who had completed a sports medicine or shoulder and elbow fellowship or had completed at least 250 shoulder arthroscopic procedures. Each subject was randomly assigned to perform arthroscopic tasks on either 3D-PASS or CASS (Alex 3, Sawbones, Vashon Island, WA). After randomization, there were 5 medical students in the 3D-PASS group, 5 medical students in the CASS group, and 5 expert surgeons in the 3D-PASS group and 5 expert surgeons in the CASS group. All subjects completed a timed assessment of the arthroscopic tasks on a designated shoulder simulator.

[0484] The four arthroscopic tasks included exploring different locations, inserting suture anchors into the greater tuberosity, pulling sutures through portals, and measuring anatomical structures. Subjects also completed shoulder anatomy tests before and after the tasks, as well as questionnaires after completing the tasks. Arthroscopic tasks were recorded and the time to complete all tasks was measured. The videos were reviewed in a blinded fashion by a sports medicine surgeon who had completed an accredited sports medicine fellowship and was dually board certified in orthopedics and sports medicine by the American Board of Orthopaedic Surgery (ABOS). Each subject was scored using the Arthroscopic Surgical Skills Assessment Tool (ASSET) global rating scale.

[0485] Construct validity was determined by empirically measuring differences between the two groups of surgeons in AS SET and task completion. Additional construct validity was measured using the time to complete all arthroscopic tasks. Educational value was determined by anatomy test scores before and after performing the simulation tasks. Numerical data were compared between the two groups using the Student 2-sample t-test.

[0486] result

[0487] When medical students and expert surgeons were tested on the 3DPASS, their ASSET ratings differed significantly (p = .001, see Fig.99 There was no significant difference in AS SET ratings between medical students and expert physicians. (p = .63)

[0488] On average, the medical students took 729 seconds to complete the simulation task on CASS and 385 seconds on 3D-PASS (p = .01, see Fig.100The expert surgeon group took 295 and 248 seconds to complete the arthroscopic task on the CASS and 3D-PASS, respectively (p = .51). The medical student group took longer to complete the arthroscopic task than the expert surgeon group on both the CASS (p = .003) and 3D-PASS (p = .046).

[0489] There was a moderate negative correlation between the number of shoulder arthroscopies performed by the user and the time to complete the simulation tasks on the CASS (r = -.60) and 3D-PASS (r = -.43). Subjects' anatomy test scores improved from 62% to 80% after performing 4 tasks on the CASS (p = .022) and from 62% to 84% after performing 4 tasks on the 3D-PASS (p = .049, see Fig.101 ).

[0490] Additionally, expert surgeons rated the 3D-PASS as more portable and more likely to improve suture management skills than the CASS (p = .004 and p = .04, respectively).

[0491] discuss

[0492] The vast majority of orthopedic residents and attendings agree that surgical simulators should be widely incorporated into residency education.7,8 However, in reality, less than 20% of U.S. orthopedic residents have access to arthroscopic surgical simulators.9

[0493] CAS S is the Alex 3, Sawbones shoulder simulator model. Ceponis et al. demonstrated that hands-on training using the Alex model combined with instructional videos was at least as effective as using a cadaver in teaching orthopedic residents the basics of diagnostic shoulder arthroscopy. 11 This study also had participants complete pre- and post-tests to assess the effectiveness of the Alex 3 simulator compared with a cadaver simulator. The study demonstrated equivalent improvements in anatomical test scores on the 3D-PASS and CASS; the latter has previously been shown to be as effective as a cadaver simulator.

[0494] The time it took medical students to complete the 4 tasks on CASS was almost twice as long as on 3D-PASS. Furthermore, there was no difference in the time it took expert surgeons to complete the tasks on the two simulators. Therefore, novice medical students can complete more arthroscopic simulation repetitions in the same amount of time compared to on CASS. In the field of surgical training, where procedures can be repeated up to 250 times to reach a proficient skill level, completing more tasks in a shorter time may lead to faster achievement of proficiency. 2,3

[0495] Two expert surgeons reviewed the video recordings of the four tasks for each subject individually using the AS SET scoring criteria. Statistically significant differences were found between expert surgeons and medical students when scoring participants on the 3DPASS (p = .001). ASSET ratings between expert surgeons and medical students on the CASS were nearly identical. Based on these results, the 3DPASS has construct validity. Construct validity is the ability of the simulator to distinguish between novice and expert subjects. A simulator with construct validity is a useful tool in surgical training because it can more closely simulate the skill level required to proficiently perform actual surgical procedures.

[0496] Conclusions: The 3D printed arthroscopic shoulder simulator had comparable construct validity and educational value to a commercially available shoulder simulator. Additionally, medical students were able to complete arthroscopic tasks faster using the 3D printed shoulder simulator compared to the commercial simulator.

