New Virtual Reality Surgery Simulator Hones Surgeons' Skills, Improves Patient Safety

The Department of Surgery recently won a $50,000 grant from the Oregon Simulation Alliance to purchase a state-of-the-art virtual reality laparoscopic surgery simulator, the LSW 3.0. The device, created by Surgical Science of Stockholm, Sweden, emulates, with a high degree of accuracy, the anatomy of organs and tissues and fills what has been until now a significant void in virtual reality simulators, according to OHSU Chairman of Surgery John Hunter, M.D. - the ability to feel when you've made a mistake.

"With earlier simulators, you couldn't 'feel' when you were touching something. Now, if your surgical instrument contacts 'virtual' tissue, you will feel it. The instruments give you force feedback in your hands that mimics how tissue and blood vessels feel and behave in real life. That's a great advance in simulators and a tremendous advantage for training our surgeons," said Hunter, co-director of the OHSU Digestive Health Center and a pioneer in laparoscopic surgery.

The tremendous advantage Hunter is referencing has long been established: a 2002 Yale study published in the Annals of Surgery showed surgical residents trained to perform laparoscopic surgery using the first iteration of virtual reality simulators, known as MIST VR trainers, were more proficient and made fewer errors in the operating room than those who received no virtual reality simulated education.

Fewer errors translates into better patient outcomes and, it is hoped, lives saved.

Laparoscopic surgery is used to treat a plethora of diseases and conditions, including several procedures for the morbidly obese (bariatrics), removal and reconstruction of diseased or precancerous tissue of the esophagus or other portions of the digestive tract, cancer dissection and more. It involves inserting tiny cameras, lights and instruments through a quarter-sized incision in the abdomen to see and operate inside

the body. Traditional, or open, surgery, on the other hand, requires making a large incision in the patient's abdomen or chest. Surgeons' interest in using the former has grown dramatically during the past two decades as they've discovered its inherent benefits to patients.

"It hurts less, costs less, allows quicker recovery, and is associated with fewer postoperative complications and smaller scars, generally speaking," explained Hunter.

And with the realization of these advantages comes the need for surgeons-in-training as well as those already in practice to gain greater proficiency outside the operating room, where "time is cheap and mistakes don't cause surgical complications," said Hunter. "VR (virtual reality) simulators are helping to accelerate that learning curve."

OHSU surgical residents train weekly using the virtual reality simulator under the guidance of Robert O'Rourke, M.D., an assistant professor of surgery (general surgery) in the OHSU School of Medicine and director of the laparoscopic surgery residency training program. They also practice on their own time. The simulator offers sophisticated task training programs. It records errors and provides a way of measuring operative efficiency and performance, functioning both as an educational tool and a skills validation instrument.

"Since the 1990s we've measured residents' technical skills and knowledge through didactic and hands-on training. Right now we're in the process of setting up a more formalized training system that includes virtual reality simulation," said O'Rourke.

"At this time, there is no legal organization that accredits laparoscopic surgeons, but that will change as the specialty continues to grow and the need for outcomes to be more closely scrutinized becomes apparent. In the meantime, the virtual reality surgical simulator makes easier the process of establishing a strict metric."

OHSU offers a comprehensive simulation education program through its full-scale, 6,000-square-foot Simulation and Clinical Learning Center - the first such center in Oregon. Virtual reality simulation education is offered in conjunction with existing manikin-based and computer-based training programs, which span multiple health care disciplines. For more information about simulation education at OHSU, visit http://www.ohsu.edu/simulate/index.html. For more information about the Department of Surgery, visit, http://www.ohsu.edu/surgery.