With more than 600,000 performed in the United States each year, hysterectomies are the most commonly administered gynecological surgical procedures. Most hysterectomies have traditionally been performed via traditional, "open" abdominal surgery – but over the past decade, the number performed via minimally invasive surgery has increased substantially. In fact, many healthcare facilities now perform more minimally invasive hysterectomies than open ones.

Commonly used in orthopedic surgery, thoracic surgery, urology, gastrointestinal surgery, and even heart surgery, minimally invasive surgery is also a good choice for many women facing gynecological surgery and hysterectomy. Studies have found that a woman who has undergone a hysterectomy via minimally invasive surgery can expect a significantly shorter hospital stay than one who opted for abdominal surgery – in one study, the length averaged about 1.6 days, versus 3.9 days.

Another advantage: fewer incisions and faster time to heal. A hysterectomy via minimally invasive surgery requires just a few 8- to 12-millimeter incisions, as opposed to traditional hysterectomy, which requires a 6- to 10-inch incision across the abdomen. Fewer, smaller incisions equate to reduced scarring and pain; reduced hemorrhaging and less possible need for blood transfusions following the hysterectomy; and reduced risk of infection as the patient isn't exposed as much or as long as she is during a traditional hysterectomy.

Hysterectomy is a major procedure which renders the patient unable to bear children. As such, the surgery is only recommended when other options for treatment are unavailable. Reasons for recommendation may include a diagnosis of cancer, the discovery of tumors, or chronic pelvic pain. In all cases, it's essential that the surgeon understands the patient's needs, ensuring an exceptional level of care delivery.

It's also necessary that surgeons performing hysterectomies via minimally invasive surgery have mastered an array of high-level, up-to-date skills, including the use of special tools and instruments; proper posture; efficient hand and arm movement; and manual dexterity. And because the patient's internal organs and tissue are viewed via a video screen, the surgeon must develop a range of hand-eye coordination specific to monitoring the surgery while using unique, state-of-the-art surgical equipment.

All these skills can be learned with the use of a virtual reality (VR) simulator for minimally invasive surgery. Education is key to success: simulation offers surgeons a safe environment in which to practice, learn from their mistakes, and most importantly, perform actual hysterectomies with minimal complications and a great deal of confidence. With one in three women undergoing a hysterectomy by age 65, it's absolutely essential that their surgeons are qualified and competent.

PHILADELPHIA (CBS) — A training tool developed locally will help future doctors and medical personnel save lives during childbirth.

C-Celia is a one-of-a-kind, lifelike “manikin” used to teach students at the Drexel University College of Medicine to perform caesarean sections before seeing a real patient.

Dr. Owen Montgomery, chair of the department of obstetrics and gynecology, says the device allows a surgery resident “to actually do a caesarean using a knife and cutting through tissue and delivering a baby, just as if it was happening in the real world.  Simulation allows us to put residents in situations where they need to prepare for the future.”

Second-year resident Roxanna Irani said it was like doing the surgery for real.

“It was kind of a fun surprise to get a scalpel and, rather than be saying, ‘Okay I’m going to cut into the abdomen,’ to actually get to do it,” she said.

The damaged parts are repaired or replaced, and C-Celia is ready for the next procedure.

Source.

UB researchers have helped develop and evaluate the first simulation-based training curriculum for robotic surgery, which has been shown to effectively train surgeons in key skills.

According to a study published in Urology, those trained with the Fundamental Skills of Robotic Surgery curriculum demonstrated greater precision in surgical skills than those who did not receive training.

Training Simulator Developed in Buffalo
The curriculum makes use of the Robotic Surgical Simulator (RoSS), one of the first simulators to accurately mimic the da Vinci Surgical System.

RoSS was developed by two of the curriculum study researchers: senior author Khurshid A. Guru, MD, who directs robotic surgery at Roswell Park Cancer Institute (RPCI), and co-author Thenkurussi Kesavadas, PhD, who directs UB’s Virtual Reality Lab and is a professor of mechanical and aerospace engineering.