[0497] References cited in this example

[0498] 1. Waterman BR, Martin KD, Cameron KL, Owens BD, Belmont PJ. Simulation training improves surgical proficiency and safety during diagnostic shoulderarthroscopy performed by residents. Orthopedics. 2016;39(3):e479-e485.doi:10.3928 / 01477447-20160427-02

[0499] 2.Middleton RM, VoA.Ferguson J, et a1. Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectionalStudy Highlighting the Impact of Working Time Directives.ArthrosC J ArthroscRelat Surg.2017;33(6):1151-1158.doi:10.1016 / J.ARTHRO.2016.10.025

[0500] 3.O’Neill PJ,Cosgarea AJ,Freedman JA,Queale WS,McFarlandEG.Arthroscopic proficiency:A survey of orthopaedic sports medicinefellowship directors and orthopaedic surgery department chairs.Arthrosc JArthrosc Relat Surg.2002;18(7):795-800.doi:10.1053 / JARS.2002.31699

[0501] 4.Fairfax LM,Christmas AB,Green JM,Miles WS,Sing RF.Operative Experience in the Era of Duty Hour Restrictions:Is Broad-Based General SurgeryTraining Coming to an End?https: / / doi.org / 101177 / 00031348

[0502] 1007600619.2010;76(6):578-582.doi:10.1177 / 000313481007600619

[0503] 5.Hope WW,Griner D,Van Vliet D,Menon RP,Kotwall CA,Clancy TV.Resident Case Coverage in the Era of the 80-Hour Workweek.J Surg Educ.2011;68(3):209-212.doi:10.1016 / J.JSURG.2011.01.005

[0504] 6.Ghoshal S,Rigney G,Cheng D,et al.Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19Pandemic andPostvaccination Recovery Period.JAMA Netw Open.2022;5(8):e2227443-e2227443.doi:10.1001 / JAMANETWORKOPEN.2022.27443

[0505] 7.Seil R,Hoeltgen C,Thomazeau H,Anetzberger H,Becker R.Surgicalsimulation training should become a mandatory part of orthopaedic education.JExp Orthop.2022;9(1):1-5.doi:10.1186 / S40634-022-00455-1 / FIGURES / 1

[0506] 8.Karam MD,Pedowitz RA,Natividad H,MurTay J,MarshJL.Current andfuture use of surgical skills training laboratories in orthopaedic residenteducation:A national survey.J Bone Jt Surg.2013;95(1).doi:10.2106 / JBJS.L.00177

[0507] 9. Keith K, Hansen DM, Johannessen MA. Perceived value of a skills laboratory with virtual reality simulator training in arthroscopy: A survey of orthopedic surgery residents. J Am Osteopath Assoc. 2018; 118(10): 667-672. doi: 10.7556 / JAOA.2018.146 / MACHINEREADABLECITATIO N / RIS

[0508] 10. Hansen J, Lee C, Hewins B, et al. Cost Analysis of an In-HouseArthroscopic Skills Simulator. J Orthop Bus. 2022; 2(1): 7-9. doi: 10.55576 / JOB.V2I1.8

[0509] 11. Ceponis PJM, Chan D, Boorman RS, Hutchison C, Mohtadi NGH. A randomizedpilot validation of educational measures in teaching shoulder arthroscopy to surgical residents. Can J Surg. 2007; 50(5): 387. Accessed December 6, 2022. / pmc / articles / PMC2386192 /

[0510] Example 10 - Novel 3D printed surgical simulation platform for surgical training

[0511] What does the USAF think about simulators? ″Simulators train aircrew at fraction of cost″ https: / / www.af.mil / News / Article-Display / Article / 500033 / simulators-train-aircrew-at-fraction-of-cost /

[0512] ● Learn from mistakes made in the simulator to avoid them in the real aircraft

[0513] ●You can learn basic knowledge in a low-stress environment

[0514] ● More time in the simulator than in the real aircraft

[0515] ●Spend 124 hours in the simulator

[0516] ●35 hours in real aircraft

[0517] What do orthopedic surgeons think about simulators?

[0518] 84% of surgical trainees believe simulation should be mandatory

[0519] 86% of trainee program directors believe simulation should be mandatory

[0520] 93% of residents felt uncomfortable performing an arthroscopy for the first time

[0521] 80% of residents reported that there was no surgical skills laboratory in their arthroscopy training program

[0522] ●Karam, MD, Pedowitz, RA, Natividad, H., Murray, J., & Marsh, JL (2013). Current and future use of surgical skills training laboratories inorthopedic resident education: a national survey. JBJS, 95(1), e4.

[0523] ●Seil, R., Hoeltgen, C., Thomazeau, H., Anetzberger, H., & Becker, R. (2022). Surgical simulation training should become a mandatory part of orthopaediceducation. Journal of Experimental Orthopaedics, 9(1), 1-5.

[0524] ●Keith, K., Hansen, DM, & Johannessen, MA (2018). Perceived value of skills laboratory with virtual reality simulator training in arthroscopy: survey of orthopedic surgery residents. Journal of Osteopathic Medicine 118(10), 667-672.

[0525] Why aren't simulators for surgical training standard like they are for aircraft pilot training?

[0526] 80% of residents reported that there was no surgical skills laboratory in their arthroscopy training program

[0527] 87% of orthopedic residency program directors cited lack of funding as the primary reason for not having surgical simulation training

[0528] ●Simulators are too expensive

[0529] ●The implementation cost is too high

[0530] Karam, MD, Pedowitz, RA, Natividad, H., Murray, J., & Marsh, JL (2013). Current and future use of surgical skills training laboratories in orthopaedic resident education: a national survey. JBJS, 95(1), e4. The implementation scheme described herein can increase access and revolutionize surgical training.

[0531] ●Accessibility

[0532] ● Low cost

[0533] ●Scalable

[0534] Durable

[0535] ●Object recognition / feedback

[0536] Visual recognition

[0537] Voice recognition

[0538] ●Tactile (touch) recognition

[0539] Current simulators may not be anatomically accurate, may require a 6-week to 12-week lead time, may not provide tactile feedback, may be expensive, and are costly to maintain.

