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Does Virtual ‘Warm-up’ Improve Surgical Performance?

Researchers at University of Washington Medicine will lead a three-year multicenter study to see whether the practice leads to faster, more effective work — and fewer errors.

 

Below is an excerpt from the UW Health Sciences News Beat written by Michael McCarthy:

credit: Clare McLean

Dr. Thomas Lendvay demonstrates the virtual reality program surgeons will use to ‘warm up’ before operating.  photo credit: Clare McLean

The study will enroll surgeons operating with robotic surgery systems, through which surgeons manipulate surgical instruments remotely with computer assistance. This assistance gives the surgeon exquisite control over their instruments and allows them to perform complex procedures through dime-sized incisions.

In the study, the surgeons will be randomly assigned to perform operations with and without warm-up. The warm-up will consist of performing a set of tasks in a virtual reality program that will mimic tasks commonly performed during surgery. The surgeons’ performance during the first 15 minutes of each operation with or without a warm-up will then be compared.

The study, which is being funded by a $1.35 million grant from the U.S. Department of Defense, will be led by Thomas Lendvay, a UW associate professor of urology and a pediatric urologist at Seattle Children’s Hospital, and Timothy Brand, urologic surgeon at Madigan Army Medical Center in Tacoma.

“In athletics, music and other activities in which you are required to perform both complex physical and mental tasks at the same time, performers typically warm-up beforehand. This has been shown to improve performance,” said Lendvay. “We want to see whether a short, standardized, pre-operative warm-up can improve the performance of surgeons as well.”

In a previous study, Lendvay and Brand looked at how a short warm-up in a separate virtual reality computer program affected a surgeon’s ability to perform a variety of tasks with the robotic surgery system, such as suturing and placing small rings on pegs mounted on slowly gyrating pegboards. The researchers found that after the virtual reality warm-up the surgeons were faster, worked more economically and, importantly, made fewer errors while suturing.

Thomas Lendvay looks on as Justin Ahn, a resident at UW Medical Center, practices suturing in the virtual reality program.

“The warm-ups appear to help the surgeon to reach a mental state where actions like suturing don’t require a lot of attention,” Lendvay said. “This means they can spend less time thinking about suturing and more on the decisions they have to make as the operation proceeds.”

If the study finds that the warm-up significantly improves the surgeon’s performance, Lendvay envisions that warm-up could become part of routine pre-operative preparations.

“We are hoping to design a short, standardized warm-up protocol that will improve performance for a wide variety of procedures,” he said.

The study will be conducted in collaboration with a University of Washington team led by Blake Hannaford, professor of electrical engineering and director of the Biorobotics Laboratory, and another UW Medicine urologist, Mathew Sorenson at VA Puget Sound Health Care System, as well as the University of Minnesota, Florida Hospital System’s Nicholson Center and Madigan Army Medical Center.

Click here to learn more about using the dV-Trainer for surgical warm-up or visit MShare, Mimic’s online curriculum sharing portal, to download a Surgical Warm-up curricula for your dV-Trainer.

For more information on robotic surgery simulation training click here to contact a Mimic Representative.

 

 

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Back to School Fall Robotic Surgery Simulation Training Courses

Don’t wait to start thinking about Fall training courses, register today!

Mimic will be supporting the following Fall hands-on robotic surgery simulation training courses:

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Can’t make it to a conference?  You can earn CME credits through MimicMED at the Florida Hospital Nicholson Center.  Click here to learn more about full day training courses and personalized one-on-one training.

To learn more about simulation training, please contact: training@MimicSimulation.com

 

 

 

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Hands-on Training in Robotic Surgery Growing More Popular in Europe

Mimic Technologies supports hands-on training courses at EAU 2015 in Madrid

Mimic announced recently the beginning of a new partnership with the internationally acclaimed ORSI – OLV Robotic Surgery Institute that will jointly deliver new innovative training for robotic surgeons in Europe.  This year at the annual European Association of Urology in Madrid, Mimic provided dV-Trainers for the robotic surgery hands-on training courses.

EAU TV went along at EAU 2015 to check out the hands-on training courses. Watch the video below to hear how some of the trainees enjoyed the course:

“We are delighted to collaborate with Mimic to incorporate the dV-Trainer into our EAU Fellowship Program. The dV-Trainer has built-in evaluation metrics and curriculum tools that align well with our results oriented mission”, said Prof. Alexandre Mottrie, CEO of ORSI.

Todd Larson, Executive Director of MimicMED, the training subsidiary of Mimic, also feels that this will be the beginning of something very special, “We are extremely excited to partner with a progressive institution like ORSI. It is a real privilege to partner with leading educators like Dr. Mottrie and his colleagues. We believe that by joining ORSI’s expertise in education with our training technologies, curriculum expertise, and data collection platform, we will be able to take robotic training to the next level.”

 

About ORSI

ORSI stands for the OLV Robotic Surgery Institute. ORSI has an international recognition of providing top quality surgical operations within several areas of expertise for robotic surgery. The mission of ORSI is to pass on our experience and expertise in the field of robotic surgery to physicians and their teams via result oriented training.

