“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.
The following is a transcript from Mimic’s Art Director Gordon Nealy who spoke about Mimic’s approach to training, instruction and education during the recent Association of Medical Illustrators (AMI) Annual Conference. In his speech, Nealy explains how Mimic has created new training, instruction, and educational approaches to robotic surgery simulation and how surgeons and patients are benefiting.
“At the core of our training for robotic surgeons is the performance and assessment of psycho-motor skills. We train medical students, residents, fellows, experienced surgeons, and practicing robotic surgeons.
I want to draw your attention to the master grips which are the interactive element of the Simulator.
They manipulate the virtual instruments within the skills exercise environments. Performing these exercises is how the learner acquires and develops psycho-motor skills for application to the surgical robotic system. Surgeries on the da Vinci are performed using hand/eye coordination only. It is truly amazing how these surgeons can operate without tactile feedback from the tissues, the cavity walls, sutures and needles.
In psycho-motor training, competence requires practice. At Mimic, we have devised over 59 exercises that trainees can use to advance their skills on the da Vinci robotic system.
However, a well-structured simulation program contains not only performance based exercises, but also a solid assessment program.
Our simulator uses an assessment program we developed called MScore™. MScore is an objective and reliable evaluation of the user’s performance because it breaks down exercises into individual actions. From these, we’ve created the measurements, or metrics, that we use to score the completion of tasks within an exercise. It allows us to evaluate how many times a user dropped an object, whether they collided their instruments, if they missed any targets, and whether the activity was completed within the time limit. The scoring is important for two reasons – one, it provides feedback to the individual as to how they are progressing and two, it informs us how effective the instruction is and if we need to alter it.
Simulation is one of the few areas where one has permission to fail because it is a safe environment. Learning to perform surgery on the da Vinci system is difficult. One of our principal intentions is to reduce the steep learning curve associated with developing robotic surgical skills.
We’ve created instructional materials in the form of text and images, video, and user guides. This step- by- step text instruction example provides the trainee with learning objectives, what they will learn, as well as specific task objectives and what actions are they expected to accomplish in the exercise. The instructional materials also describe the layout of the foot pedals, the types of targets, tips for obtaining a better score, and tips for developing a good technique.
For those who learn better by watching we’ve created video instructions which also contain audio narration. These videos demonstrate how to perform the skills as executed by an accomplished user. By watching the videos users can observe insightful techniques for correct instrument positioning, hand-offs, avoiding pitfalls, task transitions, and principally absorb a mental image of how to perform the exercise.
It is extremely important to develop proper techniques because the ultimate goal is patient safety. Nothing replaces practice but these instructions will assist in advancing the user more quickly and therefore reduce the steep learning curve.
A while ago, our company created a division called MimicMED to address educating the novice and practicing robotic surgeons. MimicMED teaches classes using the dV-Trainer, surgical associated anatomy, and surgical procedure to provide a complete educational experience. Ultimately, this improves the learner’s cognitive and psycho-motor skills.
Why are established robotic surgeons using this additional practice? Because there may be long periods of time when they haven’t performed a robotic surgery because they are performing open surgeries. This means that their skills can get a little rusty. They come to MimicMED to take a class and refresh their skills. Afterwards, they can get back on the robot with confidence.
We recently created a couple of products that further the cognitive skills of our trainees, one of which is the Xperience Team Trainer™. This setup enables two users – a console-side surgeon (who sits at the dV-Trainer) and an assistant (who stands at the Team Trainer). The two hardware units are connected allowing the two users to collaborate in performing the same skills exercise. We’re hoping this will educate them in team dynamics through their practice of collaboration and communication on the simulators.
The other product is our Augmented Reality video exercise. This exercise features virtual instruments, layered over actual surgical video (with actual instruments). The exercise walks robotic surgeons through a partial nephrectomy procedure performed by an expert robotic surgeon.
During this procedure the learner’s cognitive skills are challenged. The user is quizzed on things such as the sequence of steps of the surgery and what was accomplished in a step. They must also identify anatomy and pathology and where to cut or cauterize tissue.
In short, these are the important considerations of our company’s approach to simulation as defined by training, instruction and education.”
