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Precision Under Pressure: AR Simulation for Postpartum Cesarean Hysterectomy

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I. THE PROBLEM

  • Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, causing over 70,000 deaths annually and complicating 1 in 5 cesarean deliveries.
  • When bleeding cannot be controlled, emergency postpartum cesarean hysterectomy, surgical removal of the uterus after delivery, becomes the only life saving option and must be performed within minutes under extreme pressure.
  • No dedicated simulator exists. Most residents encounter this procedure for the first time on a living patient, as cadaveric training is costly, limited, and unable to replicate true postpartum anatomy or hemorrhage conditions.

1. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America�2. Weill Cornell Graduate School of Medical Sciences, New York, New York, United States of America

IV. NEEDS STATEMENT

A way to train physicians and residents in postpartum cesarean hysterectomy to improve provider comfort with the procedure and reduce severe maternal morbidity.

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II. OUR SOLUTION- THE HYBRID HAPTIC AR APPROACH

  • We developed the first dedicated hybrid simulator for postpartum cesarean hysterectomy, combining silicone based tissue haptics with HoloLens 2 augmented reality. Surgeons perform incisions on silicone tissue calibrated to match postpartum cadaveric resistance.
  • Through HoloLens 2, surgeons visualize internal anatomy, anatomical boundaries, and live collision alerts in real time.
  • By combining physical haptics with AR visualization, the system recreates the tactile and cognitive demands of a real emergency cesarean hysterectomy.

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III. SYSTEM ARCHITECTURE

Real silicone skin and uterus phantom. Surgeon feels true tissue resistance during incision.

2. TRACKING LAYER

HoloLens 2 infrared tracking detects retroreflective markers on surgical tools, enabling real-time identification of scalpel and forceps from a single camera.

3D tool position is computed at 30 FPS using stereo triangulation with a 99.6 mm baseline, validated against hardware specs.

A Bosch BNO055 IMU uses built-in sensor fusion to track real-time tool orientation (pitch, roll, yaw).

Holographic overlay of uterus, bladder, and uterine arteries on phantom with surgical-grade registration.

3. AR LAYER

Real-time alerts: red warning for danger zone entry, green cue for correct dissection plane.

Depth-triggered reveal of full anatomy within 2 seconds of incision for intraoperative realism.

VI. TRACKING PERFORMANCE AND VALIDATION

VII. AR EXPERIENCE AND RESULTS

  • Surgeon stands at phantom. AR guide line marks correct pfannenstiel incision position on silicone skin.
  • Real scalpel cuts through silicone layers. Depth threshold triggers AR anatomy reveal in 2 seconds.
  • Bladder zone flashes red if tool gets too close. Correct uterine artery plane confirms green with audio cue.
  • Hold tool on uterus 3 seconds. Hemorrhage stops. Patient saved.

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VIII. FUTURE WORK

Omar Abououf 1, Daniella Ameh 1 , Shreya Dandwate 1 , Dr. Newton DeFaria 1, Dr. Suelia Fleury Rosa1,

Jordan McMahan1, Jack Thompson 1Dr. Tamatha Fenster 2, Dr. Anna Daoud 2��

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  1. PHYSICAL LAYER

V. PHYSICAL PHANTOM

  • Selected: EcoFlex 0030 + 50% Silicone Thinner
  • Built using a layer-by-layer pour process, dried overnight. Postpartum realism incorporated via:
      • Surface stitching replicating prior cesarean scarring
      • Reduced-constraint layering to replicate postpartum skin laxity

To replicate postpartum tissue, we evaluated 8 silicone formulations using dial indicator force measurement against an available skin reference model.

Figure 5.1 Dial indicator force reference testing against available skin model.

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Figure 7.2 IR Blob detection (AHAT Camera)

Figure 6.1 Wearable Surgical Tracking Prototype

Figure 7.1 Unity - Operation Room

  • Incorporate fully patient-specific anatomical models using real CT/MRI data to create highly personalized surgical simulations for pre-operative planning.
  • Enhance the “Black Box” feedback engine with advanced AI analytics capable of tracking surgical precision, hand movement efficiency, and decision-making patterns in real time.
  • Improve haptic and kinesthetic feedback systems to more accurately replicate tissue resistance, instrument handling, and operating room interactions.
  • Expand the platform with cloud-enabled, multi-user VR simulations featuring adaptive difficulty levels, emergency surgical scenarios, and rare procedural complications to support collaborative training, remote mentorship, and advanced surgical education.

Metric

Result

Stereo baseline

99.6 mm HoloLens 2 spec

3D position tracking

30 FPS real-time

Orientation tracking

100 Hz, zero drift observed

Collision detection

60 Hz response

Tool ID (scalpel vs forceps)

Single camera feed via tetrad geometry

External cameras

None

Figure 7.3 Left Normal postpartum uterine anatomy rendered at procedure start, showing organ boundaries and surgical landmarks. Right: Active hemorrhage state triggered by incorrect plane entry, uterine vasculature turns red. Correct tool placement for 3 seconds resolves the bleed and confirms procedural success.