Surgical Simulation: Surgical Simulation: We dont need simulation. - - PDF document

▶
surgical simulation surgical simulation
SMART_READER_LITE
LIVE PREVIEW

Surgical Simulation: Surgical Simulation: We dont need simulation. - - PDF document

Mar 17, 2023 364 likes •468 views

Typical Surgeons Perspective Typical Surgeons Perspective Surgical Simulation: Surgical Simulation: We dont need simulation. We dont need simulation. A Clinical Perspective A Clinical Perspective We have plenty of

slide-1
SLIDE 1

1

Surgical Simulation: Surgical Simulation: A Clinical Perspective A Clinical Perspective

Christoph R. Kaufmann, MD, MPH, FACS Christoph R. Kaufmann, MD, MPH, FACS

Associate Professor of Surgery Associate Professor of Surgery Co Co-

  • Director, National Capital Area Medical Simulation Center

Director, National Capital Area Medical Simulation Center Uniformed Services University, Bethesda, MD USA Uniformed Services University, Bethesda, MD USA

http:// http://simcen simcen. .usuhs usuhs.mil/mmvr2002 .mil/mmvr2002

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Typical Surgeon’s Perspective Typical Surgeon’s Perspective

“We don’t need simulation.” “We don’t need simulation.” “We have plenty of clinical “We have plenty of clinical material.” material.” (patients) (patients)

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Outline Outline

  • Surgery yesterday and today

Surgery yesterday and today

  • Surgical simulation yesterday and today

Surgical simulation yesterday and today

  • Surgical education and certification

Surgical education and certification

  • Surgical patient care

Surgical patient care

  • Simulation in trauma care

Simulation in trauma care

  • Surgical simulator development

Surgical simulator development

– – Today’s challenges Today’s challenges – – Ultimate challenges Ultimate challenges

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgery: Surgery: 50 years ago 50 years ago

  • No vascular surgery

No vascular surgery

  • No

No intracardiac intracardiac surgery or pump surgery or pump

  • Open surgery only

Open surgery only

  • Patients spend weeks in hospital

Patients spend weeks in hospital

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgery: Surgery: Today Today

  • Vascular surgery,

Vascular surgery, intracardiac intracardiac surgery surgery

  • Minimally invasive surgery

Minimally invasive surgery

  • Expanding knowledge base

Expanding knowledge base

  • More procedures

More procedures\ \ increasingly technical increasingly technical

  • 50% of US surgery is on outpatient basis

50% of US surgery is on outpatient basis

slide-2
SLIDE 2

2

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgical Simulation: Surgical Simulation: 50 years ago 50 years ago

  • Patients

Patients

  • Animals

Animals

  • Cadavers

Cadavers

  • Dolls

Dolls

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Patients Patients Animals and Cadavers Animals and Cadavers

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Dolls Dolls

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgical Simulation: Surgical Simulation: Today Today

  • Patients

Patients

  • Animals

Animals no no change change

  • Cadavers

Cadavers

  • Dolls

Dolls Mannequins Mannequins

  • Virtual Reality

Virtual Reality

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Mannequins Mannequins

slide-3
SLIDE 3

3

Virtual Reality Simulators Virtual Reality Simulators

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Traditional Surgical Education Traditional Surgical Education

  • Apprenticeship

Apprenticeship

  • See one, do one, teach one

See one, do one, teach one

  • Learning on patients

Learning on patients

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgical Education Today Surgical Education Today

  • Less physician teaching time

Less physician teaching time

  • Less resident time

Less resident time

  • Fewer patient hours available for resident and

Fewer patient hours available for resident and student teaching student teaching

  • Larger number of procedures to learn

Larger number of procedures to learn

  • Procedures more technical and high risk

Procedures more technical and high risk

  • Institute of Medicine report

Institute of Medicine report

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Challenges in Surgical Education Challenges in Surgical Education

  • Need a safe transition from classroom to

Need a safe transition from classroom to patient patient

  • Solution:

Solution:

Surgical Simulators Surgical Simulators

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

slide-4
SLIDE 4

4

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Definitions Definitions

  • Virtual Reality (VR)

Virtual Reality (VR)

  • Immersive Environment

Immersive Environment

  • Haptics

Haptics

  • VR Simulators

VR Simulators

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgical Selection and Surgical Selection and Certification Certification

  • Selection for training

Selection for training

  • Selection for completion of training

Selection for completion of training

  • Written and oral examinations

Written and oral examinations

  • No technical skills examination

No technical skills examination

  • Interest exists in using simulators to certify

Interest exists in using simulators to certify surgeons surgeons

  • (

(Recertification Recertification also) also)

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgeon Patient Care Steps: Surgeon Patient Care Steps: Perceived Perceived

  • See patient

See patient

  • Cut patient

Cut patient

slide-5
SLIDE 5

5

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgeon Patient Care Steps: Surgeon Patient Care Steps: Actual Actual

(Trauma Patient Care) (Trauma Patient Care)

  • Triage

Triage

  • History and Physical Examination

History and Physical Examination

  • Resuscitation

Resuscitation

  • Diagnostic Studies

Diagnostic Studies

  • Decision making

Decision making

  • Operative care

Operative care

  • Postoperative care

Postoperative care

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Triage Triage

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Triage Triage

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: History and Physical History and Physical Examination Examination

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Resuscitation Resuscitation

  • A, B, C’s of trauma care

A, B, C’s of trauma care

slide-6
SLIDE 6

6

Simulation in Trauma Care: Simulation in Trauma Care: Diagnostic Studies Diagnostic Studies

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Decision Making Decision Making Simulation in Trauma Care: Simulation in Trauma Care: Decision Making Decision Making

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Operative Care Operative Care

  • Technique/skill trainer
  • Partial task trainer
  • Task trainer
  • Validity?
  • Transference rate?

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Operative Care Operative Care

  • Educate/consent/prepare patient
  • Preoperative planning
  • Position, scrub, drape patient
  • Skin and subcutaneous incision
  • Deep (muscle, fascia) incision
  • Tissue dissection

(sharp,blunt, cautery, hand)

  • Suturing
  • Knot tying (instrument, hand)

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Patient Counseling Patient Counseling

slide-7
SLIDE 7

7

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Preoperative Planning Preoperative Planning Preoperative Planning Preoperative Planning

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Operative Care Operative Care

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Postoperative Care Postoperative Care

slide-8
SLIDE 8

8

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Simulation in Trauma Care: Simulation in Trauma Care: Postoperative Care Postoperative Care

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

Surgical Simulator Development Surgical Simulator Development Today’s Challenges Today’s Challenges

  • Multiple use

Multiple use

  • Task training focus (integrated scenarios)

Task training focus (integrated scenarios)

  • High volume surgical cases or

High volume surgical cases or low volume/high risk low volume/high risk

  • Fidelity: adequate graphics and

Fidelity: adequate graphics and haptics haptics

  • Inexpensive

Inexpensive

  • Validated

Validated

A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002

The Ultimate Challenges The Ultimate Challenges

  • Open surgery

Open surgery – – all procedures all procedures

  • Instruments and hands

Instruments and hands

  • 2 point tactile discrimination

2 point tactile discrimination

  • Kaufmann

Kaufmann test (Can I tell if I’m operating test (Can I tell if I’m operating

  • n a real patient or a simulated patient?)
  • n a real patient or a simulated patient?)