[0540] Advantages of embodiments of the present invention:

[0541] ●Assembles without tools, just like Lego blocks

[0542] PLA is biodegradable

[0543] ●Real-time updates in seconds

[0544] Global deployment

[0545] 2 major validation studies:

[0546] ●Comparative study of 3D printed simulators and commercial simulators

[0547] ●A study to evaluate the effectiveness of training orthopedic residents in improving surgical skills in cadaveric arthroscopy

[0548] result

[0549] ●3D-printed simulators – good educational validity and construct validity

[0550] 3D-printed simulators can be used to train residents - improving surgical skills on cadavers

[0551] ●Expert surgeons rated the simulator of the present invention highly for the following items

[0552] ○Should be incorporated into residency training and well designed and structured

[0553] ■ Easy to use and should be offered to all surgical trainees as it is more portable and more likely to improve suture management skills

[0554] in conclusion :

[0555] 3D printed arthroscopic shoulder simulator is effective as a training tool for surgical trainees

[0556] ● Low cost

[0557] ●Can be deployed internationally to conduct training around the world

[0558] Example 11 - 3D printed arthroscopic shoulder simulator for surgical training: a randomized study

[0559] summary :

[0560] Background: When incorporating arthroscopic shoulder simulators into the curriculum, most training programs are limited by cost and geographic availability.

[0561] Objective: To compare the construct validity of a novel 3D-printed simulator with commercially available simulators using three different groups of people performing arthroscopic tasks.

[0562] Results: There were differences in the time to complete the simulation task between the three training levels for CASS and 3D-PASS (p = .002 and p = .014, respectively).

[0563] Conclusions: The 3D printed simulator demonstrated construct validity, was faster for experienced arthroscopic surgeons to perform, and had educational value comparable to commercially available simulators.

[0564] background :

[0565] Introduction: Currently, adoption of arthroscopic shoulder simulators in training programs is limited by the cost of existing solutions ($1000 to $130,000) and their geographic availability. 1.84% of surgical trainees and 86% of program directors believe that surgical simulation should be a mandatory part of surgical training.

[0566] 2,3

[0567] Purpose :

[0568] Comparison of the new 3D printed arthroscopic shoulder simulator (3D-PASS) ( Fig.103 ) and compared it with a commercially available shoulder simulator (CAS S).

[0569] method :

[0570] Grouping - The 24 subjects were randomly divided into 3 groups:

[0571] ●Medical students,

[0572] ● Novice arthroscopic surgeon

[0573] ●Expert Arthroscopic Surgeon.

[0574] ●Subjects were randomly assigned to perform tasks on either the 3D-PASS or the CASS. This study was a prospective randomized controlled trial approved by the local Institutional Review Board (IRB).

[0575] Method: Testing

[0576] ● All subjects underwent a timed assessment of 4 arthroscopic tasks. These included exploration, screw placement, suture pulling, and suture threading through the rotator cuff.

[0577] ●All subjects also underwent anatomy testing to assess learning value. Construct validity was determined by the time to complete the task. ANOVA was performed to compare the data with post hoc tests.

[0578] result :

[0579] The more times the subject had undergone shoulder arthroscopies, the less time was spent on both models: 3D-PASS (r = -.46) and CASS (r = -.46)

[0580] ●Performing 4 tasks improved anatomy scores ( Fig.104 ).

[0581] 55% to 72% on CASS (p = .005)

[0582] 48% to 73% on 3D-PASS (p = .01)

[0583] ● There were significant differences in the time to complete the simulation task across the three training levels for 3D-PASS and CASS (p = .014 and p = .002, respectively, see Fig.105 ).

[0584] ●CASS: Novice and expert surgeons performed faster than medical students (.013 and p = .001, respectively).

[0585] 3D-PASS: Novice and expert surgeons performed faster than medical students (p = .046 and p = .004, respectively)

[0586] in conclusion :

[0587] The 3D-printed arthroscopic shoulder simulator has comparable effectiveness to commercially available shoulder simulators

[0588] ●3D simulators also have learning value.

[0589] References cited in this example :

[0590] 1. Hansen, J., Lee, C., Hewins, B., MacDonald, A., Rasmussen, A., Weissbrod, E.,... & Franklin, B. (2022). Cost Analysis of an In-House Arthroscopic Skills Simulator. Journal of Orthopedic Business, 2(1), 7-9.

[0591] 2. Karam, MD, Pedowitz, RA, Natividad, H., Murray, J., & Marsh, JL (2013). Current and future use of surgical skills training laboratories inorthopaedic resident education: a national survey. JBJS, 95(1), e4.

[0592] 3. Seil, R., Hoeltgen, C., Thomazeau, H., Anetzberger, H., & Becker, R. (2022). Surgical simulation training should become a mandatory part of orthopaediceducation. Journal of Experimental Orthopaedics, 9(1), 1-5.