This year’s Association of Medical Illustrators (AMI) Annual Conference brought together 400+ visual communication experts to share tales of cutting-edge medical procedures, newly discovered molecular processes, revealing scientific mysteries, and inspirational journeys that fascinate all of us. Mimic was honored to have three of our talented team members (Steve Rowse, Gordon Nealy and Emily Shaw) speak at the event, and even go on to win the prestigious “Charlotte Holt Award of Excellence” for the dV-Trainer, Mimic’s Robotic Surgery Simulator.
The following is a transcript from Mimic’s lead 3D Artist, Steve Rowse, who spoke about “Designing the Original Robotic Surgery Simulator” at AMI 2014. In his speech, he talks about the role of a 3D medical robotic simulation artist and why he passed up a “dream job” as the Lead Technical Environment Artist on Microsoft’s Halo team to work with Mimic Technologies.
“I’m a 3D medical robotic simulation artist. Of course, when I tell people this I typically get a blank stare followed by… ‘wow.. that’s umm, interesting.’ So what do I do?
I am responsible for the 3D content in our simulator software including soft and hard modeling, animation, lighting, rigging, rendering, FX, and the technical art pipeline.
I’d like to share a bit of the inner workings of our software and how we are helping to bridge the gap between medical illustration and real-time interaction through Virtual Reality, Simulation and Augmentation.
In previous jobs, I have created all kinds of content including, 2d and 3d animations, 2d and 3d environments, Vehicles and Weapons for Sony PlayStation SOCOM series, X-Box’s Need for Speed and children’s PC games.
In 2012 I passed up an offer for my “dream job” as the Lead Technical Environment Artist on Microsoft’s Halo team and took a position with Mimic because I became totally intrigued with what they were doing and recognized it as the next big idea – not just in 3D but in technology. Sitting on the corner of Simulation, Robotics, Virtual Reality and of course Medical illustration, I knew I just had to become a part of this. I saw clearly after interviewing with Mimic, that medical simulation is here and that the fusion of video games and Medical Illustration is inevitable. I believe that both careers are very important to our futures and we as professionals have to be aware of the other.
In other words it’s going to take a bridge to combine the two. Simulation is for the purpose of education and not the purpose of entertainment. So In recognition of this, when I was faced with my first major task at Mimic of redesigning and creating a look and feel for our exercises, I had to keep this in mind. My first reaction was to go photo-realistic. That not only presented a lot of technical and practical problems but my worry was that surgeons wouldn’t accept the mostly-realistic experience because they get caught up in the details of it not being exact. I came face to face to the Uncanny Valley. – the creepy experience we get when things are almost reality – but not quite.
The uncanny valley is a hypothesis in the field of human aesthetics which holds that when human features look and move almost, but not exactly, like natural human beings, it causes a response of revulsion among some human observers. The “valley” refers to the dip in a graph of the comfort level of humans as subjects move toward a healthy, natural human likeness described in a function of a subject’s aesthetic acceptability.
My choice then became to make as immersive experience as possible, but with a distinct message that this is not real thus not interfering with the users experience. This launched me into a Medical Illustration type position and not just a medical rendering position. My choice was to follow Pixar’s example of creating an experience rather than duplicating reality. I believe that Illustration holds an invaluable contribution to the world of simulation, because after all aren’t we just bringing a text book to life by learning in a more experiential way? No matter what the technical advances are in CG, Artists and Illustration will always be an important and crucial piece of creating experiences and to enter this forum we must be both illustrators and game developers – a pretty high demand. In order to do this we use hand painted textures and simplified geometry. This also works to our advantage when is comes to more Software development issues like tiling textures and real time deformation.
So what else does the future hold in simulation?
One of the area’s that we are now working in is Augmented Reality using real video as a backdrop to answer questions in an interactive way about a surgery. Because this is actual video we avoid the uncanny valley, but we also lose our total interactive experience. In addition we are inventing new way to develop software in perceived 3D. What this means is that our development space is in 3D – not just our end product. While this is not artistically exciting at this point – what’s exciting about this is the technology behind it that will, I believe, be the next bridge to a hybrid of illustration, CT scanned 3D data and real time simulation which will give us the ability to offer virtual surgeries of real patients before the actual surgery is performed.
