The red DRAGON: a multi-modality system for simulation and training in minimally invasive surgery.

With the development of new technologies in surgery, minimally invasive surgery (MIS) has drastically improved the way conventional medical procedures are performed. However, a new learning curve has resulted requiring an expertise in integrating visual information with the kinematics and dynamics of the surgical tools. The Red DRAGON is a multi-modal simulator for teaching and training MIS procedures allowing one to use it with several modalities including: simulator (physical objects and virtual objects) and an animal model. The Red DRAGON system is based on a serial spherical mechanism in which all the rotation axes intersect at a single point (remote center) allowing the endoscopic tools to pivot around the MIS port. The system includes two mechanisms that incorporate two interchangeable MIS tools. Sensors are incorporated into the mechanism and the tools measure the positions and orientations of the surgical tools as well as forces and torques applied on the tools by the surgeon. The design is based on a mechanism optimization to maximize the manipulability of the mechanism in the MIS workspace. As part of a preliminary experimental protocol, five expert level surgeons performed three laparoscopic tasks--a subset of the Fundamental Laparoscopic Skill (FLS) set as a baseline for skill assessment protocols. The results provide an insight into the kinematics and dynamics of the endoscopic tools, as the underlying measures for objectively assessing MIS skills.