[0593] Example 12 - Evaluation of the effectiveness of a 3D printed arthroscopic shoulder simulator: medical students vs. novice and expert orthopedics Experimental evaluation of construct validity for arthroscopic surgeons

[0594] Introduction: Currently, the adoption of arthroscopic shoulder simulators in training programs is limited by the cost of existing solutions ($1000 to $30,000) and their geographic availability. A 3D-printed anatomical shoulder simulator has been developed that is low-cost and globally deployable because it relies on the common fused deposition modeling (FDM) printing technology. The purpose of this study was to validate the educational effectiveness of a novel 3D-printed arthroscopic shoulder simulator (3D-PASS) against a widely adopted and commercially available shoulder simulator (CASS).

[0595] Methods: This study was a prospective randomized controlled trial approved by the local Institutional Review Board (IRB). Twenty-four subjects were recruited and divided into 3 groups: medical students, novice arthroscopic orthopedic surgeons, and expert arthroscopic orthopedic surgeons. Medical students were current medical students who had not completed their orthopedic residency. Novice surgeons were orthopedic surgeons who had not completed a sports medicine or shoulder and elbow fellowship and had performed less than 250 shoulder arthroscopic procedures. Expert surgeons were attending orthopedic surgeons who had completed a sports medicine or shoulder and elbow fellowship or had performed at least 250 shoulder arthroscopic procedures. Each subject was randomly assigned to perform the arthroscopic task on either the 3D-PASS or CASS. After randomization to each group, all subjects completed a timed assessment of the arthroscopic tasks on a designated shoulder simulator. The four arthroscopic tasks included exploring different locations, inserting a suture anchor into the greater tuberosity, pulling a suture through the portal, and measuring anatomical structures. All subjects completed a shoulder anatomy test and a questionnaire before and after completing a given task.

[0596] Educational value was determined by anatomy test scores before and after performing the simulation task, while construct validity was determined by empirically measuring differences in time to complete the task between the three groups. Analysis of variance with post hoc tests was used to compare numerical data between the three groups.

[0597] result :

[0598] On average, the time to complete the CASS simulation task was different among the three groups (p = .002). The average time to complete the task on the CASS model was 705 seconds for the medical students, 477 seconds for the novices, and 317 seconds for the experts. The time to complete the simulation task on the 3D-PASS model was also different among the three groups (p = .014). The average time to complete the simulation task on the 3D-PASS was 551 seconds, 360 seconds, and 240 seconds, respectively.

[0599] There was a moderate negative correlation between the number of shoulder arthroscopies performed by the user and the time to complete the simulation tasks on the CASS (r = -.46) and 3D-PASS (r = -.46). Across all participants, subjects' anatomy test scores improved from 55% to 72% after performing 4 tasks on the CASS (p = .005), and from 48% to 73% after performing 4 tasks on the 3D-PASS (p = .01, see Table 1). Fig.105 ).

[0600] Additionally, expert surgeons rated the 3D-PASS higher than the CASS in terms of: should be included in residency training, should be easily accessible to all surgical trainees, well designed and constructed, more portable, and more likely to improve suture management skills.

[0601] Conclusions: The 3D printed arthroscopic shoulder simulator had construct validity, and experienced arthroscopic surgeons performed tasks faster. The 3D printed arthroscopic shoulder simulator had comparable construct validity and educational value to commercially available shoulder simulators. Additionally, medical students were able to perform arthroscopic tasks faster using the 3D printed shoulder simulator compared to the commercial simulator.

[0602] Example 13 - 3D printing technology and tactile feedback

[0603] Three-dimensional (3D) printed simulators are a relatively new concept. The artificial model is sent from the computer to the 3D printer and a real-world model is created for the trainee to train on. A big advantage of this technology is the unique global deployment. Since the model can be printed on site instead of transported by vehicle, it has the potential to reduce the carbon footprint. Another advantage is that the printed material is derived from corn and is made of biodegradable polylactic acid (PLA).

[0604] Recently, a 3D printed shoulder simulator was shown to have excellent construct and face validity and improve the user’s anatomical knowledge. The simulator can be printed to a remote site using a 3D printer and PLA. The parts are printed separately and the shoulder simulator can then be easily assembled and immediately ready for training. In the study, the authors compared expert arthroscopic surgeons and third- and fourth-year medical students in the performance of four basic arthroscopic tasks, including exploration, placement of suture anchors, passing sutures through the rotator cuff tendon, and measuring landmarks. The authors also randomized users to a 3D printed simulator and a commercially available simulator. On both simulators, it was found that expert surgeons were able to complete the tasks faster than the medical students. However, only the 3D printed simulator had construct validity when measured by the AS SET. Finally, contact on both simulators improved anatomy test scores. Surgeons also commented that the 3D printed simulator was very realistic compared to the real shoulder. The 3D printed simulator can be used for training exercises such as double-row rotator cuff repair.

[0605] Another basic 3D printed simulator has been created that costs only $12 to produce with filament. Several different configurations exist for basic arthroscopic skills. The authors report that residents improved their arthroscopic skills through repeated and diligent training on the simulator. Finally, another group of authors created a 3D printed hip arthroscopy simulator. This hip arthroscopy simulator has synthetic skin to simulate the patient's thigh and is equipped with an acetabulum and labrum. The authors reported high construct validity, with performance correlated with surgeon experience. Early studies have shown good construct validity and face validity. Their greatest advantage is the potential for rapid implementation due to their low cost and ability to be printed remotely.

