Developing a multimedia environment for customized teaching of an adrenalectomy Juan Cendan, 1 Minho Kim, 3 Sergei Kurenov, 2 Jorg Peters 3 1 University of Florida College of Medicine, PO Box 100286, JHMHC, Gainesville, FL 32610-0286, USA 2 Department of Surgery, University of Florida, Gainesville, FL, USA 3 Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, USA Received: 1 September 2006/Accepted: 30 October 2006/Online publication: 16 December 2006 Abstract We have developed a computer based simulation pro- cess which allows a surgical expert to create a custom- ized operative environment. This virtual environment, the Toolkit for Illustration of Procedures in Surgery (3D TIPS), is deployed on a low-cost computer system and requires minimal training for the programmer. The learner can be engaged in training immediately and the educator can modify the system and annotate the pro- cedure to highlight specific points using video clips, operative images, and the like. A laparoscopic adrenal- ectomy is presented as a proof of concept in the accompanying article. Key words: Education, surgical — Technical, general — Technical, imaging and VR — Technical, training courses Medical illustrations and, more recently, videos have become the standard for the dissemination, documen- tation, and teaching of surgical procedures. Presently, the hurdles for taking descriptive text to illustration demand long hours from a trained medical illustrator and the physician developing the presentation. The illustrator generates images that are subsequently re- vised before results are satisfactory. In cases in which an accurate depiction is required, a three-dimensional or multiple-view representation may be necessary to pro- vide satisfactory transfer of information. These paper- bound reproductions are generally limited in the ability to illustrate the nuances of relative size, texture, or po- sition. The process is only partly in the surgeonÕs control and can take years in the case of textbooks to reach the end user—senior residents or novice surgeons. The sys- tem is intended to illustrate anatomic relationships and surgical procedures. Anatomists, surgical residents, or practicing surgeons could take advantage of our system. Alternatively, in the realm of laparoscopy, the pro- cedure can be captured on video and then edited to optimize the viewerÕs time and disk memory limitations. This situation is limited by the anatomic realities of the patient being recorded, a procedure that also requires the consent of the patient. Furthermore, only passive viewing is involved in the current learning process. In this article we describe the system and demonstrate a proof of concept by illustrating a laparoscopic adre- nalectomy with the three-dimensional Toolkit for Illus- tration of Procedures in Surgery (3D TIPS). Description of the optimal system After word processors became commonplace, docu- ments were entered and edited completely by the author. Along with the Internet, this capability increased busi- ness communications several orders of magnitude and currently facilitates the bulk of the publishing market. We have developed the 3D TIPS system that facili- tates the documentation of a surgical procedure on a surgeonÕs desktop computer. The system allows for immediate procedural capture, annotation, and active replay by the learner. This has become possible because of our recent ability to exploit graphics hardware for haptic authoring [1]. The development goal is for the surgeon to be able to document critical procedural relationships with the click of the computer mouse or a similarly easy-to-use input device. In our system we have opted to record the pro- cedural and tactile details [2] of the surgical procedure through a feedback stylus guided by the surgeon (Fig. 1). Once recorded, the procedure can be edited and augmented with additional images and text. The ulti- mate product is a robust instructional document that students can use immediately. The haptic stylus can then Correspondence to: Juan Cendan New Technologies Surg Endosc (2007) 21: 1012–1016 DOI: 10.1007/s00464-006-9119-2 Ó Springer Science+Business Media, LLC 2006