Virtual Simulators Enhance Operating Room Skills

	Young visitors to the UW Health Sciences Center Open House test their CPR skills on the anesthesia mannequin.

A surgical resident inserts a catheter through a small incision and views the surgical site on a screen via the optical fiber of an endoscope. He then drains bile from a gallbladder. He attaches clamps and dissects around a gallstone, watchful for bleeding. As he cuts, he feels tissue resistance. The patient doesn’t feel a thing. There is no patient.

In surgical training, virtual reality is the way of the future. This is particularly true for less-invasive endoscopic surgery. The technology will make it easy for trainees to practice procedures repeatedly while their performance is objectively tracked. In the next decade, sophisticated simulators are set to become a routine part of surgery training and surgeon assessment.

In 2002, scientific tests validated basic simulators by proving that their use in training improves performance. The American College of Surgeons is putting together national multicenter trials to further develop and test surgery simulators. The University of Washington will participate as a leading center.

At the UW Human Interface Technology Laboratory, affiliated with the College of Engineering, researchers are doing performance analyses on a series of simulators. These include a prostate surgery simulator in collaboration with the Department of Urology; a suturing simulator in collaboration with the Division of Dermatology; and a sinus surgery simulator, in collaboration with Madigan Army Medical Center at Fort Lewis in Tacoma.

At the UW Center for Videoendoscopic Surgery, Dr. Mika Sinanan, associate professor of surgery, is gathering data for the next generation of simulators. In collaboration with the Department of Electrical Engineering, his team has built mechanical systems to measure the forces and movements that occur during a surgical procedure.

The Department of Surgery installed two surgery simulators in 2002 and plans to implement virtual reality training. For a glimpse of that future, surgeons-to-be can look to a simpler but mature simulation model in use at the Department of Anesthesiology.

UW anesthesiology students train on a sophisticated quarter-million-dollar simulator, a computer-controlled mannequin with mathematical models for the heart, lungs, blood system and more. It can be set up with various physiologies, fat or thin, young or old, with diabetes or with heart disease. If a trainee injects any of 150 drugs, the computer recognizes the drug and calculates the blood level.

Students attest that in practice the mannequin performs realistically. It breathes and blinks its eyes; it has a pulse and a heartbeat. Infrequent events such as a heart attack or malignant hyperthermia can be programmed to happen during a procedure.

“These are critical events that our surgery residents may never see in their training on real patients,” said Dr. Brian Ross, associate professor of anesthesiology. “They need to know how to manage them before they enter the operating room.”

The operating room is sometimes unforgiving of mistakes in surgery or in anesthesiology. Full-scale simulation and virtual reality promise a safer training ground.