[0606] Example 14 - Evaluation of the effectiveness of a 3D printed arthroscopic shoulder simulator: medical students versus novice and expert orthopedics Experimental evaluation of construct validity for arthroscopic surgeons

[0607] Purpose :

[0608] To evaluate the construct validity and educational value of a novel 3D-printed arthroscopic shoulder simulator (3D-PASS) and compare it with a widely adopted and commercially available shoulder simulator (CASS) at 3 different training levels.

[0609] Method: See Figure 106 to Figure 107

[0610] result :

[0611] ●Expert and novice surgeons were faster than medical students on both simulators (see Fig.105 )

[0612] A. There were differences in the time to complete the simulation task between the three training levels for CASS and 3D-PASS (p = .002 and p = .014, respectively).

[0613] B. On 3D-PASS, expert surgeons and novice surgeons performed faster than medical students (p = .004 and p = .046, respectively).

[0614] C. On the CASS, expert surgeons and novice surgeons performed faster than medical students (p = .001 and .013, respectively).

[0615] ●Comparison between the 3D printed arthroscopic shoulder simulator (PASS) and commercially available shoulder simulators

[0616] ASSET on the device (CASS)

[0617] A. For the 3D-printed simulator, expert surgeons had higher ASSET than novices and medical students (p = .02 and .001, respectively).

[0618] B. There was no difference between ASSET in the three groups of CASS (p = .91)

[0619] C. No difference between novice surgeons and medical students on 3DPASS (p = .55)

[0620] ● For Alex 3 (CASS) and new simulators, the use of shoulder arthroscopy simulators before and after

[0621] The anatomy test is then scored. (See Fig.104 )

[0622] A. The number of previous shoulder arthroscopy examinations was associated with CASS (r = -.46) and 3D-PASS

[0623] There was a moderate negative correlation between task completion time and the time it took to complete the task (r = -.46).

[0624] B. Across all participants, subjects' anatomy test scores improved from 55% to 72% after performing 4 tasks on the CASS (p = .005), and from 48% to 73% after performing 4 tasks on the 3D-PASS

[0625] (p=.01).

[0626] in conclusion :

[0627] ●3D printed arthroscopic shoulder simulator has structural validity, experienced arthroscopy

[0628] Surgeons can perform tasks faster, and the educational value is comparable to commercially available shoulder simulators.

[0629] ●3D printed arthroscopic shoulder simulator is effective in both time and ASSET

[0630] ● Commercially available simulators demonstrate construct validity in terms of time, but lack validity in terms of ASSET

[0631] ● 3D printed arthroscopic shoulder simulator is effective as a training tool for surgical trainees ● Low cost - a fully functional high-fidelity simulator is available for the price of a cigar box simulator

[0632] ●Can be deployed internationally to conduct training around the world

[0633] A modular anatomical system for demonstrating, practicing, or evaluating medical procedures or techniques is described herein. In one embodiment, a second modular anatomical system identical to a first modular anatomical system (as described herein) can be positioned away from the first modular anatomical system. The second modular anatomical system is communicatively coupled to the first modular anatomical system. A trainer using the first modular anatomical system can perform a medical procedure or technique remotely displayed on a virtual display available to the trainee, wherein the trainee can follow using the second modular anatomical system. A trainee using the second modular anatomical system can perform a medical procedure or technique remotely displayed on a virtual display available to the trainee, wherein the trainer can use the first modular anatomical system to perform guidance actions visible to the trainee. This remote training capability may include any number of modular anatomical systems.

[0634] One or more applications running on the processor of the modular dissection system can implement artificial intelligence to provide virtual instructions to the user of the modular training system. The instructions may include virtual pointers, virtual simulations of procedures, written instructions, verbal instructions, or any combination thereof. The artificial intelligence can monitor the user's activities and provide real-time corrections.

[0635] Computer networks suitable for use with the embodiments described herein include local area networks (LANs), wide area networks (WANs), the Internet or other connection services and network variants, such as the World Wide Web, public Internet, private Internet, dedicated computer networks, public networks, mobile networks, cellular networks, value-added networks, etc. The computing device coupled or connected to the network can be any microprocessor-controlled device that allows access to the network, including terminal devices, such as personal computers, workstations, servers, minicomputers, mainframe computers, laptop computers, mobile computers, palmtop computers, handheld computers, mobile phones, TV set-top boxes, or combinations thereof. The computer network may include one or more LANs, WANs, the Internet, and computers. The computer may be used as a server, a client, or a combination thereof.

[0636] The modular anatomical system can be a component of a single system, multiple systems, and / or geographically separated systems. The modular anatomical system can also be a subcomponent or subsystem of a single system, multiple systems, and / or geographically separated systems. The components of the modular anatomical system can be coupled to a host system or one or more other components of a system coupled to a host system.

[0637] One or more components of the modular anatomical system and / or corresponding interfaces, systems or applications coupled or connected to the modular anatomical system include a processing system and / or run under a processing system and / or run in association with a processing system. As known in the art, a processing system includes any collection of processor-based devices or computing devices operating together, or components of a processing system or device. For example, the processing system may include one or more of a portable computer, a portable communication device operating in a communication network, and / or a network server. The portable computer may be any of a plurality of devices selected from a personal computer, a personal digital assistant, a portable computing device, and a portable communication device and / or a combination of these devices, but is not limited thereto. The processing system may include components within a larger computer system.

