Computer-assisted training simulator to sharpen surgeon's skills in laparoscopy and hysteroscopy

Darmstadt 24 January 2000Newly emerging minimally invasive surgical procedures such as laparoscopy and hysteroscopy require specific skills both from novice and experienced surgeons. These complex interventions in a patient's abdomen or a woman's uterus need to be frequently trained and practised in detail before the operation can take place safely on the actual patient. In the first half of 1998, a consortium of German, Portuguese and Spanish partners set up a project under the umbrella of the Educational Multimedia Task Force (EMTF) initiative, funded by the European Commission, in order to design an advanced training system called Lahystotrain, for this type of procedures. The surgical simulator will integrate virtual environments and combine them with intelligent tutoring technology to build realistic operation scenarios.


The Fraunhofer Institut für Graphische Datenverarbeitung is the co-ordinator of the Lahystotrain project, supported both by DG XIII's Telematics and Applications Programme and by DG XXII's Leonardo da Vinci Programme. This institute equally participates in the Virtual Medical Worlds Community (VMWC) Group. Three partners assist in providing the advanced technology to develop the innovative surgical training system which includes intuitive 3D/2D interaction and haptic feedback. These are the Instituto de Engenharia Biomédica, hosted in Portugal; Labein, the Technological Research Centre in Spain; and Karl Storz GmbH in Germany.

Three medical centres, one in each partnering country, will test and validate Lahystotrain. These end-users are the Hospital de Sao Joao; the Osakidetza Hospital de Basurto; and the Universitäts-Frauenklinik Frankfurt, the Zentrum für Minimal-invasive Operationen. In this regard, the project partners aim to overcome the limitations of the traditional hands-on training and the simple "learning by doing" approach. Lahystotrain offers a highly realistic operative setting allowing trainees and students to acquire and practise the typical skills needed for the various interventional methods in laparoscopy and hysteroscopy. These also include crucial operating steps and complication management.

In turn, the tutor is given the ability to control the entire procedure as well as to evaluate the progress made by the trainee, who can repeat the virtual operation as many times as necessary. Multimedia information, including digital video and audio, enable novice users to apply the basic version of the training simulator to focus on the theory and the conceptual aspects of both laparoscopy and hysteroscopy. Expert surgeons can use an advanced version of Lahystotrain to refine their skills in minimally invasive interventions with virtual reality techniques. To this purpose, the project team will introduce a graphics workstation, a tracking device and force feedback.

The basic training system for novice surgeons will be made available on low-cost platforms. Via a simple PC, students will be able to access Lahystotrain on the World Wide Web and be guided through a multimedia training course on laparoscopy and hysteroscopy. They will equally have the opportunity to consult all relevant published documentation on these medical specialities or establish an electronic conference with an instructor in this area. As far as the advanced training system is concerned, its architecture allows the more experienced surgeon to study virtual anatomical structures and simulate the movements of the endoscope and surgical instruments.

In addition, each superficial error is detected by Lahystotrain while its cause is being indicated. A user model represents the current knowledge level of the surgeon in order to present all missing data to the user through the most appropriate media. The different training sessions and exercises are tailored to the personal trainee's needs by a tutor. The surgeon thus can experience the behaviour of organs in case of collision, cutting, or deformation through the haptic device. The trainee is also able to feel the give and resistance of the anatomical structures via the instruments.

Lahystotrain will take shape in three steps, by first evaluating the existing training methods and systems to define the requirements of the new system. Second, Lahystotrain has to be implemented and made accessible via the Internet. The third phase involves the installation and testing in hospitals and training centres to receive feedback from the trainees. This assessment will enable the project team to customise and adapt the training system to the needs of its divergent user public even more, be they expert or starting surgeons, students or trainers. Information on the Lahystotrain system is available from the project co-ordinator Mr. Wolfgang Müller at the Fraunhofer Institute.

Leslie Versweyveld

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