Gamers Make Better Robotic Surgeons

If you're about to have surgery, like a hysterectomy or a prostatectomy, chances are you'll be having robotic-assisted surgery, where the surgeon operates the controls of a robot that preforms the actual surgical procedure. And while you're thinking about your upcoming operation, and the surgeon who will have your life in their hands, you're probably hoping and reassuring yourself that you've got the best possible medical professional at your side. You were impressed that they graduated from the Ivy League, attended the best medical schools, are board certified, and have preformed a large number of the exact procedure you're having with a high rate of success. But did you check their high scores on the latest video games?

Robotic Surgery Simulator at the American Association of Gynecologic Laparoscopists Conference

A new report presented at the American Gynecologic Laparoscopists’ 41st Annual Global Congress on Minimally Invasive Gynecology, written by researchers at the University of Texas Medical Branch, concludes that:

"The superior hand-eye coordination and hand skills gained from hours of repetitive joystick maneuvers mimic the abilities needed to perform today’s most technologically advanced robotic surgeries." 

The researchers pitted non-video game playing resident physician surgeons, against high school and college students who played 2-4 hours of video games every day. The subjects preformed virtual robotic surgical procedures on training simulators, with their skills and competency levels measured across more than 30 robotic surgery teaching steps, and 20 different skill parameters. The results? You guessed it, on average, the students matched or exceeded the skills of the resident physicians when it came to precise hand-eye coordination tasks like the amount of tension to place on surgical instruments, the accuracy level of suturing, or lifting different instruments with the robotic arms.

Dr. Kilic, University of Texas Medical Branch, Robotic Training Simulator Study

The Univeristy of Texas Medical Branch at Galveston, a leader in minimally invasive and robotic surgery, conducted the research in an effort to find new ways for people to prepare themselves for the the increasing demand for physicians trained in robotic surgery. The inspiration for the study came when Dr. Kilic witnessed his young son testing out the robotic surgery simulator while setting up for a presentation. With zero medical or robotic training, the boy, an avid video games player, was able to quickly master the controls of, and effectively preform operations with, the robotic surgery training simulator. With plans to incorporate the results of their study into their training curriculum, UTMB is one of a number of academic medical centers that are developing standardized programs for students and physicians to train for robotic surgery on robotic surgery training simulators.

So the next time your kid is playing hour after hour of the latest video game instead of doing their homework, maybe think twice before giving them a hard time. Are they really wasting time playing mindless video games, or are they developing the necessary hand-eye coordination skills that will be required to preform the robotic surgeries of the future?

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Training Simulators Critical to Robotic Surgery

With the number of robotic surgeries that take place every year rapidly increasing, the need for robotic surgery training simulators is quickly rising in parallel. In 2012 there were 367,000 robotic surgeries performed in the United States, more than 3 times the amount there were in 2008. Robotic surgery involves the use of computer controlled instruments attached to robotic arms, inserted into the patient through minimally invasive incisions, and controlled by human surgeons to preform operations. As with any surgical procedure, training is paramount in order to insure a high rate of success, however training for robotic surgery presents a number of new challenges that can only be overcome through the use of robotic surgery training simulators.

Robotic Surgery Simulator

Intuitive Surgical's da Vinci Surgical System is a popular example of a robotic surgery system that was designed to preform complex surgical procedures, through minimally invasive techniques, including:

• Prostatectomies
• Hysterectomy
• Cardiac Valve Repair
• Gynecologic Surgical Procedures
• Spleen-Sparing Distal Pancreatectomy

So how do surgeons train to operate this robotic surgical system that have extremely steep learning curves? Training simulators of course. With more than 2,000 of these robotic surgical systems sold worldwide, the demand for surgeons who are well-trained on robotic surgery systems is rising quickly. Robotic surgery training simulators are a proven way of creating this required supply of surgeons trained in the latest robotic techniques.

A recent article published in Urology, the Official Journal of the Societe Internationale D'Urologie, established that surgical trainees who receive simulation-based training demonstrate a higher level of precision during surgery over those who do not receive the same training. The article titled, Fundamental Skills of Robotic Surgery (FSRS): A Multi-institutional Randomized Controlled Trial for Validation of a Simulation-based Curriculum, seeks to develop and establish the effectiveness of a simulation-based robotic curriculum. The report concludes that by incorporating the FSRS into a virtual reality simulator, the approach is:

"a valid, feasible, and structured curriculum that demonstrates its effectiveness by significant improvements in basic robotic surgery skills"

The University at Buffalo, State University of New York, School of Engineering and Applied Sciences, in a partnership with the Center for Robotic Surgery at Roswell Park Cancer Institute, developed the RoSS (Robotic Surgery Simulator) that Urology used to conduct research and write the article on. The University of Buffalo, School of Medicine and Biomedicine Sciences, helped to develop and evaluate one of the first simulation-based training curriculum for robotic surgery. The simulator was developed by Thenkurussi Kesavadas, PhD, professor of Mechanical and Aerospace Engineering, and surgeon Khurshid Guru, MD, director of the Center for Robotic Surgery at Roswell Park Cancer Institute.

Developers Thenkurussi Kesavadas and Khurshid Guru

Another company that is developing a robotic surgery training simulator is Seattle-based Mimic Technology. Their da Vinci Trainer and Skill Simulator replicates the controls of the real-world da Vinci robotic surgeon, allowing trainees to preform a number of surgical operations safely and risk-free in virtual reality. The simulator, which sells for just under $185,000, has sold more than 1,000 units. