Simulation - The Future of Medicine

Surgical Simulation

Laproscopic Surgery Simulation

I was on a plane a few years ago flying from Denver to Baltimore. Toward the end of the flight, I put my work away in my briefcase and stowed it under the seat, at which point the gentleman sitting next to me struck up a conversation. It turned out he was a senior pilot for United Airlines and the route he flew was Newark, New Jersey, to Tokyo, Japan. He explained that he lived on the Eastern Shore of Maryland and would fly up to Newark where he would captain a Boeing 747 nonstop to Tokyo. Once he arrived in Tokyo he was required to spend a number of days resting and getting over jetlag before beginning the return flight. When he returned, he had a long hiatus before he flew the next flight.

Unlike in his younger days flying a 737 with multiple take-offs and landings each day, he now did only a few take-offs and landings each month. This explained why he was also flying from Denver to Baltimore. He had been in Denver at the United Airlines Simulation Center where for two days he had practiced more than a dozen take-offs and landings with multiple simulated emergencies, weather issues, and so on. He explained that it had been a great experience, almost exactly as though he were in the cockpit of his Tokyo-bound 747, and that it gave him the opportunity to maintain his skills.

Using simulators for operating room practice is not commonplace; however, I am sure that it will become routine in the coming years. Simulators today for the operating room are nowhere near as advanced as they are for the airline industry, even though a variety of simulators is available. The military has developed simulators to train medics to insert chest tubes; simulators allow for practice inserting a tube into the airway while others simulate starting IV lines.

Endoscopy Simulator

I had the opportunity to try out a limited laparoscopic simulator. The device looked like a box with a rubberlike cover that was meant to imply the abdominal wall. The laparoscopic instruments passed through a number of half-inch slits in the wall. One instrument held the miniaturized camera that projected onto a TV screen in front of me, and the other instrument held a set of pinchers. Inside the abdomen were five small round dishes. In one of the dishes were four marbles. My task was to move the laparoscopic pinchers into the dish with the marbles, grab a marble, lift it out of the dish, and then place it in one of the other dishes. This was repeated until there was a marble in each of the four dishes.

Having never handled any type of laparoscopic instrument before, I can tell you that this was something of a challenge. Within a few minutes though, I was able to grasp the marbles and get them moved to the various dishes. I was rather proud of myself, but the simulator gave me a poor score. "Why?" I questioned the instructor who was standing beside me. "Well," she said, smiling, "you got them from the one dish to the other dishes, but it took you five minutes, whereas it would take an experienced surgeon less than thirty seconds. Second, you got them there, but the simulator monitored your hand motions. Look at this graph on the monitor, you were certainly not smooth. The idea is to move them in a very smooth movement; yours were not."

Now, I'm not a surgeon, but I do have reasonable dexterity, and what I took away from this rather limited example is that every medical student should have the same experience I had and every surgical resident should have to demonstrate a high level of competence on this and other simulation devices before ever being allowed to assist in laparoscopic surgery in the operating room. That's exactly what is happening in some medical centers around the country. Yes, the current simulators are still relatively crude, but they are improving every year. Trainees who have the opportunity to work with them almost invariably say that it was a major help in learning to do laparoscopic surgery. One of the advantages of a simulator is that you get immediate feedback, as I did in my limited experiment.

At a conference recently, I learned that the surgical residents who warmed up with some video game time were found, in a simulated environment, to have 32 percent fewer errors, to be 24 percent faster, and to have an overall 26 percent better score on a standardized procedure. Considering this, should you ask your surgeon just before being put to sleep if she did well on her video game before breakfast this morning?



Last Modified: June 11, 2010

Copyright (c) Stephen C. Schimpff, MD