Introduction

One key factor, which has been identified as a cause of considerable numbers of surgical errors, is the rapid growth of medical knowledge and the very fast turnover of new technologies, which makes it hard for practitioners to keep up. Possibly the most significant change in recent times has been the advent of minimally invasive surgery (MIS) in the late 1980s. This technique minimizes the damage to healthy tissue during interventions on internal organs. An example of this procedure for laparoscopic interventions is depicted in Figure 1.1. The relatively large cuts in open surgery are replaced by small incisions, through which optical and surgical instruments are inserted. Reduced tissue injury and careful selection of the entry points results in a major gain in patient recovery after the operation as well as reduced scarring. The price for these advantages is paid by the surgeon, who loses direct contact with the operation site. Visual information is acquired via endoscopic cameras and displayed on a monitor, thus impairing normal hand-eye coordination. In addition, much of the manipulative freedom usually available in open surgery is lost. Therefore, performing operations under these conditions demands very specific capabilities of the surgeon, which can only be gained with extensive training. Nevertheless, MIS procedures have been superseding traditional approaches in several areas. For instance, laparoscopic gallbladder surgery has largely replaced conventional interventions. More than 90? of all cholecystectomies in the United States are done using this MIS technique. Taking all these points into consideration, the need for improved medical training and continuing education becomes apparent.

The remainder of this chapter serves two purposes. Firstly, a broad overview of the area of surgical simulation is provided to lay the foundations for the following, more detailed discussion of training scenario definition. Secondly, the complete process of scene generation is introduced and the stage is set for the subsequent in-depth scrutiny of the individual process elements.