New Surgical Simulation Lab gives hands-on experience to improve patient safety

Los Angeles 25 May 2006Compared to traditional, open-incision operations, minimally invasive surgical procedures have reduced hospital stays, recovery times, cost and pain for patients, but they demand specialized sensory skills for surgeons - the kinds of skills that can be honed in the new Surgical Simulation and Training Laboratory in the Department of Surgery at Cedars-Sinai Medical Center.


The laboratory, part of the Division of Surgical Research, may be the first state-of-the-art simulation and training lab in California and among the first in the western United States. In addition to providing hands-on training for surgical residents and refresher opportunities for experienced surgeons, it will be used to advance the science of surgery and simulated surgery, according to Edward Phillips, MD, executive vice chairman of the Department of Surgery and chief of the Division of General Surgery.

The lab provides several workstations with equipment ranging from a "box trainer" for the development of basic skills to more sophisticated, computerized simulators that allow surgeons to go through the motions of actual laparoscopic operations and endoscopic procedures. "The box trainer is a tool that is used primarily for new surgeons who are starting their residency. It allows them to work on basic laparoscopic skills involving depth of field and movement", Dr. Phillips stated. "The instruments go into the box at a fixed point, a fulcrum point, which is similar to the way laparoscopic surgery is performed."

In laparoscopic surgery, long, thin surgical instruments and a rod-shaped telescope are inserted through several small incisions in the skin. The surgeon manipulates the tools externally while viewing the surgical site, magnified many times, on a video monitor. Because most of the body’s internal organs can now be examined, removed, biopsied or repaired without large incisions and long hospital stays, laparoscopic techniques have revolutionized many common and not-so-common surgical procedures. Even elderly and frail patients who might be considered poor candidates for open procedures and general anaesthesia may benefit from the more easily tolerated laparoscopic approaches.

Endoscopic procedures also take advantage of high-resolution displays and miniaturized instrumentation. Long, flexible tubes with fiber-optic technology are inserted into natural openings such as the esophagus and colon to evaluate tissues and organs, remove tissue for biopsy, and perform surgical procedures, such as the removal of growths or polyps in the colon.

In Cedars-Sinai's simulation lab, one computer-based simulator, the Simbionix LAP Mentor, enables surgeons to perform all the steps of removing a gall bladder or repairing a hernia laparoscopically. Another simulator, the GI Mentor, "sequences" endoscopic procedures of either the esophagus or the colon. This device, made available through a grant from the Sharon Osbourne Colon Cancer Programme at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, gives surgeons specialized training in the diagnosis of colon diseases and the techniques of colonoscopic procedures.

"Our computerized simulators help surgeons learn the skills and sequences of procedures, keeping track of hand motions, how often instruments are pointed in the wrong direction and have to be corrected, and the length of time required to complete a procedure. With the amount and variety of information provided by the simulators, surgeons can assess themselves and their performance on each trial", Dr. Phillips stated.

The facility also includes a mannequin that is used to train surgeons in such skills as inserting breathing tubes and bronchoscopes, used to visualize the lungs, and performing tracheostomies, surgery to open the airway.

Dr. Phillips recently served as a faculty member during an educational session on surgical simulation at the annual meeting of the Society of American Gastro-intestinal and Endoscopic Surgeons in Dallas. "We had about 60 surgeons from around the United States taking the course, an indication that there is significant interest in this young but growing field", he stated. "Surgical simulators are not as far along as airline simulators, which can sequence a pilot through a variety of scripts or problems. The human body is more variable than an airliner, however, which places additional demands on surgical simulator technology. We expect to perform studies at Cedars-Sinai that will lead to even greater technological sophistication, and we will conduct validity studies to determine which performance criteria in a virtual setting correlate with safety and skill accomplishment in the real setting."

Cedars-Sinai will make the Surgical Simulation and Training Laboratory available to medical students and surgical residents at universities and other hospitals in the Los Angeles area, Dr. Phillips stated. "Surgical simulation technology may be in its early stages, but it provides valuable experience for surgeons learning or fine-tuning their skills, without the use of animals or patients. Our primary objective is to improve surgeons' skills and enhance patient safety."

The first of eight hospitals in California whose nurses have been honoured with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest non-profit academic medical centres in the Western United States. For 18 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programmes and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programmes Inc. (AAHRPP)

Leslie Versweyveld

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