The following blog post is a transcript of a speech Andrew J. Hung, MD (Director, Surgical Simulation & Education at USC Institute of Urology) gave during this year’s American Urological Association Annual Meeting in Orlando, Florida.
“Existing robotic virtual reality simulators have been focused on basic surgical skills. This has been a very appropriate entry point for surgeons who want to adopt robotic surgery into their practice. Procedure specific simulation is the next frontier.
In developing Procedure-Specific Simulations we have learned the following:
First, the collaboration between the surgeon and the software developer is absolutely critical. A surgeon brings to the table an intricate understanding of the anatomy as well as the procedure. The software developer brings engineering, and very specific technical capabilities, such as the 3D artist who brings our ideas into a 3D environment that’s interactive and engaging.
Second, our whole process starts with the storyboard. In our case, the robotic Partial Nephrectomy scripted from beginning to end, skin-to-skin, not leaving out a single detail. And, we record the operating room procedure. The High Definition Stereo 3D is very sophisticated recording device capable of recording the procedure with the absolute highest graphic definition.
Third, we then take the whole procedure, edit it, introduce anatomy, and ask users to point out main parts, as a baseline test, before they are allowed to move on to the next step in the operation. The procedure step leads to another cognitive type question. We ask users ‘what is the next step coming up?’ because it is important to know what to anticipate in the surgeon’s mind.
Finally, because this is now called ‘Procedure-Specific,’ we’re teaching advanced skills such as tissue retraction. We ask the surgeon, ‘Where do you grab the tissue?’ and ‘which direction do you pull it?’ and ‘with what amount of force should it be pulled?’ The intent is to create tissue manipulation that appears to be real.
In the past, procedure simulation was designed by engineers and then validated in retrospect by surgeons. But now we have flipped this process around. Now, during design development, the surgeons and engineers have to collaborate and really test their user studies. We invited faculty, expert surgeons, novice surgeons, and we’ve had them form the basic validation steps. We ask the experts, ‘is this realistic? Is this going to be a useful training tool?’ And, importantly, we compare and look in very close detail at novice performance versus expert performance because we want to see that there is an ability to distinguish between the two.
We not only look at which questions had a good difference between a novice user and an expert user, but actually focused on the questions that failed to meet current validation. And we looked at the very visual questions or exercises, and thought about how we could improve this particular question. As a result, we now have the ability to test augmented reality experiences, and this is where more and more procedure specific simulation is going.
The emphasis here is that during development, validation begins. The more advanced levels of validation, for example being able to bring or correlate the performance on this platform and real tissue, happens immediately as part of the development process. The next few steps that we want to take include integrating global assessment; sophisticated assessment into a procedure specific environment; and, full virtual reality integration.
Today everybody wants to manipulate that tissue. They want it to be real. And finally, the ultimate goal of what we do, and I think all of the folks at simulation want to do, is go beyond Procedure-Specific and into Patient-Specific rehearsal.”
New Maestro AR™ 3D augmented reality brings procedure-specific content to robotic surgery simulation training
Partial Nephrectomy module debuts at AUA, May 17-20, 2014
Mimic Technologies announces the launch of Maestro AR, a new augmented reality software module exclusively available on the dV-Trainer® robotic surgery simulator. Maestro AR is the first robotic surgery simulation technology that provides 3D virtual instruments for interaction with anatomy in a 3D video environment.
Maestro AR is available as a multi-specialty package, including Partial Nephrectomy (available now) with Hysterectomy, Prostatectomy and General Surgery modules in development for future delivery. Maestro AR for Partial Nephrectomy will be demonstrated at the Mimic Technologies booth (#917) during the American Urological Association (AUA) annual meeting, May 17 – 20, 2014, Orlando, FL.
Maestro AR for Partial Nephrectomy (partial removal of a kidney) was developed in collaboration with Inderbir S. Gill, MD (Chairman and Professor of the Catherine and Joseph Aresty Department of Urology, Founding Executive Director of the USC Institute of Urology and Associate Dean for Clinical Innovation, Keck School of Medicine of USC) and Andrew J. Hung, MD (Clinical Fellow, Advanced Robotics and Laparoscopy, Keck School of Medicine of USC).
Using the dV-Trainer, Partial Nephrectomy trainees interact with anatomical regions using virtual robotic instruments within augmented 3D video. The Partial Nephrectomy video used in the module is taken from an actual case performed by Dr. Gill.
The module also features audio narration from Dr. Gill to help guide the trainee through five procedure steps:
1) Colon mobilization
2) Kocherization of duodenum
3) Hilar dissection
4) Completion of kidney mobilization
5) Tumor excision and renorrhaphy
As they progress through the module, the trainees will identify anatomy, anticipate tissue retractions, predict regions for dissection and refine surgical skills. Partial Nephrectomy includes an embedded virtual reality renorrhaphy skills exercise designed to match the needle pattern used in this procedure.
“Mimic is proud to help fulfill demand that has built up for truly meaningful, procedure-specific content,” said Jeff Berkley, PhD, CEO, Mimic Technologies, Inc. “Our vision is to provide an exceptional training support option across multiple specialties that promotes skill development and basic familiarity with a procedure. We’re pleased that early feedback on Partial Nephrectomy suggests that Maestro AR is exceeding expectations through its unique combination of 3D instruments and augmented video.”
For more information:
Mimic Technologies, Inc, founded in 2001 and based in Seattle, is a pioneer and leader in robotic surgery simulation and training. The dV-Trainer by Mimic was the first simulator to recreate the look and feel of the da Vinci® Surgery System from Intuitive Surgical. F
- For more information about Dr. Gill:
- For more information about Dr. Hung:
- For more information about Dr. Jeff Berkley:
With the latest MSim™ software update to the dV-Trainer robotic surgery simulator, Mimic Technologies is providing customers and research partners with a preview of forthcoming augmented video simulation technology.