[0638] The processing system of the embodiment includes at least one processor and at least one memory device or subsystem. The processing system may also include or be coupled to at least one database. The term "processor" as generally used herein refers to any logical processing unit, such as one or more central processing units (CPUs), digital signal processors (DSPs), application specific integrated circuits (ASICs), etc. The processor and memory may be monolithically integrated on a single chip, distributed in multiple chips or components, and / or provided by a certain algorithm combination. The methods described herein may be implemented in any combination in one or more of software algorithms, programs, firmware, hardware, components, circuits.

[0639] Aspects of the modular dissection system and corresponding systems and methods described herein may be implemented as functionality programmed into any of a variety of circuits, including programmable logic devices (PLDs), such as field programmable gate arrays (FPGAs), programmable array logic (PAL) devices, electrically programmable logic and memory devices, and standard cell-based devices, and application specific integrated circuits (ASICs). Some other possibilities for implementing aspects of the modular dissection system and corresponding systems and methods include: microcontrollers with memory (such as electronically erasable programmable read-only memory (EEPROM)), embedded microprocessors, firmware, software, and the like. In addition, aspects of the modular dissection system and corresponding systems and methods may be embodied in microprocessors with software-based circuit simulation, discrete logic (sequential and combinational), custom devices, fuzzy (neural) logic, quantum devices, and a mix of any of the above device types. Of course, the underlying device technology may be provided in a variety of component types, such as metal oxide semiconductor field effect transistor (MOSFET) technology (such as complementary metal oxide semiconductor (CMOS)), bipolar technology (such as emitter coupled logic (ECL), polymer technology (e.g., silicon conjugated polymers and metal conjugated polymer-metal structures), hybrid analog and digital, and the like.

[0640] It should be noted that any system, method and / or other component disclosed herein can be described using computer-aided design tools, and expressed (or represented) as data and / or instructions embodied in various computer-readable media in terms of its behavior, register transfer, logic components, transistors, layout structure and / or other characteristics. Computer-readable media that can embody such formatted data and / or instructions include, but are not limited to, various forms of non-volatile storage media (e.g., optical, magnetic or semiconductor storage media) and carriers that can be used to transmit such formatted data and / or instructions via wireless, optical or wired signal media or any combination thereof. Examples of transmitting such formatted data and / or instructions via carriers include, but are not limited to, transmission (upload, download, email, etc.) on the Internet and / or other computer networks via one or more data transmission protocols (e.g., HTTP, FTP, SMTP, etc.). When such data and / or instruction-based expressions of the above-mentioned components are received in a computer system via one or more computer-readable media, such data and / or instruction-based expressions of the above-mentioned components can be processed by a processing entity (e.g., one or more processors) in the computer system in conjunction with the execution of one or more other computer programs.

[0641] The above description of the embodiments of the modular dissection system is not intended to be exhaustive or to limit the systems and methods to the precise form disclosed. Although specific embodiments and examples of the modular dissection system and corresponding systems and methods are described herein for illustrative purposes, those skilled in the relevant art will recognize that various equivalent modifications are possible within the scope of the systems and methods. The teachings of the modular dissection system and corresponding systems and methods provided herein may be applied to other systems and methods, and are not limited to the above-described systems and methods.

[0642] Elements and acts of the various embodiments described above can be combined to provide additional embodiments.These and other changes can be made to the modular dissection system and corresponding systems and methods in light of the above detailed description.

Claims

1. A modular dissection system for demonstrating, practicing or evaluating a medical procedure or technique, the system comprising: an anatomical structure, the anatomical structure comprising a base portion and one or more anatomical elements; the base portion comprising one or more attachment mechanisms, wherein the one or more attachment mechanisms are configured to removably attach to corresponding one or more anatomical elements; at least one tracking element; at least one camera for receiving visual information of the anatomical structure and the at least one tracking element; and One or more applications running on at least one processor of the computing device, the one or more applications configured to use information of the at least one tracking element to overlay a three-dimensional virtual feature on a marker in a virtual display of at least a portion of the anatomical structure.

2. The system of claim 1, wherein the one or more anatomical elements are representations of bones, joints, tissues, structures, nerves, blood vessels, or surgical hardware.

3. The system of claim 1, wherein the one or more anatomical elements are constructed from diagnostic imaging.

4. The system of claim 1, wherein the one or more attachment mechanisms are at different locations on the base.

5. The system of claim 1, wherein the anatomical structure further comprises a covering portion, wherein the covering portion comprises at least one access port.

6. The system of claim 5, wherein the at least one access port comprises anterior, anterior superior, anterior inferior, superior, lateral, posterior inferior, posterior, or any combination thereof.

7. The system of claim 1, wherein the one or more anatomical elements are configured to removably receive a tissue substitute.

8. The system of claim 7, wherein the one or more anatomical elements include one or more receiving elements configured to receive the tissue substitute.

9. The system of claim 8, wherein the one or more receiving elements comprise a container, a bag, a peg, a hook, a slider, a hole or a socket for receiving the tissue substitute.

10. The system of claim 8, wherein the one or more containing elements are embedded in the anatomical element.

11. The system of claim 7, wherein the tissue substitute comprises cadaveric tissue, synthetic tissue, or animal tissue.

12. The system of claim 1, wherein the system or portion thereof is manufactured via molding, machining, 3D printing, or any combination thereof.

13. The system of claim 11, wherein the synthetic tissue comprises bone, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, neural tissue, a medical device, or a combination thereof.

