近年來，腹腔鏡手術越來越被廣泛使用，對患者來說，腹腔鏡手術具有傷口小、流血少、回復速度快等優點，但對醫師來說，腹腔鏡手術比傳統開腹手術更難執行，所以手術訓練就變得更加重要。目前的訓練方式以實體訓練箱和動物實驗為主，由於這兩種方式在訓練上需要有經驗的醫師在旁指導，且缺乏客觀的分析評估，所以虛擬實境的訓練方式越來越受到重視。

然而，目前市面上的虛擬實境訓練系統，訓練複雜度參差不齊，有些只具備基礎的技巧訓練，具備真實手術模擬的系統價格又普遍過高，動輒數百萬讓醫院望之卻步，因此虛擬實境的訓練方式尚無法普及。

本論文使用平板電腦作為系統的開發平台，提高本系統的可攜性，並設計一套模擬膽囊剝離手術的虛擬實境訓練模組，透過實驗收集醫師與新手的操作軌跡，可以明顯地區別出醫師與新手在操作器械的穩定度差異，問卷的結果也顯示醫師認為本系統與真實手術情形有一定程度的相似度，具有訓練的效果。

Recently, laparoscopic surgery has become widely used based on its advantages of small incisions, less blood and faster recovery comparing with traditional open surgery. However, laparoscopic surgery is more challenging to operate than the open surgery because surgeons can only see the surgical elements through a monitor in 2D plane. This indicates that numerous training processes are required to help surgeons establish standard skills before doing clinical operations. Nowadays, the presented training methods include physical box trainer and animal experiment. However, both approaches require the corresponding instructions from experienced surgeons and are lack of objective assessment and analysis during training procedure. These drawbacks make the virtual reality training becomes an advanced training platform for supporting flexible training complexity for the future prospect.
Currently, even though several simulators are available on the market declaring successful training experiences, their use is extremely limited due to the unstandardized training complexities and the economic costs involved. The high cost of equipment let virtual reality training cannot become universal in most hospital.
To overwhelm this problem, we developed a virtual reality training system based on low cost tablet. Not only can we mitigate the cost but also to increase the portability of system. We designed an animation to simulate laparoscopic cholecystectomy operation. Through tracking the operating process from both experienced surgeons and novices, the system equips with ability to differentiate the stability between experienced surgeon and novice. Besides, we also design a questionnaire for doctors to evaluate the effectiveness of the proposed system. The results show that the presented system provides a training environment that is closer to practical surgery comparing than marketed devices. It also reveals that the proposed system is acquired training success.

