Abstract:

Mitral regurgitation is a structural heart disease characterized by dysfunction of the mitral valve. It can be treated through minimally invasive transcatheter edge-to-edge repair procedures, such as those involving the MitraClip system. Despite its clinical efficacy, the procedure poses technical challenges, requiring interventional cardiologists to undergo multiple procedures to achieve instrumentation proficiency. Previous studies have demonstrated the efficacy of extended reality simulators in improving surgical skill training. The purpose of this study is to evaluate the effectiveness of visuo-haptic feedback within an extended reality simulator to accelerate and enhance the learning process for the MitraClip procedure, potentially offering a valuable tool in surgical training. In this study, based on the prototype of our previous simulator, we further implemented a novel cardiac dynamic environment, a visual feedback interface, an innovative haptic armband, and a new model of the catheter to enhance the simulator’s fidelity and educational usability. Experiment results demonstrated that users benefiting from visuo-haptic feedback exhibited significantly reduced completion times, reduced deviation from predefined trajectories, and presented safer navigation results. Moreover, users preferred the visuo-haptic feedback experience, highlighting its perceived value in enhancing training. These findings underscore the potential of adding visuo-haptic feedback to extended reality simulators in surgical training for complex procedures, improving proficiency and patient surgery outcomes.

Abstract:

Mitral regurgitation is a structural heart condition affecting the mitral valve that can be treated with the MitraClip system ™, a device that allows a percutaneous intervention for the deployment of a catheter-embedded clip on the valve leaflets to prevent blood-backflow from the left ventricle to the left atrium. Despite its efficacy, the procedure presents technical challenges, relying on fluoroscopy guidance and surgeon expertise. In the context of human-machine interface for autonomous robotic catheter cardiac intervention, this study aims to evaluate the effectiveness of Augmented Reality (AR) for training surgeons in the MitraClip procedure. Users using an AR Interface demonstrated better performance compared to those using an interface emulating traditional visualization methodologies (fluoroscopy and transesophageal echocardiogra-phy). AR-based training offers a more engaging and effective learning experience, leading to improved surgical dexterity and safety in the procedure.

Abstract:

Accurate pelvic alignment is essential for assessing femoroacetabular impingement (FAI) when using CT-based three-dimensional bone models, as the acquisition is performed in a supine rather than a standing position, which does not accurately reflect the patients kinematics. This study investigated whether reliable pelvic alignment could be achieved using a reduced, unilateral field of view (FOV) based solely on treatment-side anatomical landmarks,with the goal of reducing both radiation exposure and segmentation time.Correlation analyses of landmarks, found on the pelvis and femora, showed strong interdependence, with Pearson correlation coefficients reaching up to 97 %, enabling the selection of the femoral head center (FHC), anterior inferior iliac spine (AIIS), and pubic tubercle (PT) for alignment. Regression models were trained on these landmarks to accurately predict both treatment-side and contralateral anterior superior iliac spine (ASIS) positions, which are required for the standard alignment method, achieving mean absolute errors between 2.39 mm and 6.03 mm across all three cartesian axes. Error propagation analyses indicated that the alignment differences resulting from the predictions averaged by 2.8 →, which was expected to influence only the average anteversion measurement in less than 15 % of the cases. Isolated outliers were observed for Center Edge and Tönnigs Angle.Reducing the superior scan limit, from the ASIS to the AIIS, allowed for an average reduction of 21 % in scan length, translating into a proportional decrease in radiation exposure. Furthermore, the findings of this study support the hypothesis that unilateral landmark information is sufficient for reliable pelvic alignment and FAI evaluation, offering a practical approach to optimize segmentation time and reduce patient dose. Further validation on larger datasets is recommended to ensure robustness and generalizability.