The increasing complexity of surgical procedures, particularly in anatomically dense regions such as the temporal area, makes the availability of simulation tools capable of effectively supporting surgical training and education increasingly necessary. However, many currently available simulators present limitations in terms of tactile and morphological realism. For this reason, the present thesis project, carried out at the University of Pavia in collaboration with the IRCCS Policlinico San Matteo Foundation in Pavia, aimed at the development of a surgical simulator of the temporal region using additive manufacturing, with particular attention to the realistic replication of the skin and underlying tissues. The temporal region was selected due to its clinical relevance and the variety of oto-neurosurgical procedures that involve this anatomical district. The simulator was developed using the Stratasys J750 Digital Anatomy Printer 3D printing technology, which allows the use of photopolymers with different mechanical properties. Starting from digital anatomical models obtained through CT image segmentation, multilayer structures representing skin, fat, muscle, and temporal bone were designed and printed. Particular attention was devoted to the development and optimization of a material preset for the simulation of temporal skin, while predefined material mixtures available within the GrabCAD Print software were used for the underlying tissues. The different material mixtures developed for temporal skin simulation were mechanically characterized through tensile, puncture, cutting, peeling, and suture pull-out tests, and qualitatively evaluated by experienced surgeons in terms of tactile realism, incision behavior, and suturability. The results show a good overall level of realism of the simulator, with a stronger correspondence from a perceptual point of view than from a strictly mechanical one. The final simulator was surgically validated as a training tool for procedures involving the temporal region, confirming the potential of additive manufacturing for the development of realistic surgical simulators.
La crescente complessità delle procedure chirurgiche, in particolare in distretti anatomici ad alta densità strutturale come la regione temporale, rende sempre più necessario disporre di strumenti di simulazione in grado di supportare efficacemente la formazione e l’addestramento chirurgico. Tuttavia, molti simulatori attualmente disponibili presentano limitazioni in termini di realismo tattile e morfologico. Per questo motivo, il presente progetto di tesi, avviato presso l’Università di Pavia in collaborazione con la Fondazione IRCCS Policlinico San Matteo di Pavia, ha avuto come obiettivo lo sviluppo di un simulatore chirurgico della regione temporale mediante manifattura additiva, con particolare attenzione alla replica realistica della cute e dei tessuti sottostanti. La regione temporale è stata scelta per la sua rilevanza clinica e per la varietà di procedure oto-neurochirurgiche che la coinvolgono. Il simulatore è stato realizzato utilizzando la tecnologia di stampa 3D Stratasys J750 Digital Anatomy Printer che consente l’impiego di fotopolimeri con differenti proprietà meccaniche. A partire da modelli anatomici digitali ottenuti mediante segmentazione di immagini TAC, sono state progettate e stampate strutture multistrato rappresentative di cute, grasso, muscolo e osso temporale. Particolare attenzione è stata dedicata allo sviluppo e all’ottimizzazione di un preset di materiali per la simulazione della cute temporale, mentre per i tessuti sottostanti sono state adottate miscele di materiali predefinite disponibili nel software di stampa GrabCAD Print. Le diverse miscele di materiali sviluppate per la simulazione della cute temporale sono state caratterizzate meccanicamente mediante test di trazione, puntura, taglio, peeling e trazione del punto di sutura, e valutati qualitativamente da chirurghi esperti in termini di realismo tattile, incisione e suturabilità. I risultati mostrano un buon livello di realismo complessivo del simulatore, con una corrispondenza più marcata dal punto di vista percettivo rispetto a quello strettamente meccanico. Il simulatore finale è stato validato chirurgicamente come strumento di training per procedure chirurgiche nella regione temporale, confermando il potenziale della manifattura additiva per lo sviluppo di simulatori chirurgici realistici.
Sviluppo e validazione di un simulatore chirurgico della regione temporale realizzato mediante manifattura additiva per applicazioni oto-neurochirurgiche
TRABUCCHI, MARTINA
2024/2025
Abstract
The increasing complexity of surgical procedures, particularly in anatomically dense regions such as the temporal area, makes the availability of simulation tools capable of effectively supporting surgical training and education increasingly necessary. However, many currently available simulators present limitations in terms of tactile and morphological realism. For this reason, the present thesis project, carried out at the University of Pavia in collaboration with the IRCCS Policlinico San Matteo Foundation in Pavia, aimed at the development of a surgical simulator of the temporal region using additive manufacturing, with particular attention to the realistic replication of the skin and underlying tissues. The temporal region was selected due to its clinical relevance and the variety of oto-neurosurgical procedures that involve this anatomical district. The simulator was developed using the Stratasys J750 Digital Anatomy Printer 3D printing technology, which allows the use of photopolymers with different mechanical properties. Starting from digital anatomical models obtained through CT image segmentation, multilayer structures representing skin, fat, muscle, and temporal bone were designed and printed. Particular attention was devoted to the development and optimization of a material preset for the simulation of temporal skin, while predefined material mixtures available within the GrabCAD Print software were used for the underlying tissues. The different material mixtures developed for temporal skin simulation were mechanically characterized through tensile, puncture, cutting, peeling, and suture pull-out tests, and qualitatively evaluated by experienced surgeons in terms of tactile realism, incision behavior, and suturability. The results show a good overall level of realism of the simulator, with a stronger correspondence from a perceptual point of view than from a strictly mechanical one. The final simulator was surgically validated as a training tool for procedures involving the temporal region, confirming the potential of additive manufacturing for the development of realistic surgical simulators.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14239/33926