14. The system of claim 1, wherein the one or more anatomical elements are capable of being articulated or actuated.

15. The system of claim 1, wherein the one or more anatomical elements are actuatable by a resilient element.

16. The system of claim 15, wherein the elastic element comprises a rubber band.

17. The system of claim 1, wherein the system is configured to simulate a medical procedure.

18. The system of claim 17, wherein the system is configured to assess an operator's proficiency in the medical procedure.

19. The system of claim 18, wherein the medical procedure comprises a surgical procedure.

20. The system of claim 19, wherein the surgical procedure comprises an otolaryngology procedure, a neurosurgery procedure, a gastroenterology procedure, a urology procedure, cardiovascular surgery, oral surgery, pediatric surgery, plastic surgery, orthopedic surgery, cardiothoracic surgery, dental surgery, podiatric surgery, or any combination thereof.

21. The system of claim 20, wherein the medical procedure comprises an arthroscopic procedure, a laparoscopic procedure, an endoscopic procedure, a fluoroscopic image-guided procedure, an ultrasound-guided procedure, or an image-guided procedure.

22. The system of claim 21, wherein the surgical procedures include acromioclavicular reconstruction, rotator cuff repair, anterior labrum repair, posterior labrum repair, superior labrum repair, glenohumeral ligament humeral avulsion repair, shoulder arthroscopy procedures, knee arthroscopy procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, medial collateral ligament reconstruction, lateral collateral ligament reconstruction, autologous osteochondritis dissecans fixation, meniscus repair), hip arthroscopy procedures (CAM resection, femoral osteochondroplasty, labrum repair), ankle arthroscopy procedures (osteochondral fracture fixation, autologous osteochondral transplantation, loose body removal, ankle distraction, ankle fusion), elbow arthroscopy (osteophyte debridement, loose body removal, osteochondral fragment removal, microfracture, autologous osteochondral transplantation, plica resection), wrist arthroscopy, or a combination thereof.

23. The system of claim 1, wherein the one or more anatomical elements are arranged to model an anatomical feature, deformity, or lesion.

24. The system of claim 23, wherein the anatomical feature, deformity, or lesion comprises a human anatomical feature, deformity, or lesion.

25. The system of claim 24, wherein the anatomical feature, deformity, or lesion is selected from the group consisting of: maxillofacial procedures, neurosurgical procedures, proximal humeral fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric femoral fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus, radial head, olecranon fractures, radial and ulnar shafts, distal radius, posterior malleolus fractures, calcaneal fractures, tarsometatarsal fracture-dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joint, pedicle, subtrochanteric fractures, socket, and femoral shaft fractures.

26. The system of claim 1, wherein the at least one tracking element comprises an alphanumeric code, an optical marker, or a chip.

27. The system of claim 1, wherein the at least one tracking element is located within the anatomical structure.

28. The system of claim 1, wherein the at least one tracking element is externally attached to the anatomical structure.

29. The system of claim 1, wherein the at least one camera comprises the computing device.

30. The system of claim 1, wherein a second modular anatomical system identical to the modular anatomical system is positioned remotely from the modular anatomical system.

31. A system according to claim 30, wherein the second modular dissection system is communicatively coupled to the modular dissection system.

32. A system according to claim 31, wherein a trainer using the modular anatomical system performs a medical procedure or technique remotely displayed on a virtual or augmented reality display available to a trainee, who can follow along using the second modular anatomical system.

33. A system according to claim 32, wherein a trainee using the second modular anatomical system performs a medical procedure or technique remotely displayed on a virtual display available to the trainee, wherein the trainer uses the modular anatomical system to perform guided actions visible to the trainee.

34. A system according to claim 1, wherein the one or more applications implement artificial intelligence for at least one of: providing virtual instructions to a user of the modular anatomical system and receiving voice command instructions for performing training tasks in a virtual environment.

35. A modular dissection system for demonstrating, practicing or evaluating a medical procedure or technique, the system comprising: an anatomical structure, the anatomical structure comprising a base portion and one or more anatomical elements; the base portion comprising one or more attachment mechanisms, wherein the one or more attachment mechanisms are configured to removably attach to corresponding one or more anatomical elements; a virtual reality controller, wherein the virtual reality controller is attached to the surgical probe; a virtual reality camera device; One or more applications running on one or more processors of at least one of the virtual reality controller and the virtual reality camera device, the one or more applications configured to: establishing a position of the virtual reality controller relative to the virtual reality camera; receiving three-dimensional data of the anatomical structure, the anatomical structure including the one or more anatomical elements within the anatomical structure; mapping an xyz position of the controller to an xyz position of the anatomical structure using the three-dimensional data; using the mapped information to track the position of the surgical probe relative to the anatomical element; as well as A virtual display of the surgical probe is generated within the context of the anatomical structure.

36. The system of claim 35, wherein the mapping comprises placing the virtual reality controller in a fixed position relative to the anatomical structure.

37. The system of claim 35, wherein the mapping comprises the virtual reality camera mapping the environment.

38. The system of claim 37, wherein the mapping comprises the virtual reality camera using the information of the environment map and the three-dimensional data to map the xyz position of the controller to the xyz position of the anatomical structure.

39. The system of claim 35, wherein the one or more anatomical elements are representations of bones, joints, tissues, structures, nerves, blood vessels, or surgical hardware.