Training Improves Surgical Skills
Recruited from UB, RPCI, the Henry Ford Health System in Detroit and the Cleveland Clinic, 53 surgeons, fellows, residents and medical students participated in the study. Most had no prior robotic or laparoscopic surgical experience.

Initially, an experimental group completed the four-hour training course while a control group did not.

When tested on the da Vinci system, the trained group performed three tasks with more precision and speed than the control group.

Twenty-three control participants then also completed the training. When they were re-tested on the same tasks, their average performance improved considerably.

The researchers now plan further study to establish the extent to which their robotic surgery curriculum may affect long-term surgical proficiency.

More.

For decades, simulation has been a training mainstay in the aeronautical and military fields for its ability to prepare learners for real-life situations. Pilots-in-training clock flight time, heighten alertness, and learn how to react in emergencies. Seeing this success, many academic and medical institutions have also turned to simulation to develop advanced skills in their healthcare learners. Surgical learners in particular must enhance their hand range and dexterity, as well as the ability to anticipate how a patient's physiology will react to certain procedures. To specifically cultivate a surgeon's minimally invasive -- or laparoscopic -- techniques, a hospital or medical school can establish an in-house laparoscopic surgery training program.

First and foremost, an institution must determine the scope of its training requirements: what skills can be targeted to positively effect surgical skill deployment, and what simulation technology will be best suited for the environment? A robust laparoscopic surgery training program should include several tiers of educational equipment. Beginning surgical residents who wish to develop their laparoscopic skills must first master suturing and knot-tying. More advanced laparoscopic learners may next use tools to manipulate objects within a homemade, unplugged "box" trainer. Finally, a sophisticated virtual reality (VR) laparoscopic simulator allows surgeons-in-training to control virtual objects by handling wired, realistic laparoscopic instruments. Both box and VR laparoscopic simulators allow learners to improve muscle memory and refine their hand and arm range.

To encourage positive learning outcomes, a laparoscopic surgery training program must also make sure that simulation is fully integrated into the overall curriculum. Learners should be incentivized to work with the simulators: training outcomes show progress over time, can be tracked for mandatory skill mastery and course completion, and may even help establish an essential competitive spirit between users. Simulation sessions scheduled for every laparoscopic learner on a daily, weekly, or biweekly basis encourage skill retention and ensure regular assessment.

Simulation is also a key to skill standardization in a laparoscopic surgery training program. With both box and VR trainers, every learner completes the same simulation scenarios for diverse skill development. This allows instructors to make fair assessments of whether their laparoscopic learners have consistent reasoning ability, instrument positioning, posture, and spatial awareness.

As laparoscopic surgery training programs become more common worldwide, so too will there be more research and best practices available over time. Program administrators discuss what's worked, what hasn't, and go on to develop new practices for more advanced and efficient skill development. Ultimately, this is a boon for patients: better trained laparoscopic surgeons lead to better surgical outcomes and faster recovery times.

The rate of laparoscopic hysterectomy has greatly increased over the past decade and is now higher than that of abdominal hysterectomy, according to a study in the April issue of the American Journal of Obstetrics & Gynecology.

Lindsay C. Turner, M.D., and colleagues from the University of Pittsburgh assessed trends among 13,973 patients who had undergone hysterectomies at Magee-Womens Hospital from 2000 to 2010. The researchers found that over this period, laparoscopic hysterectomy increased from 3.3 to 43.5 percent, abdominal hysterectomy decreased from 74.5 to 36.3 percent, and vaginal hysterectomy decreased from 22.2 to 17.2 percent. In 2010, three percent of laparoscopic cases converted to open surgery. Hysterectomy was performed for gynecological malignancy in 24.4 percent of cases. The average length of stay was only 1.0 day for laparoscopic hysterectomy and only 1.6 days for vaginal hysterectomy compared with 3.1 days for abdominal hysterectomy. The average patient age for the three procedures ranged from an average of 46.9 to 51.7 years old, with a significant increase in patient age over time.