For more information: www.orsi-online.com

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New Maestro AR™ 3D augmented reality brings procedure-specific content to robotic surgery simulation training for Gynecology

Hysterectomy module debuts at AAGL, November 18-20, 2014

Hysterectomy

Maestro AR for Hysterectomy will be demonstrated at the Mimic Technologies booth (#330) during the Global Congress on Minimally Invasive Gynecology (AAGL) in Vancouver, British Columbia, Canada, on November 18-20, 2014.

Mimic Technologies, Inc announces the launch of the Maestro AR Hysterectomy, a new augmented reality software module exclusively available on their dV-Trainer® robotic surgery simulator. Maestro AR is the first robotic surgery simulation technology that allows trainees to manipulate 3D virtual robotic instruments as a way to interact with 3D video footage of an actual surgical case.

This full procedure simulation was developed in collaboration with Dr. Arnold Advincula, president-elect of AAGL (American Association of Gynecologic Laparoscopists) and the Vice Chair of Women’s Health and Chief of Gynecologic Surgery at Columbia University Medical Center.  Using 3D augmented video, Dr. Advincula guides trainees through each step of a robot assisted total laparoscopic hysterectomy (RATLH).

At each critical juncture of the procedure, trainees experience both cognitive learning and robotic surgery skills development through identification of anatomical structures and surgical landmarks, simulated tissue retractions, predicting dissection planes, answering multiple choice questions, and completing virtual reality skills exercises. These embedded virtual reality tasks, such as vaginal cuff closure, emphasize hand-eye motor skills critical to proficient surgical technique. For each step in the procedure, comprehensive metrics are gathered and reported, allowing trainees to objectively track their progress at learning the procedure and becoming proficient with required robotic surgery skills.

Maestro AR for Hysterectomy divides the complete RATLH procedure into the following steps:

1. Pelvic Survey

2. Desiccation and Transection of Fallopian Tube and Utero-Ovarian Ligament

3. Desiccation and Transection of Round Ligament

4. Incision and Separation of Broad Ligament

5. Skeletonization and Desiccation of Uterine Arteries and Vasculature

6. Creation of the Vesicouterine Reflection and Adhesiolysis

7. Transection of Uterine Vasculature

8. Colpotomy

9. Vaginal Cuff closure

Maestro AR for Hysterectomy

“By augmenting real surgical video with interactive virtual content, we are able to deliver realism on a whole new level,” said Jeff Berkley, PhD, CEO, Mimic Technologies, Inc.

“By augmenting real surgical video with interactive virtual content, we are able to deliver realism on a whole new level,” said Jeff Berkley, PhD, CEO, Mimic Technologies, Inc. “Our process for generating augmented reality is also extremely efficient and we expect to generate a large volume of content over the next few years that will allow trainees to walk through a wide variety of surgical scenarios as presented by world leading educators. We feel this will expose surgeons to a tremendous variety of surgical scenarios that would not normally be encountered under a normal case load.”

Maestro AR is available exclusively on the Mimic dV-Trainer as a multi-specialty package, that includes Hysterectomy and Partial Nephrectomy, (lead by Dr. Inderbir Gill of USC).  Prostatectomy and Lower Colon Resection will be added to the package within the next half year.

Maestro AR for Hysterectomy will be demonstrated at the Mimic Technologies booth (#330) during the Global Congress on Minimally Invasive Gynecology (AAGL) in Vancouver, British Columbia, Canada, on November 18-20, 2014. Mimic’s Maestro Hysterectomy will also be featured in an AAGL class (ROBO Course 603) to be held on Monday the 17th, which will be proctored by Dr. Peter Lim, Dr. John Lenihan, Dr. Martin Martino, Todd Larson, RN, MS, CNOR, Dr. Gerald Harkins, Dr. Michelle Nisolle, and Dr. Fatih Sendag.

For more information: www.MimicSimulation.com/Hysterectomy

 

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Augmented Reality, Other Trainers for Complex Disease

Dr. Advincula is a leader in minimally invasive surgical techniques and one of the world’s most experienced gynecologic robotic surgeons who has published and taught extensively in the area of minimally invasive surgery as well as developed surgical instruments in use worldwide. He is a board certified obstetrician-gynecologist and a fellow of the American College of Surgeons.

Dr. Advincula is a leader in minimally invasive surgical techniques and one of the world’s most experienced gynecologic robotic surgeons who has published and taught extensively in the area of minimally invasive surgery as well as developed surgical instruments in use worldwide. He is a board certified obstetrician-gynecologist and a fellow of the American College of Surgeons.

Arnold Advincula, MD and Sarah Sherwood wrote “Augmented Reality, Other Trainers for Complex Disease” for the September issue of OBGYN.net. Below is an excerpt from the article.

“A four-year residency is not enough,” says Mona Orady, MD, director of Robotic Surgery Education at Cleveland Clinic. “I see women after they have had unfinished, poorly performed surgeries every single day.” Orady believes hospitals need to adopt stratification where they designate what is routine and what requires simulation and other forms of surgical training. “There are higher levels of care and, for that, high-quality training is essential.”

