UW CVES:


		EDUCATIONAL STUDIES SURGICAL SIMULATION WORKING GROUP What makes a technically good or expert surgeon, and how can we measure this expertise? To address this issue, the CVES has developed a campus-wide group with the intention of bringing together current education theory and simulation technology. This multidisciplinary Surgical Simulation Working Group (SSWG) is made up of members of the CVES, Division of Surgical Education, Department of Anesthesiology, Department of Medical Education, the Biorobotics lab in Electrical Engineering, and the virtual reality (VR) Human Interface Technology Lab (HITL) in Fluke Hall. Studies from the SSWG have included psychomotor and visuospatial skills testing of resident applicants and resident all levels. Over time, our hope is to be able to correlate performance in the residency with aptitude in these areas. We are also performing videoendoscopic skills training to determine: 1) whether video game performance correlates with vidoendoscopic skill, and 2) whether skills training in a simulator improves clinical safety and efficacy. PHYSICAL SIMULATORS In conjunction with the HITL and Simulab Corporation, we have developed and are continuing to refine tissue-realistic physical simulators and VR simulators for these tasks. Validation objective, numerical measures of expert performance is an important part of this effort that may , in time, allow more precise training (perhaps in simulators ) to overcome differences in aptitude. If we are thus able to quantitate surgical skill based on performance in objective skills tests, quality assessment and "credentialing" of surgeons and surgical trainees may become a more achievable goal. VR PORT SITE SIMULATOR PROJECT In another project, virtual reality technology is also being used to evaluate optimal laparoscopic port site arrangements and working angles. The Virtual Reality Laparoscopic Port Site Simulator Project combines real laparoscopic instruments inserted into a prosthetic abdominal "shell". The instruments are tracked using 6 degree-of-freedom VR trackers and their location in space is calculated and projected into a virtual abdomen displayed on a computer screen. The images displayed are from an actual laparoscopic cholecystectomy and therefore appear real. We expect to see differences in operative performance with different port sites and between individuals with different levels of laparoscopic experience. Effect of Skills Training on Objective Performance in a Novel Laparoscopic Dexterity Device. Other CVES projects have examined how residents learn laparoscopic skills. In one study, the R1 residents were tested performing a newly designed laparoscopic dexterity (LD) task. One group is tested before and after 45 minutes of practicing with standardized laparoscopic skills stations. The other group is tested initially and then after an additional ten minutes of practicing the same task. The hypothesis is that only practice in the specific task/operation will provide the necessary skill acquisition. Preliminary data regarding this project was presented at the Society for Surgical Education last year. The effect of simulation on clinical performance has been assessed in a pilot study of 4th year medical students. The students were randomized into two groups: Simulation (S) and No Simulation (NS). All students got the same theoretical introduction to laparoscopic surgery, anatomy and the specifics of a laparoscopic cholecystectomy. Group S had two practice rounds on a laparoscopic cholecystectomy simulator (Simulab). Both groups then performed a cholecystectomy on a pig and were tested for time and performance. This study showed a trend towards improved clinical performance in the group using a simulated model. The next part of this study will increase the number of participants to 24 and, we hope, will show a statistically significant difference. Funding has been secured from SAGES for completion of this project over the next 4 months. PUBLICATIONS AND PRESENTATIONS B. Hannaford, J. Trujllo, M. Sinanan, M. Moreyra, J. Rosen, J. Brown, R. Lusechke, M. MacFarlane. Computerized endoscopic surgical grasper. Proceedings of Medicine Meets Virtual Reality and presented at same. San Diego, 1/98. M. MacFarlane, J. Rosen, B. Hannaford, C. Pellegrini, M. Sinanan. Biological and simulated soft tissue force profiles generated from a force feedback grasper. Submitted Surgical Endoscopy. Presented at the Society for American Gastrointestinal Surgeons, Seattle, 4/98. M. MacFarlane, J. Rosen, B. Hannaford, C. Pellegrini, M. Sinanan. Force feedback grasper helps restore the sense of touch in minimally invasive surgery. Submitted: Journal of Gastrointestinal Surgery. Presented at the 1998 Society of Surgeons for Surgery of the Alimentary Tract, New Orleans, LA, 5/98. J. Rosen, B. Hannaford, M. MacFarlane, M. Sinanan. Force controlled and teleoperated endoscopic grasper for minimally invasive surgery—Experimental Performance Evaluation. J. Rosen, M. MacFarlane, C. Richards, B. Hannaford, C. Pellegrini, M. Sinanan. Surgeon/endoscopic tool force-torque signatures in the evaluation of surgical skills during MIS. Submitted to MMVR-1999. San Francisco, CA, 1/99.		Laboratory Studies Clinical Studies


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