St. Luke's - Roosevelt Hospital Center

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Anagnostopoulos CE | Balaram SK | Belsley SJ | Swistel DG | Tilson MD | Todd GJ
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SLRHC Robotics and Surgical Sciences Lab

 

 

 

 

 

 

 

 

 

SIMULATION

 

 

 

 

 

 

 

The laboratory conference rooms were designed to take full advantage of teleconferencing facilities and have direct links to the operating rooms at St. Luke's.

 

The Center for Simulation, Training and Robotic Surgery was established at St. Luke's Hospital in 2003. By integrating the disciplines of Surgery, Medicine, Biomedical Engineering, Computer Science and Cognitive Learning, the center aims to design systems that allow physicians and paramedical personnel to improve the technical and cognitive education necessary for the care of patients. The advancement of surgical training as well as ongoing imaging, simulation and robotic research is the guiding compass for the Center.

The Center is composed of nearly 2,500 square feet of research, training and office space on the 11th floor of the Science and Research (S&R) building at the St. Luke's site. The fully operational research operating suite serves as host for robotic and laparoscopic training programs for both surgical residents and visiting surgeons. Advanced inanimate laparoscopic training modules as well as a laparoscopic computer simulator (LapSim) are housed in two other dedicated areas of the Center.

 

Numerous studies have demonstrated that residents trained in laparoscopic skills in a simulated environment including virtual reality simulators have improved performance during and beyond the course of their training. A few studies have even demonstrated an improvement in their laparoscopic skills in the operating room. Most studies have concentrated on areas such as coordination, cutting, clipping, and grasping. Our aim is to analyze the performance of attendings, senior residents, and junior residents at St. Luke's-Roosevelt Hospital Center using the LapSim ® Suturing and Dissection module.

Attendings for purposes of our analysis are defined as surgeons who actively practice minimally invasive surgery. Senior residents are PGY 4 to 6; junior residents are PGY 1,2 and 3. After one practice session on the LapSim ® tutorial and Dissection module, subjects attempt the test modules - one attempt per level of difficulty (out of four) until failure. Data on multiple parameters collected by the LapSim ® database are analyzed.

Although we continue to perform simulation studies, previous analyses have shown that junior residents caused less tissue damage on the Suturing module when compared with attendings or senior residents (p<0.011). No significant differences were found between the 3 groups for the Dissection module. The most frequent cause of failure in all 3 groups was an inability to complete 2 square knots within the allotted time. Comparing attendings who failed to those who passed revealed a significant difference in total time (p<0.046), % knot error (p<0.042), and left instrument path length (p<0.046). Senior residents who failed also had significant differences in total time (p<0.032), % knot error (p<0.026), left and right instruments path length (p's<0.034), and left and right instruments angular path length (p's<0.034). Likewise, junior residents who failed had significant differences in total time (p<0.024) and left and right instruments path length and angular path length (p's<0.025). However, a significant difference was also noted in number of tissue damage (p<0.025). A similar analysis of the dissection module could not be performed as only one resident passed it successfully.

Among the three groups, we expected the junior residents to have improved performance on the Suturing module due to their increased patience and caution, willingness to accept directions, as well as decreased reliance on tactile feedback and increased reliance on visual cues. On the other hand, attendings had increased efficiency of movement but were more likely to cause tissue damage due to their reliance on tactile feedback. No differences were noted on the Dissection module. Of note, junior residents may cause more procedural errors (missing clips, ripped vessel/duct) in comparison to attendings who may have decreased efficiency of movement on the Dissection module. However, statistical significance will require a larger sample size.

 

 

 

 

 

This exercise simulates the application of a clip to a delicate blood vessel.

 

 

 

 

 

The green bead is passed over to the purpose repository to test laparoscopic dexterity.

 

 

 

 

 

3D laparoscopic coordination is a difficult skill to master with only the 2D monitor provided by traditional laparoscopy.

 

 

 

 

 

 

 

 

 

 

 

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