With severe limits on resident duty while hospitals strive for improved patient outcomes, touch-enabled simulators allow trainees to 'practise to perfection' on computers, with zero risk to patients and the ability to acquire skills that can only be learned by feeling. Funded in part by the Society for Thoracic Surgeons (STS) and its Thoracic Surgery Foundation for Research and Education (TSFRE), the simulator was showcased at the Western Thoracic Surgical Association (WTSA) annual meeting in Ojai Valley, California.
VATS lobectomies have replaced traditional open lung surgery in the past decade, but the limits of visibility complicate resident training. Peering through a 3D stereoscopic viewer while holding a surgical scope, residents must know with certainty the "feeling" of the local anatomy in order to avoid collisions that might harm the patient. Practising on cadavers or cadaveric organ blocks is costly and allows only one-time use; and, initial supervised learning-by-doing requires senior medical staff and operating room time that is increasingly in short supply.
"It's impressive how surgeons learn when combining visual and factual information, with a sense of touch", stated Dr. Eugene Grossi, professor of cardiothoracic surgery at NYU School of Medicine and the director of cardiac surgery research at the NYU Cardiac and Vascular Institute. "With haptics in a simulator, we can train residents to operate within a 'closed environment' they encounter in any number of minimally invasive and endoscopic procedures. For instance, residents literally feel what it's like to move a scope up and over the lung to reach the critical anatomy, but not to damage a vital structure. They can practise on unlimited anatomical variations that they might only rarely see in the operating room - but now, with a simulator, they'll be prepared for these scenarios in advance." Dr. Grossi added: "Equally important is the ability of the simulator to gather quantifiable data to assess the resident's skill level and the progression of their training."
BioDigital's RULR simulator teaches the identification of structures such as the right pulmonary artery, superior and inferior pulmonary veins, and the right pulmonary ligament, combining visual representation and tactical feel. The student learns and practises proper placement of the camera port, dissector port, and stapler port. After reaching a level of mastery, the trainee is given six different types of anatomic pathology that range from the most typically occurring to rare. Because the simulator is computer-based, it provides a consistent, quantifiable metric of competence. It allows residents to train in off-hours, at their convenience, and repeat modules until mastery is achieved.
With only an estimated 20 percent of thoracic surgeons having expertise in the VATS lobectomy procedure, the simulator also offers follow-on applicability for training and certifying practising physicians.
"The BioDigital Human virtual surgery platform integrates SensAble's PHANTOM haptic devices and OpenHaptics 3.0 programming toolkit for an unprecedented experience in cognitive and tactile virtual surgery training", stated Aaron Oliker, partner and director of 3D technology at BioDigital. "SensAble's haptic devices, and particularly its OpenHaptics 3.0 programming toolkit, allowed us to accurately reproduce the feeling of moving and manipulating the surgical tools within the patient's anatomy - and the flexibility to tailor the tactile experience in follow-on training solutions", Aaron Oliker stated.
"The BioDigital Human platform can replicate almost any type of surgical procedure in a realistic interactive 3D virtual environment. It supports additional medical simulation and training applications, beyond thoracic surgery including craniofacial, breast reconstruction, dental, and cleft-lip and palate surgery. We are pursuing field validations to further expand its applicability", Aaron Oliker stated.
"The case for touch-enabled, computer-based medical simulators is compelling, and BioDigital's work with NYU Langone Medical Center demonstrates why", stated Joan Lockhart, vice president of marketing for SensAble Technologies. "Using haptically-enabled simulators, medical centres can provide a more accessible and objective training experience with zero risk to patients - with the goal of better surgical outcomes. It's gratifying to see this product supported by esteemed surgical societies."
BioDigital and its NYU Langone surgical partners also will be offering the use of the BioDigital RULR simulator at the national residency training forums this summer to teach the skills that can be learned from such touch-enabled cognitive task trainers.
BioDigital is dedicated to using state of the art biomedical visualization systems to improve training, education, data capture and analysis. From 3D animation, to immersive virtual training environments, to systems that intuitively store and visualize medical data, BioDigital's products and services promise to revolutionize the way we understand medicine. Since 2002, BioDigital has helped a wide range of health care clients visualize medical subjects, and in turn, improve patient care. Located in Manhattan, the team of software engineers, digital artists, and physicians benefit from close affiliations with prominent New York hospitals.
Founded in 1993, SensAble Technologies is a developer of 3D touch-enabled (force feedback) solutions and technology that allow users to not only see and hear an on-screen computer application, but to actually "feel" it. With 41 patents granted and over 8000 systems installed worldwide, SensAble Technologies' haptic technology is being used in applications ranging from designing toys and footwear, to surgical simulation and stroke rehabilitation, to dental restorations, as well as a range of research and robotic applications. The company markets its own 3D modelling solutions as well as its haptic devices and developer toolkits to medical, dental, design, and manufacturing companies; educational and research institutions; and OEMs. SensAble products are available through direct and reseller channels worldwide. More company news is available in the VMW March 2010 article SensAble delivers more dental restorations, speed and convenience with new release 3 of SensAble Dental Lab System.