Orady encourages simulation training by incentivizing it. She sets the bar and requires passage in order to operate. Many other centers of excellence are now setting their own requirements. The Robotic Training Network (RTN) has unified robotics training and testing at over 50 institutions, with participating hospitals including Johns Hopkins and Harvard. The RTN curriculum, which includes cognitive testing and skills evaluation through physical models and simulation, is growing rapidly in popularity.

At Columbia, we have begun implementing the RTN curriculum on both the resident and fellow training level. As the Vice-Chair & Chief of Gynecology at Columbia University Medical Center, I can tell you that the days of learning-as-you-go on patients are not acceptable. Surgeons must simulate to proficiency before entering the actual operating room.

What’s New?
“We believe this is the future of GYN training,” says Mimic CEO Jeff Berkley, PhD. “Practicing surgery on animals will only take us so far. Through augmented reality, we hope to expose surgeons to a wide variety of surgical scenarios that they would not normally encounter as a part of the typical case load. This approach may help limit the amount of learning that must not take place on real patients.”

“We believe this is the future of GYN training,” says Mimic CEO Jeff Berkley, PhD. “Practicing surgery on animals will only take us so far. Through augmented reality, we hope to expose surgeons to a wide variety of surgical scenarios that they would not normally encounter as a part of the typical case load. This approach may help limit the amount of learning that must not take place on real patients.”

Most hospitals that use the da Vinci® robot also use simulation training to some degree. This technology, created by Mimic Technologies, has been independently validated by research and academic medical centers around the country. Mimic has also recently developed training technology for traditional laparoscopic surgery that supports the surgical assistant in robotic procedures. The goal is to help all members of a robotic surgical team perform at a high level.

Mimic’s training director, Todd Larson, is a former Walter Reed Army Medical Center specialist, and agrees with Orady that most surgeons coming directly out of residency have not reached a level of competency that allows them to perform advanced surgical procedures. Consequently, they will seek Fellowship training or some other advanced training to acquire those skills. Mimic Technologies has partnered with the Florida Hospital Nicholson Center to develop simulation training to aid the specialist in safely acquiring advanced skills.

According to Larson, most surgeons who participate in simulation training note improvement. They are evaluated through technology called M-Score, which measures performance and provides an actual score on areas that represent their strengths and weaknesses. This type of assessment is meant to improve training efficiency, since the surgeon can then focus on his or her own specific deficiencies.

Once surgeons complete their training, they must meet the credentialing standards of the hospital where they are practicing. Currently, there are no universal standards or benchmarks for robotic surgery. Each individual hospital has its own standards for credentialing and privileging. There is an effort through the American College of Surgeons to develop the Fundamentals of Robotic Surgery; however, these standards are still in development. Since the Joint Commission requires ongoing professional practice evaluation to ensure surgeon competency, simulation can serve not only as an objective performance measure but also as a tool to maintain competency utilizing advanced technology, such as robotics. Surgeons claim that individual high surgical case volumes lend themselves to maintaining one’s skills. This is why objective-based simulation can serve as a great tool for skills maintenance and overall competency. As Orady and Larson point out, surgical skill is individualistic and skills decay will vary with each individual practitioner. However, by continuing to use simulation, a surgeon can continue to evaluate and maintain his or her skills.

“There is a lot of equipment in the hospital that has the potential to cause harm. Robotics is certainly no different,” says Larson. “What is unique about robotics is the means to safely acquire and maintain a surgeon’s skills through simulation and advanced training.”

robotic surgery training

“There is a lot of equipment in the hospital that has the potential to cause harm. Robotics is certainly no different,” says Larson. “What is unique about robotics is the means to safely acquire and maintain a surgeon’s skills through simulation and advanced training.”

Since gynecology is becoming more specialized, the need for advanced training is even more necessary. Mimic is also working on an augmented reality product that will simulate hysterectomy, coming out this fall. Augmented reality combines three-dimensional (3D) computer-generated objects and text and superimposes them onto real images and 3D surgical video footage, all in real time. The surgeon then has the feeling of being in an actual surgery. This accompanying video provides a brief example of how this augmented reality training software will work.

Larson says this is needed because the current controlled basic training environment is incomplete: “The current animal model used in training does not adequately emulate actual practice. What would be ideal is to perform the procedure in a simulated environment and be objectively evaluated on your performance.” Hospitals are constantly looking for the safest way to acquire skills, learn the specifics of the surgical procedure, and learn how to manage potential complications.

“We believe this is the future of GYN training,” says Mimic CEO Jeff Berkley, PhD. “Practicing surgery on animals will only take us so far. Through augmented reality, we hope to expose surgeons to a wide variety of surgical scenarios that they would not normally encounter as a part of the typical case load. This approach may help limit the amount of learning that must not take place on real patients.”

Berkley explains that it was gynecologists who were the first to make the aggressive push toward simulation testing to gain surgical privileges. This is due, in part, to the access issues of training in the OR. “Gynecology training is special—it is tougher to get to the volume of surgeries you need,” he says. “It can be tough to keep up those needed skills. That is why we have made women’s health a priority, because skills maintenance through simulation should play a larger role in gynecology.”

Continue reading the full article on OBGYN.net

 

 

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