Technical Note

Introducing a Robotic Lumbar Puncture Simulator with Force Feedback: LP Sim

Abstract

Purpose: Lumbar Puncture (LP) is widely used for spinal and epidural anesthesia or Cerebrospinal fluid (CSF) sampling procedures. As this procedure is highly complicated and needs high experience to be performed correctly, it is necessary to teach this skill to the physicians. Considering the limitation of number of usage of rubber models and advantages of Virtual Reality (VR) environment for digital training of skills, we tried to investigate the capability of VR environment to train the LP procedures. 
Materials and Methods: Geometrical model of the lumbar area of L2 to L5 are extracted from fusion of MR and CT imaging modalities. Also physical model of resistance of each layers against needle insertion at lumbar area are investigated through specially designed sensorized handle for LP needle and recorded from a 41-year-old female patient. Then geometrical and physical models of lumbar area are fused together and the VR model of it, with insertion force rendering capability is extracted. Then the model is integrated with a haptic device and the complete VR environment is investigated.  
Results: In this work we introduced a robotic Lumbar Puncture Simulator (LP Sim) with force feedback which may be used for training the LP procedures. Using the LP Sim, when a trainee inserts the needle inside the lumbar area at the provided virtual reality environment, he/she may feel the insertion forces against his/her movement inside the virtual lumbar area.
Conclusion: The LP Sim is a virtual reality-enabled environment, with force feedback, that provides an appropriate framework for training this skill.

1- e. a. B. Carvalho, "Patient preferences for anesthesia outcomes associated with cesarean delivery," anesthesia & Analgesia, vol. 101, pp. 1182-1187, 2005.
2- M. B. a. J. Carvalho, "Intraoperative nausea and vomiting during cesarean section under regional anesthesia," International journal of obstetric anesthesia, vol. 14, pp. 230-241, 2005.
3- M. S. Ellenby, K. Tegtmeyer, S. Lai, and D. A. Braner, "Lumbar puncture," New England Journal of Medicine, vol. 355, no. 13, 2006.
4- V. Dubey, N. Vaughan, M. Y. Wee, R. Isaacs, and A. Andrade, Biomedical engineering in epidural anaesthesia research. InTech, 2013.
5- e. a. A. Jackson, "Informed consent for labour epidurals: what labouring women want to know," Canadian journal of anaesthesia, vol. 47, pp. 1068-1073, 2000.
6- e. a. A. T. Sia, "A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor," Anesthesia & Analgesia, vol. 104, pp. 673-678, 2007.
7- C. Watterson, P. Mallett, M. Taylor, and T. Bourke, "G31 (P) Reducing the trauma of lumbar punctures using simulation," Archives of Disease in Childhood, vol. 104, no. Suppl 2, p. A13, 2019.
8- C. Sutherland, K. Hashtrudi-Zaad, R. Sellens, P. Abolmaesumi, and P. Mousavi, "An augmented reality haptic training simulator for spinal needle procedures," IEEE Transactions on Biomedical Engineering, vol. 60, no. 11, pp. 3009-3018, 2012.
9- N. Sargsyan, X. W. Robertson Bassy, S. Akula, J. Liu, C. Seals, and J. White, "Augmented Reality Application to Enhance Training of Lumbar Puncture Procedure: Preliminary Results," in Proceedings of 32nd International Conference on, 2019, vol. 63, pp. 189-196.
10- B. Reid-McDermott, S. Lydon, P. O’Connor, Á. de Bhulbh, B. Hanahoe, and D. Byrne, "P18 Integrating simulation-based education and precision teaching to improve physicians’ performance of lumbar puncture in clinical practice," ed: BMJ Specialist Journals, 2019.
11- S. Lydon et al., "Can simulation-based education and precision teaching improve paediatric trainees’ behavioural fluency in performing lumbar puncture? A pilot study," BMC medical education, vol. 19, no. 1, p. 138, 2019.
12- W. E. Clifton, A. C. Damon, and W. D. Freeman, "Development of a lumbar drain simulator for instructional technique and skill assessment," Neurocritical care, pp. 1-5, 2019.
13- C. Sun and X. Qi, "Evaluation of Problem-and Simulator-Based Learning in Lumbar Puncture in Adult Neurology Residency Training," World neurosurgery, vol. 109, pp. e807-e811, 2018.
14- S. Ali, M. Qandeel, R. Ramakrishna, and C. W. Yang, "Virtual simulation in enhancing procedural training for fluoroscopy-guided lumbar puncture: a pilot study," Academic radiology, vol. 25, no. 2, pp. 235-239, 2018.
15- R. Wang, J. Yao, L. Wang, X. Liu, H. Wang, and L. Zheng, "A surgical training system for four medical punctures based on virtual reality and haptic feedback," in 2017 IEEE symposium on 3D user interfaces (3DUI), 2017, pp. 215-216: IEEE.
16- M. Pfandler, M. Lazarovici, P. Stefan, P. Wucherer, and M. Weigl, "Virtual reality-based simulators for spine surgery: a systematic review," The Spine Journal, vol. 17, no. 9, pp. 1352-1363, 2017.
17- M. Färber, F. Hummel, C. Gerloff, and H. J. M. o. i. i. m. Handels, "Virtual reality simulator for the training of lumbar punctures," vol. 48, no. 05, pp. 493-501, 2009.
18- Z. Keri et al., "Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial," vol. 62, no. 7, pp. 777-784, 2015.
19- D. O. Kessler et al., "Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments," BMJ Simulation and Technology Enhanced Learning, vol. 3, no. 1, pp. 17-22, 2017.
20- M. J. V. Henriksen et al., "Assessment of residents readiness to perform lumbar puncture: a validation study," Journal of general internal medicine, vol. 32, no. 6, pp. 610-618, 2017.
21- H. J. McMillan et al., "Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety," BMC medical education, vol. 16, no. 1, p. 198, 2016.
Files
IssueVol 7 No 1 (2020) QRcode
SectionTechnical Note
DOI https://doi.org/10.18502/fbt.v7i1.2727
Keywords
Lumbar Puncture Force Feedback Virtual Reality Haptics Simulation Robotics

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mirbagheri A, Owlia M, Khabbazan M, Moradi M, Mohandesi F. Introducing a Robotic Lumbar Puncture Simulator with Force Feedback: LP Sim. Frontiers Biomed Technol. 2020;7(1):74-81.