The thought I most want to share is simple and straightforward. Despite the ever present force of the technology push, and the desire for more “realistic looks”, illustration and art are not going to be replaced – they will just look slightly different. Illustration, for the purpose of education and communication will be essential in Virtual Reality and Simulation.”
“At the heart of our profession are compelling stories” – AMI 2014
Mimic’s Steve Rowse, Gordon Nealy and Emily Shaw will speak about “Designing the Original Robotic Surgery Simulator” at this year’s Association of Medical Illustrators (AMI) Annual Conference at Mayo Clinic in Rochester, MN, July 23-26, 2014.
This world-renowned event brings together 400+ visual communication experts to share tales of cutting-edge medical procedures, newly discovered molecular processes, revealing scientific mysteries, and inspirational journeys that fascinate all of us.
Since 1945, AMI Annual Conference has brought together artists, illustrators, animators, and visual communicators from around the world, to celebrate innovations and explore advancements, inspirations, and ideas in the dynamic fields of biomedical science and healthcare.
Speakers will highlight topics ranging from sculpting, anatomical body painting, écorché modeling, mobile technology, virtual 3D simulation, and paper quilling to environmental physiology, regenerative medicine, 3D medical imaging, patient engagement strategies, and the separation of conjoined twins.
Meet the Mimic team speaking at this year’s AMI!
Mimic is honored to have three of our inspirational team members sharing their stories of bringing to life the Original Robotic Surgery Simulator.
Steve Rowse started his art career in computer gaming at Humongous Entertainment, a 2D children’s gaming company, as an animation lead and environment artist after graduating from the Art Institute of Seattle. Steve was the Lead Vehicle Artist for what would eventually become the very successful Forza Motor Sports series on Xbox, a vehicle artist for Electronic Arts in Canada (EA) on the Need for Speed franchise; his title credits include Underground 2, Most Wanted, and Carbon. Steve has also worked for SONY as a weapons and vehicle artist at Zipper Entertainment working on such titles as M.A.G. and the SOCOM series of games. Steve now works for Mimic Technologies as the software team’s 3D artist. He is responsible for creating all the art content, and visual technologies for Mimics software.
Gordon Nealy, MS, is a graduate of the Medical College of Georgia. He began his medical illustration profession on staff at the Cleveland Clinic in Ohio and Tufts New England Medical Center. His assiduous pursuit of video and 3D graphics brought him to Seattle, where he joined an organization that designed curricula and visual databases for science education. As Gordon developed his 3D skills, Microsoft was entering the video game enterprise. This was an opportune time, so he jumped over to the burgeoning game industry where he participated in shipping four successful games on PC and Xbox. Today, he is the Art Director at Mimic Technologies.
Emily Shaw, MA, CMI, EMT-B, has almost a decade of experience in the field of clinical simulation with Laerdal DC and Laerdal Medical, Clinical Simulation Center–Baltimore, SiTEL, MedStar, and MedStar Health, and currently conducting robotic surgery simulator sales as the NE Territory Manager for Mimic Technologies. Emily also holds a BFA in painting from Maryland Institute College of Art and a MA in medical illustration from The Johns Hopkins University School of Medicine’s Department of Art as Applied to Medicine.
More about the speakers here: http://www.ami.org/meetings/2014/?page_id=661
Lehigh Valley Health Network is hosting the third annual Robotic Simulation Olympics this weekend! Participants are competing for the title “America’s Next Top Doctor” by trying their skills on Mimic’s simulation platform for the da Vinci Surgical System®, the same training system used by LVHN robotic surgeons. The final round is June 28 at Coca-Cola Park in Allentown. Finals begin at 5 p.m., followed by the awards presentation and the closing ceremonies.
Can’t make the event in person? Finals will be streamed live tomorrow from Coca Cola Park between 5 and 6:30PM EST tomorrow night at SimulationOlympics.com
This special event is spearheaded by Martin Martino, MD, a board-certified gynecologic oncologist with Lehigh Valley Health Network. He is also medical director of the robotic surgery program and a founding member of the Robotic Training Network
“I’m passionate about finding the state-of-the-art treatments, whether it’s robotic surgery or new chemotherapies that have been identified, to help our patients get better,” he says. Learn more about him at http://www.lvhn.org/find_a_doctor/profile-2365