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Background: Virtual surgery planning has proven useful for reconstructing head and neck defects by fibula osteocutaneous free flaps (FOFF). Benefits include improved healing, function, and aesthetics, as well as cost savings. But available virtual surgery planning systems incorporating fibula in craniomaxillofacial reconstruction simulate only bone reconstruction without considering vessels and soft tissue.

Methods: The Haptics-Assisted Surgery Planning (HASP) system incorporates bone, vessels, and soft tissue of the FOFF in craniomaxillofacial defect reconstruction. Two surgeons tested HASP on 4 cases they had previously operated on: 3 with composite mandibular defects and 1 with a composite cervical spine defect. With the HASP stereographics and haptic feedback, using patient-specific computed tomography angiogram data, the surgeons planned the 4 cases, including bone resection, fibula design, recipient vessels selection, pedicle and perforator location selection, and skin paddle configuration.

Results: Some problems encountered during the actual surgery could have been avoided as they became evident with HASP. In one case, the fibula reconstruction was incomplete because the fibula had to be reversed and thus did not reach the temporal fossa. In another case, the fibula had to be rotated 180 degrees to correct the plate and screw placement in relation to the perforator. In the spinal case, difficulty in finding the optimal fibula shape and position required extra ischemia time.

Conclusions: The surgeons found HASP to be an efficient planning tool for FOFF reconstructions. The testing of alternative reconstructions to arrive at an optimal FOFF solution preoperatively potentially improves patient function and aesthetics and reduces operating room time.

Cranio-maxillofacial (CMF) surgery to restore normal skeletal anatomy in patients with serious trauma to the face can be both complex and time-consuming. But it is generally accepted that careful pre-operative planning leads to a better outcome with a higher degree of function and reduced morbidity in addition to reduced time in the operating room. However, today's surgery planning systems are primitive, relying mostly on the user's ability to plan complex tasks with a two-dimensional graphical interface. A system for planning the restoration of skeletal anatomy in facial trauma patients using a virtual model derived from patient-specific CT data. The system combines stereo visualization with six degrees-of-freedom, high-fidelity haptic feedback that enables analysis, planning, and preoperative testing of alternative solutions for restoring bone fragments to their proper positions. The stereo display provides accurate visual spatial perception, and the haptics system provides intuitive haptic feedback when bone fragments are in contact as well as six degrees-of-freedom attraction forces for precise bone fragment alignment. A senior surgeon without prior experience of the system received 45 min of system training. Following the training session, he completed a virtual reconstruction in 22 min of a complex mandibular fracture with an adequately reduced result. Preliminary testing with one surgeon indicates that our surgery planning system, which combines stereo visualization with sophisticated haptics, has the potential to become a powerful tool for CMF surgery planning. With little training, it allows a surgeon to complete a complex plan in a short amount of time.

Virtual assembly of complex objects has application in domains ranging from surgery planning to archaeology. In these domains the objective is to plan the restoration of skeletal anatomy or archaeological artifacts to achieve an optimal reconstruction without causing further damage. While graphical modeling plays a central role in virtual assembly, visual feedback alone is often insufficient since object contact and penetration is difficult to discern due to occlusion. Haptics can improve an assembly task by giving feedback when objects collide, but precise fitting of fractured objects guided by delicate haptic cues similar to those present in the physical world requires haptic display transparency beyond the performance of today’s systems. We propose a haptic alignment tool that combines a 6 Degrees of Freedom (DOF) attraction force with traditional 6 DOF contact forces to pull a virtual object towards a local stable fit with a fixed object. The object forces are integrated into a virtual coupling framework yielding a stable haptic tool. We demonstrate the use of our system on applications from both cranio-maxillofacial surgery and archaeology, and show that we can achieve haptic rates for fractured surfaces with over 5000 points.

Piezoelectric motors offer an attractive alternative to electromagnetic actuators in portable haptic interfaces: they are compact, have a high force-to-volume ratio, and can operate with limited or no gearing. However, the choice of a piezoelectric motor type is not obvious due to differences in performance characteristics. We present our evaluation of two commercial, operationally different, piezoelectric motors acting as actuators in two kinesthetic haptic grippers, a walking quasi-static motor and a traveling wave ultrasonic motor. We evaluate each gripper's ability to display common virtual objects including springs, dampers, and rigid walls, and conclude that the walking quasi-static motor is superior at low velocities. However, for applications where high velocity is required, traveling wave ultrasonic motors are a better option.

Studies indicate that haptic interaction with a computer generated virtual scene may become more intuitive by aligning (co-locating) the visual and haptic workspaces so that the visual and haptic feedback coincide as they do in the real world. Co-located haptics may gain importance when more advanced haptic interfaces, such as high-fidelity whole hand devices, become available. We describe a user study that investigates the pros and cons with physically co-located versus non-collocated haptics on two different display types: a commercial half-transparent mirror 3D display with shutter glasses and a prototype autostereoscopic display based on a Holographic Optical Element (HOE). We use two accuracy tasks with spatial accuracy as the dependent variable and one manipulation task with time as the dependent variable. The study shows that on both displays co-location significantly improves completion time in the manipulation task. However, the study shows that co-location does not improve the accuracy in the spatial accuracy tasks.