40. The system of claim 35, wherein the one or more anatomical elements are constructed from diagnostic imaging.

41. The system of claim 35, wherein the one or more attachment mechanisms are at different locations on the base.

42. The system of claim 35, wherein the anatomical structure further comprises a covering portion, wherein the covering portion comprises at least one access port.

43. The system of claim 42, wherein the at least one access port comprises anterior, anterior superior, anterior inferior, superior, lateral, posterior inferior, posterior, or any combination thereof.

44. The system of claim 35, wherein the one or more anatomical elements are configured to removably receive a tissue substitute.

45. The system of claim 44, wherein the one or more anatomical elements include one or more receiving elements configured to receive the tissue substitute.

46. ​​The system of claim 45, wherein the one or more receiving elements comprise a container, a bag, a peg, a hook, a slider, a hole or a socket for receiving the tissue substitute.

47. The system of claim 45, wherein the one or more containment elements are embedded into the anatomical element.

48. The system of claim 35, wherein the system or portion thereof is manufactured via molding, machining, 3D printing, or any combination thereof.

49. The system of claim 44, wherein the tissue substitute comprises cadaveric tissue, synthetic tissue, or animal tissue.

50. The system of claim 49, wherein the synthetic tissue comprises bone, connective tissue, vasculature tissue, muscle tissue, adipose tissue, dermal tissue, neural tissue, a medical device, or a combination thereof.

51. The system of claim 35, wherein the one or more anatomical elements are capable of being articulated or actuated.

52. The system of claim 35, wherein the one or more anatomical elements are capable of being actuatable by a resilient element.

53. The system of claim 52, wherein the elastic element comprises a rubber band.

54. The system of claim 35, wherein the system is configured to simulate a medical procedure.

55. The system of claim 54, wherein the system is configured to assess an operator's proficiency in the medical procedure.

56. The system of claim 55, wherein the medical procedure comprises a surgical procedure.

57. The system of claim 56, wherein the surgical procedures comprise otolaryngology procedures, neurosurgery procedures, gastroenterology procedures, urology procedures, cardiovascular surgery, oral surgery, pediatric surgery, plastic surgery, orthopedic surgery, cardiothoracic surgery, dental surgery, podiatric surgery, or any combination thereof.

58. The system of claim 57, wherein the medical procedure comprises an arthroscopic procedure, a laparoscopic procedure, an endoscopic procedure, a fluoroscopic image-guided procedure, an ultrasound-guided procedure, or an image-guided procedure.

59. The system of claim 58, wherein the surgical procedures include acromioclavicular reconstruction, rotator cuff repair, anterior labrum repair, posterior labrum repair, superior labrum repair, glenohumeral ligament humeral avulsion repair, shoulder arthroscopy procedures, knee arthroscopy procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, medial collateral ligament reconstruction, lateral collateral ligament reconstruction, autologous osteochondritis dissecans fixation, meniscus repair), hip arthroscopy procedures (CAM resection, femoral osteochondroplasty, labrum repair), ankle arthroscopy procedures (osteochondral fracture fixation, autologous osteochondral transplantation, loose body removal, ankle distraction, ankle fusion), elbow arthroscopy (osteophyte debridement, loose body removal, osteochondral fragment removal, microfracture, autologous osteochondral transplantation, plica resection), wrist arthroscopy, or a combination thereof.

60. The system of claim 1, wherein the one or more anatomical elements are arranged to model an anatomical feature, deformity, or lesion.

61. The system of claim 58, wherein the anatomical feature, deformity, or lesion comprises a human anatomical feature, deformity, or lesion.

62. The system of claim 61, wherein the anatomical feature, deformity, or lesion is selected from the group consisting of maxillofacial procedures, neurosurgical procedures, proximal humeral fractures, humeral shaft fractures, distal humeral intra-articular T-fractures, subtrochanteric femoral fractures, tibial plateau fractures, tibial shaft fractures, distal fibula fractures, medial malleolus, radial head, olecranon fractures, radial and ulnar shafts, distal radius, posterior malleolus fractures, calcaneal fractures, tarsometatarsal fracture-dislocations, acetabular fractures, acetabulum and femoral neck, sacroiliac joint, pedicles, subtrochanteric fractures, socket, and femoral shaft fractures.

63. A system according to claim 39, wherein a second modular anatomical system identical to the modular anatomical system is positioned remotely from the modular anatomical system.

64. A system according to claim 63, wherein the second modular dissection system is communicatively coupled to the modular dissection system.

65. A system according to claim 64, wherein a trainer using the modular anatomical system performs a medical procedure or technique remotely displayed on a virtual or augmented reality display available to a trainee, wherein the trainee follows along using the second modular anatomical system.

66. A system according to claim 35, wherein a trainee using the second modular anatomical system performs a medical procedure or technique remotely displayed on a virtual display available to the trainee, wherein the trainer uses the modular anatomical system to perform guided actions visible to the trainee.

67. A system according to claim 35, wherein the one or more applications implement artificial intelligence for at least one of: providing virtual instructions to a user of the modular anatomical system and receiving voice command instructions for performing training tasks in a virtual environment.

68. A method of simulating a medical procedure, the method comprising simulating a medical procedure using an anatomical system according to any one of claims 1 to 67.

69. A medical procedure simulation system, the system comprising: A modular dissection system according to any one of claims 1 to 67; software configured to calculate an operator proficiency score; and A display screen configured to display the operator proficiency score.

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