"This study confirms that rates of laparoscopic procedures for hysterectomy have dramatically increased over the last decade at our tertiary hospital, which is consistent with other reports in the literature," the authors write.

More.

Over the past thirty years, video games have become omnipresent in American popular culture. Children and adults alike get involved in gaming for entertainment and social engagement, as well as to take part in learning opportunities as varied as the technology itself. Reading primers are brought to life with colorful graphics and catchy, cartoon-filled comprehension exercises; guitar techniques are divulged by the hottest rock musicians; and precise hand-eye coordination is mastered by the surgeons of tomorrow. The latter is made possible with the help of not the latest console, but rather with game-inspired virtual reality (VR) laparoscopic surgical simulators.

Today’s surgical residents are tech-savvy. Indeed, they're more than likely to have a gaming console at home: according to a 2012 Neilson study, 56% of American households own an X-Box 360, Nintendo Wii, Playstation 3, or similar current generation gaming platform. And so residents are predisposed to appreciate the possibility of training through game-based simulation. VR laparoscopic surgical simulators allow residents to develop motor skills, including tool usage, dexterity, and carpal range, within a software program. During a training exercise, residents use realistic laparoscopic instruments to manipulate virtual objects by following along on a computer monitor. A wrong move immediately prompts the program to notify them through visual or physical cues, enabling understanding and correction of skill deficiencies.

Like video games, VR laparoscopic surgical simulators encourage users to practice until they receive a high score. Residents can complete exercises repeatedly, move on to higher levels requiring more skill and expertise, and see how they rank in comparison to their peers. It becomes an appealing – and even fun – challenge to master the virtual laparoscopic program and rank locally, regionally, nationally, and beyond. And because increasingly advanced educational tracts may be available, residents will always be motivated to continue their training.

Laparoscopic surgical simulators also give residents the opportunity to develop skills in a safe environment. They're free to make mistakes – and learn to improve on them – without running the risk of harming an actual patient. And when it's time to perform an actual laparoscopic procedure, they'll have clocked many hours of training, making them better able to perform at a higher caliber from the start.

Gaming technology can lead users into new worlds, help them unlock artistic potential, and sometimes even educate them in a specialty as delicate, attention-demanding, and intense as surgery. When coupled with traditional surgical training program curricula, laparoscopic surgical simulators allow residents to develop their skills – and have fun in the process.

When you’re playing Nintendo you may be learning more than how to control a voracious gorilla, rescue a kidnapped princess or negotiate a go-cart course, according to a new study.

In a study posted online Wednesday in the open access journal PLOS ONE, researchers from the department of surgical sciences at the University of Rome measured the surgical skills of students who trained on a Nintendo Wii.

Across four tasks measuring 16 skill-sets on a simulator, such as locating objects with a camera and photographing them, and touching flashing, colored balls with its corresponding tool, Wii team outshone their traditionally trained colleagues in 13 of them. Dr. Mario indeed!

“Laparoscopic simulators represent a satisfactory response to this request but their high costs have limited their spread,” the study authors wrote. “Video-games may be a cheap and widely available product, helping to develop cognitive skills that, apparently, can be transferred in improved surgical performance.”

Laparoscopic gallbladder removal requires surgeons to remotely operate tools inside the patient’s abdomen, including a fiber-optic camera. Using a surgery simulator, students were graded in four tasks involving camera movement, locating objects, moving objects and completing the procedure.

According to this new study, the students who played on the Wii showed greater efficiency and accuracy in handling surgical tools. The study involved 42 first- and second-year graduates studying general, vascular and endoscopic surgery. Half the group was trained on regular simulators and the other half spent one hour a day, five days a week for four weeks playing on a Wii.

More.

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"Tools in Surgical Simulation"

Co-Presented by:
John T. Paige, MD
Louisiana State University School of Medicine

and

Nick Sevdalis, PhD
and Louise Hull, BSc, MSc
Imperial College London

Abstract: The presentation will focus on technical, non-technical, team, and debriefing tools related to surgical simulation.

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Wednesday, March 6, 2013

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