[1] Y. Lin, Y. Luo, C. Lee, S. Yang and D. Yu, "A PC-based laparoscopic surgery skills training and assessment system," in 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Chicago, IL, 2014.
[2] I. Oropesa, P. Lamata, P. Sánchez-González, J. B. Pagador, M. E. García, F. M. Sánchez-Margallo and E. J. Gómez, "Virtual Reality Simulators for Objective Evaluation on Laparoscopic Surgery: Current Trends and Benefits," in Virtual Reality, InTech, 2011, pp. 349-374.
[3] "奇美醫院胸腔外科," [Online]. Available: http://www.chimeithoracicsurgery.com/wp-content/uploads/2014/03/20140323-05_resize.jpg. [Accessed 23 10 2015].
[4] 陳栩茹, "虛擬腹腔鏡手術訓練與評估系統之設計與開發," 國立台灣科技大學碩士論文, 2014.
[5] 黃庭豪, "具力回饋的虛擬腹腔鏡手術模擬系統之研究," 國立台灣科技大學碩士論文, 2014.
[6] S. Guo, M. Qu, B. Gao and J. Guo, "Deformation of the catheter and 3D blood vessel model for a VR-based Catheter System," Mechatronics and Automation (ICMA), 2013 IEEE International Conference on, pp. 861-866, 4-7 8 2013.
[7] J. Guo, S. Guo, N. Xiao, X. Ma, S. Yoshida, T. Tamiya and M. Kawanishi, "A novel robotic catheter system with force and visual feedback for vascular interventional surgery," Int. J. of Mechatronics and Automation, Vol. 2, No. 1, pp. 15-24, 2012.
[8] N. Xiao, J. Guo, S. Guo and T. Tamiya, "A robotic catheter system with real-time force feedback and monitor," Australasian physical & engineering sciences in medicine, pp. 283-289, 7 2012.
[9] Z. Yan, D. Wu, Y. Huang and Z. Du, "A simulation method of soft tissue cutting with haptics," Mechatronics and Automation (ICMA), 2012 International Conference on, pp. 2152-2157, 8 2012.
[10] C. Basdogan, M. Sedef, M. Harders and S. Wesarg, "VR-Based Simulators for Training in Minimally Invasive Surgery," IEEE Computer Graphics and Applications, vol. 27, no. 2, pp. 54-66, 2007.
[11] F. Uler and O. Mohammed, "A 3-D finite element mesh generator for complex volumes," Magnetics, IEEE Transactions on, vol. 30, no. 5, pp. 3539 - 3542, 9 1994.
[12] N. Haouchine, J. Dequidt, I. Peterlik, E. Kerrien, M.-O. Berger and S. Cotin, "Image-guided simulation of heterogeneous tissue deformation for augmented reality during hepatic surgery," in IEEE International Symposium on Mixed and Augmented Reality (ISMAR), Adelaide, SA, 2013.
[13] A. Malti and A. Bartoli, "Combining Conformal Deformation and Cook–Torrance Shading for 3-D Reconstruction in Laparoscopy," IEEE Transactions on Biomedical Engineering, vol. 61, no. 6, pp. 1684-1692, 2014.
[14] J. Peng, L. Li and A. Squelch, "Hybrid Surgery Cutting using Snapping Algorithm, Volume Deformation," Journal of Man, Machine and Technology, vol. 2, no. 1, pp. 35-46, 2013.
[15] "PHANTOM OMNI - Sensable," [Online]. Available: http://www.dentsable.com/haptic-phantom-omni.htm. [Accessed 15 10 2015].
[16] X. Shen, A. Hamam, F. Malric, S. Nourian, N. El-Far and N. D. Georganas, "Immersive Haptic Eye Tele-Surgery Training Simulation," in 3DTV Conference, Kos Island, 2007.
[17] S. Queiros, J. Vilaca, N. Rodrigues, S. Neves, P. Teixeira and J. Correia-Pinto, "A laparoscopic surgery training interface," in IEEE 1st International Conference on Serious Games and Applications for Health (SeGAH), Braga, 2011.
[18] T. Tokuyasu, W. Okamura, T. Kusano, M. Inomata, N. Shiraishi and S. Kitanou, "Training System for Endoscopic Surgery by Using Augmented Reality and Forceps Control Devices," in 2014 Ninth International Conference on Broadband and Wireless Computing, Communication and Applications (BWCCA), Guangdong, 2014.
[19] C. K. Huang, M. Zahiri, C. A. Nelson, R. Booton and K. C. Siu, "Outcomes of Muscle Effort Using a Novel Portable Laparoscopic Training System," Journal of Medical Devices, vol. 9, no. 3, 9 2015.
[20] "GIGABYTE技嘉科技," [Online]. Available: http://www.gigabyte.tw/products/product-page.aspx?pid=4804#kf. [Accessed 15 10 2015].
[21] Y. Kim, D. Chang, J. Kim and S. Park, "Gallbladder Removal Simulation for Laparoscopic Surgery Training: A Hybrid Modeling Method," Journal of Computer Science and Technology, pp. 499-507, 5 2013.
[22] Y. Duan, W. Huang, H. Chang, K. K. Toe, T. Yang, J. Zhou, J. Liu, S. K. Teo, C. W. Lim, Y. Su, C. K. Chui and S. Chang, "Synchronous simulation for deformation of liver and gallbladder with stretch and compression compensation," in 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Osaka, 2013.