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
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
9. Vaginal Cuff closure
“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
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.
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.”
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.”
The following is an except from OBGYN.net’s September article.
” An advanced, procedure-specific training software for physicians who perform robotic surgeries has been developed by Mimic Technologies. This new augmented reality software, Maestro AR, is to be used with the dV-Trainer and gives surgeons the look and feel of being in an actual surgery. This software is suitable for surgeons in training who want to master their skills or for those with a lower surgical volume who want to preserve their skills. This preview of the software features a partial nephrectomy and uses actual surgical footage from Inderbir Gill, MD, Chairman, Department of Urology, Founding Executive Director of the USC Institute of Urology and Associate Dean for Clinical Innovation. According to Mimic Technologies, augmented reality training software for hysterectomy will be introduced this fall.” – Continue reading full article on OBGYN.net
Don’t miss this year’s Robotic Olympic Games taking place at the 2014 Society of Laparoendoscopic Surgeons Annual Conference in Las Vegas. This year, some of the nation’s top surgeons will be competing for excellent scores for training for the daVinci Robot
Minimally invasive surgery is becoming the norm in a variety of areas of medicine, but it is complex, causing a high percentage of surgeons to opt out, even though studies show less invasive surgeries are much better for the patient. On Sept. 10-12, during the SLS Minimally Invasive Surgery Week / Annual Meeting and Endo Expo, researchers will come together to compete and train using the latest training technology—simulation of the daVinci robot on the dV-Trainer. Top surgeons and technology experts will be on hand to show how the latest in minimally invasive surgery is now done.
Dr. Jeffrey Berkley, Founder and CEO, Mimic Technologies
Dr. Paul Wetter, president of the Society of Laparoendoscopic Surgeons
Jacques Hubert, former president, Minimally Invasive Robotic Association (MIRA), and creator of the first Robotic Olympic Games
Dr. James “Butch” Rosser, FL Hospital Celebration Health
Dr. Mona Orady, Cleveland Clinic
Two Rounds of Competition:
Wed., 9/10 at 7PM and 8:30PM (Qualifying Rounds)
Thurs., 9/11 at 7AM to 2PM (Qualifying Rounds)
Friday, 9/12 at 9-10AM in the General Session (FINALS BEGIN)
Caesars Palace Hotel, Las Vegas: 3570 S Las Vegas Blvd, Las Vegas, NV 89109
Society of Laparoendoscopic Surgeons Annual meeting Booth #110
DIRECTIONS/PARKING: http://www.mapquest.com/us/nevada/restaurants-las-vegas/caesars-palace-266320278 (702) 731-7110
“One of the most powerful equalizers in any system is technology, and as medical equipment manufacturers work to improve their positions in an increasingly competitive and outcomes-based marketplace, some are considering the specific needs of women in their product development,” writes Matthew N. Skoufalos in his cover story for MedicalDealer Technology: The Great Gender Equalizer – A look at trends in women’s health.
In the article, CEO and Founder of Mimic Technologies Jeff Berkley explains that an improvement in surgical techniques — especially for procedures such as hysterectomies — can have a profound impact on health outcomes.
He believes that women’s healthcare can benefit from an emphasis on minimally invasive surgeries, particularly if the barrier of training surgeons is removed from the equation.
The following is an excerpt from the August 2014 cover story:
“I personally think that the impact simulation can make on women’s health is probably more profound than it would be on other disciplines,” Berkley said.
“People have been doing laparoscopic hysterectomies since the 1970s, and yet there is still some resistance to adopting what is clinically a better approach,” he added. “We feel a lot of this has to do with the fact that people don’t have access to the training.”
“It is an enabling technology,” Berkley said, “but the reality is it hasn’t been out that long, and even though a lot of robotics are being done for hysterectomies, endometriosis, and other surgeries, people are still going to try to make a comparison to laparoscopics. It’s not an apples to apples comparison.”
Robotics can allow surgeons to achieve “expert status” faster, Berkley said, and even carry advantages over the traditional laparoscopic approach. Wristed instruments allow greater access to tissue. A trimmer scales back motion to allow for greater precision and accuracy. Surgical robots even offer 3D vision.
But the key advantage, potentially, is that surgical robotics also offers the possibilities of simulation, which helps keep surgeons primed for practice.
“If you’re a urologist, you might do three to seven prostatectomies a day,” Berkley said; “but if you’re an OB-GYN, you’re very likely helping people deliver babies. It’s not uncommon that a GYN may only do a surgery once a month. People are going to have less practice on the job and your skills can deteriorate pretty fast in a month.”
“If you have 24-7 access to a simulator and you have some time between cases, or you want to simulate a case, you can maintain your skills,” he said.