Investigation and Development of an Endourology Haptic Robot Simulator for Surgical Training

Within any type of surgery, training is key to the patient's safety. This process requires a lot of time and can be stressful for both the trainer (experienced surgeon) and the trainee.
Robotics has been utilised within surgery, with systems such as the DaVinci [1] (a system in which the operating tools are controlled remotely), and simulation technologies.
In the field of endourology, in which small internal instruments and endoscopes are used to perform surgery within the urinary tract, the company Simbionix, with their software 'Uromentor' [2] are currently leading the market in simulators used for training. However, ttheir capabilities are limited, and, furthermore, do not include haptic feedback. Additionally, hands-on training often results in expensive equipment being damaged due to the steep learning curve of new surgeons.
The proposed research project will investigate these shortcomings and develop a novel medical simulator within this field.
Through tracking the hands of experienced surgeons when performing these procedures, there is potential to build a workspace, of motion, movements and forces. The data within this would allow the system to distinguish between novel surgeons and advanced surgeons and compare what they are doing differently. Such an investigation would also answer the question of 'how much feedback and at what resolution is required' so that the learning experience of surgical trainees is improved, and the learning length shortened. This primary research then allows for a simulator to be created with haptic feedback and multiple sensors integrated. The simulator will also record these procedures, allowing feedback to be given.
On top of using this system for training purposes, it has the potential to make experienced surgeons even better and unlearn mistakes which they have become accustomed to, as they would receive feedback in real-time. This project also provides the stepping stones for advanced diagnostics and improving instrumentation in urology.
The proposed methodology is only within its initial stage and could be subject to change through the project.

References
[1] Intuitive, "About da Vinci Systems," Intuitive , [Online]. Available: https://www.davincisurgery.com/da-vinci-systems/about-da-vinci-systems . [Accessed 31 May 2020].
[2] 3D Systems, "Uro Mentor," 3D Systems, [Online]. Available: https://simbionix.com/simulators/uro-mentor/ . [Accessed 31 May 2020].

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.