The new procedure-specific simulation training module for partial nephrectomy was developed in collaboration with Inderbir S. Gill, MD (Chairman and Professor of the Catherine and Joseph Aresty Department of Urology, Founding Executive Director of the USC Institute of Urology and Associate Dean for Clinical Innovation, Keck School of Medicine of USC) and Andrew J. Hung, MD (Clinical Fellow, Advanced Robotics and Laparoscopy, Keck School of Medicine of USC).
This new training technique will enable users to advance clinical decision-making skills as they use virtual robotic instruments to interact with anatomical regions within augmented 3D surgical video footage of a case performed by Dr. Gill. Trainees will learn to identify anatomy, anticipate tissue retractions, predict regions for dissection and refine surgical skills such as suturing. The interactive module includes audio narration from Dr. Gill to bring the user through the steps of the procedure.
“Many thought leaders in the robotic surgery community have suggested that procedure-specific simulation training would be an incredibly useful new approach to promote skill development, especially for less experienced surgeons,” said Jeff Berkley, CEO, Mimic Technologies Inc. “Through our collaboration with Drs. Gill and Hung, we could not be more delighted to now show our existing partners and customers how far we’ve come in making it a reality.”
The full partial nephrectomy procedure module is exclusively available from Mimic on the dV-Trainer, and available for purchase for May 2014 delivery.
For more information:
New component for the dV-Trainer® facilitates better teamwork between the console-side surgeon and first assistant
Mimic Technologies Inc. debuts the new Xperience Team Trainer robotic surgery simulator at the 14th annual International Meeting on Simulation in Healthcare (IMSH), January 25-29, 2014, San Francisco.
The Xperience Team Trainer is the first system exclusively designed to help the robotic surgeon’s first assistant gain experience and refine skills in a simulation environment. The new simulator functions as a complementary hardware unit for the dV-Trainer® simulator, featuring two movable laparoscopic tool ports for use by the first assistant. This enables the first assistant and console surgeon to safely train together outside of the OR.
Within the robotic surgical environment, cooperation between the console-side surgeon and first assistant is critical for efficient, effective performance. A high level of teamwork requires precise verbal communication and the ability to anticipate and react to one another’s movements during common procedural tasks.
“As the saying goes, ‘Separation is in the preparation,’” said Jeff Berkley, CEO and founder, Mimic Technologies Inc. “The first assistant’s role in influencing procedures is crucial, and perhaps underappreciated. Giving the console-side surgeon and the first assistant the chance to train together should be a tremendous asset for institutions looking to maximize patient safety and overall efficiency in robotics.”
Many of the most effective basic skills exercises on the dV-Trainer have been modified to accommodate the first assistant. These exercises build teamwork and synchronization for common maneuvers such as needle passing, tissue retraction and clip application.
“The Xperience Team Trainer should benefit institutions looking to maximize preparedness of their robotic surgery teams,” said Dr. John Lenihan, Medical Director of Robotics & Minimally Invasive Surgery, MultiCare Health Systems (Tacoma WA), Assistant Professor of OB-GYN, University of Washington School of Medicine (Seattle WA). “The new team exercises are an innovative method to help the first assistant refine their working relationship with the console-side surgeon.”
The Xperience Team Trainer leverages Mimic’s unique MScore™ evaluation system, which factors in comprehensive metrics and experienced surgeon data. MScore allows options for scoring the surgeon’s and first assistant’s performance on exercises separately, as well as for combined proficiency.
For more information about the Xperience Team Trainer go to:
Mimic Technologies Inc., founded in 2001 and based in Seattle, WA, is a pioneer and leader in robotic surgery simulation and training. The dV-Trainer was the first simulator to recreate the look and feel of the da Vinci® Surgery System from Intuitive Surgical.
dV-Trainer® Software Upgrade Provides Surgeons with Enhanced Performance, More Options for Robotic Surgery Simulation and Training
Mimic Technologies announced today the release of MSim™ 2.1, the latest simulation software platform for the dV-Trainer® robotic surgery simulator. MSim 2.1 is being provided to dV-Trainer customers and Mimic research partners worldwide.
Based on Mimic’s proprietary 3D simulation technology, the dV-Trainer provides the most realistic and life-like robotic surgery simulation for the da Vinci robot in the industry.
The MSim 2.1 upgrade expands and refines suturing and knot tying exercises on the dV-Trainer, improving realism and simulating a broader set of surgical tasks. Six suturing exercises are now fully integrated, giving researchers and institutions confidence that these can now be used in studies and curricula.
Tube closure and tube anastomosis exercises are available for the first time, providing dV-Trainer users the opportunity to develop more challenging, procedure-relevant suturing skills.
In total, the release brings more than 40 new features and functionality upgrades.
“MSim 2.1 is the latest example of our commitment to providing surgeons with
unparalleled training and simulation solutions,“ said Jeff Berkley, CEO, Mimic Technologies. “This release offers advanced features and new exercises immediately, yet it’s also indicative of our long-term mission to provide customers with a solid pathway toward new robotic simulation instruments and techniques as they become available.”
The MSim platform provides high quality 3D models of virtual instruments created from the original CAD files for the Intuitive Surgical da Vinci® robotic system. MSim offers unique advantages in user evaluation through proficiency-based performance metrics with MScore™, which contains data collected from more than 100 experienced surgeons with over 75 robotic cases completed.
Mimic Technologies, founded in 2001 and based in Seattle, WA, is a pioneer and leader in robotic surgery simulation and training. The dV-Trainer™ was the first simulator to recreate the look and feel of the da Vinci® Surgery System from Intuitive Surgical. http://www.mimicsimulation.com.