# Development and Validation of a Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS)

> **NIH NIH R01** · BAYLOR RESEARCH INSTITUTE · 2020 · $606,229

## Abstract

Project Summary
Gastroesophageal reflux disease (GERD) is prevalent in USA and affects about 20% of the
population and leads to decreased quality of life. If untreated, GERD can lead to complications
such as esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. Hiatal hernia is a
condition in which the contents of the abdominal cavity, mainly the stomach, herniate through the
hole meant for esophagus in the diaphragm and into the chest cavity. A strong link has been
established between the presence of hiatal hernias and GERD. Moreover, presence of hiatal
hernia doubles the risk of esophageal cancer. 85% of the hiatal hernia cases are of Type I and 5-
15% of the cases are of paraesophageal Type II-IV hernias, which when left untreated, apart from
inducing GERD, can also result in ischemia or volvulus of the herniated contents. Laparoscopic
hiatal hernia surgery is a minimally invasive procedure performed with specialized tools through
five small incisions on the abdomen. It is an advanced general surgery procedure that has a
learning curve of about 50 cases to achieve a low recurrent rate. Currently training for this
procedure is through limited fellowships and there exists no animal, cadaver or virtual reality
simulator to train in this specific procedure. Virtual reality simulators provide a standardized
training environment where, a procedure can be practiced repeatedly to gain proficiency. They
can also automatically assess the performance without any subjective influence. To address the
gap in training for laparascopic hiatal hernia surgery, we propose to develop the Virtual
Laparoscopic Hiatal Hernia Simulator (VLaHHS) with realistic modeling techniques, capabilities
to simulate types III hiatal hernia, custom bimanual force feedback (haptic) interface. The
VLaHHS developed in this project will also be useful to train surgeons in anti-reflux surgeries to
treat GERD. We propose three specific aims to achieve and prove the effectiveness of our
simulator. In aim1 we will develop the simulator that uses tissue properties and real-time
deformation to simulate the procedure. We will develop custom haptic device to provide force
feedback. In aim 2, we will develop, simulation scenario and metrics, and integrate into VLaHHS.
In aim 3, we will conduct validation studies to prove that training on VLaHHS will lead to improved
performance. The research will eventually lead to fewer surgical errors and improvement to
patient safety.

## Key facts

- **NIH application ID:** 10020977
- **Project number:** 5R01EB025247-02
- **Recipient organization:** BAYLOR RESEARCH INSTITUTE
- **Principal Investigator:** Ganesh Sankaranarayanan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $606,229
- **Award type:** 5
- **Project period:** 2019-09-30 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020977

## Citation

> US National Institutes of Health, RePORTER application 10020977, Development and Validation of a Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS) (5R01EB025247-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10020977. Licensed CC0.

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