Montefiore surgical residents receive laparoscopy training in freshly opened Virtual Reality and Skills Lab

Bronx 13 February 2001Montefiore Medical Center recently has opened one of the most advanced minimally invasive surgical training centres in the United States. The Montefiore Institute for Minimally Invasive Surgery (MIMIS) includes a Virtual Reality and Skills Laboratory, surgical workstations and a state-of-the-art conference room with global teleconferencing and telemedicine capabilities.


"Minimally invasive surgery is the new paradigm in the field of surgery, and Montefiore is the first academic medical centre in the New York region to offer a formalised training programme for all surgical residents", stated T.S. Ravikumar, M.D., chairman of the Department of Surgery. "It is anticipated that this modern centre, in addition to training Montefiore residents in a variety of minimally invasive surgical procedures, including laparoscopic, arthroscopic and other endoscopic interventions, will quickly become a regional centre for practising surgeons to learn new and advanced skills."

In the past ten years, minimally invasive surgery has replaced open surgery for many general procedures, such as gall bladder, knee and shoulder surgery, and is being used increasingly for more complex procedures in gynaecological, cardiac and urological surgery. "Laparoscopic surgery requires learning entirely new skill sets", explained Alan White, M.D., the director of MIMIS. "First, the surgeon must operate utilising tiny instruments at the end of two-foot-long, chopstick-like shafts. Second, his or her field of vision for the operation is a video image, that is two-dimensional. This is completely different from open surgery, in which the surgeon holds surgical tools in hand and has a 3D image."

To help surgeons learn these new skill sets, the Virtual Reality and Skills Laboratory has ten workstations, each equipped with a monitor and a range of laparoscopic instruments, including harmonic scalpels, for grasping, cutting and suturing. At some stations, a computer with virtual software programmes is hooked up to the monitor, and students practise surgical skills by placing a "ball" in a "box" with laparoscopic instruments. At other stations, students practise suturing on simulated tissue samples, seen via the monitor.

"One key advantage of the virtual stations is that they produce an ongoing video of the student's abilities and progression in left and right hand orientation which, because it is counter-intuitive in laparoscopic surgery, is fundamental. The video can be reviewed and critiqued later with the instructor", stated Dr. White. First- and second-year surgical residents are required to have five, half-day sessions at MIMIS and are required to practise on their own time. Third- and fourth-year residents begin working at workstations with graded skill complexity.

In addition to the Virtual Lab, the other main space in the 3500-square foot MIMIS facility is the high-tech conference centre, which has a full range of on-site and off-site teaching capabilities using links to local area and global communications networks. Up to 35 students can sit in comfortable chairs at varnished wooden desks and, depending on the agenda for the day listen to live lectures that use LCD projector displays on an 83-inch screen; view real time surgeries, projected onto the room's four giant monitors, which are underway in Montefiore's surgical suites or anywhere in the world; attend a teleconference on the West Coast, or engage in a telemedicine diagnosis in India, where Montefiore has a memorandum of understanding to establish a formal telemedicine programme which will encompass one of the most populous states.

The MIMIS facility is supported by grants from Ethic Endosurgery and Karl Storz Inc., leaders in minimally invasive surgical technology. Three years ago, a training facility for laparoscopic procedures has been established at the University of Kentucky. You can get more details about this Center for Minimally Invasive Surgery in the VMW September 2000 article University of Kentucky to teach keyhole surgery skills with home built simulators and models.

Leslie Versweyveld

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