Computer-based courseware familiarises medical students in Athens with laparoscopic procedures

Manchester 20 November 2001At the University of Athens, Dr. Theodoros Diamantis is working as a general surgeon and an expert in laparoscopic procedures in the First Surgical Department. At present, his team is preparing a courseware for the two-year European WebSET project, in which standard educational tools are built to teach surgical skills over the Web by means of 3D computer simulation. The courseware will be applied at the University Hospital of Athens to teach young surgeons and medical students how to establish a new operative setting and how they can put the endoscopic tools safely into the patient's abdomen. This is the first step to start a laparoscopic procedure.


The courseware will provide a module with theoretical knowledge about the laparoscopic procedure and detail the human anatomy using the computer and various sets of simulations in different layers. A second module with a specific interactive simulation of the abdominal wall is integrated so that students can use the model to gradually learn how to place needles at the exact locations and to experience which areas they have to avoid to perform the virtual procedure safely. A third part of the courseware will offer examples of what can go wrong during laparoscopic interventions, which mistakes are likely to be made and how they can be corrected. This part is followed by a questionnaire and examination in order to have students know what they have to know to perform the procedure.

Once the courseware available, the newcomers in Dr. Diamantis' unit will start practising with the simulations for laparoscopic procedures. In turn, the last year medical students will assist and work with the team of Dr. Diamantis in the operating theatre. After the course, Dr. Diamantis hopes that the students will be able to do the procedure with less complications and start performing the different steps much quicker than today. Now, medical students have to assist the experienced surgeons in many operations before they are able to put a needle into the patient. Dr. Diamantis expects that the courseware will reduce the time young surgeons have to wait before they are allowed to do anything.

Dr. Diamantis thinks the initial WebSET applications to be very impressive and anticipates that they will make the job much easier. Anatomical maps have been produced in which one can differentiate the different layers of human anatomy. These will help a lot to show students where the needle exactly will be in the next step and allow them to feel the different layers of the abdominal wall. WebSET is a very useful tool and the current simulation of the abdominal body allows students to choose the right position to place a needle and make the correct decision. Also, the simulation provides them with the idea of having a real body in front of them, presents them with ways to calculate what is wrong and right, and enables them to make objective measurements.

Dr. Diamantis is pleasantly surprised by the quality of the virtual body, which is really excellent. One can press the abdomen and watch palpations visualised under the virtual skin. All this is extremely helpful to make students see what the right place is to put the needle in. The simulations are being performed on standard PCs but the quality of the images is beyond expectation, according to Dr. Diamantis who is convinced that young doctors are very much familiar with a PC and like to try out things on a PC rather than following a lecture.

The approach of the new courseware will be much more attractive to these young trainees than just listen to the traditional explanations and watching slides. WebSET will offer them the opportunity to try things out and correct their own mistakes. This is far more instructive than attending a lecture or watching the surgeon perform a procedure in the operating theatre. The surgeon often is in a hurry and has no time for additional explanation. On the other hand, students have to wait three months before they have gained sufficient knowledge to put a needle in a patient. The safety of the patient cannot be questioned, as stressed by Dr. Diamantis.

Yet, young doctors are anxious to start participating and try something. With the WebSET simulations, they will be ready to do things much more quickly which will satisfy them. Dr. Diamantis considers this WebSET prototype system as a first step. A whole series of new courseware can be produced to simulate more complicated operations. The team plans to develop a collection of courses to prepare the students in a much more quicker and safer way to perform their first real operations.

Dr. Diamantis believes that simulation is going to play a big role and change the things surgeons used to do in the past. Experienced doctors of an advanced age have to learn new operations as well. It is very difficult for them to watch somebody else doing it. With the simulation software, surgeons can integrate the knowledge they acquired in the past with the principles and protocols of the new procedure. More details on WebSET are available in this VMW issue's article WebSET simulators to provide surgeons with objective training feedback and standardised procedures and at the WebSET project Web site.

Leslie Versweyveld

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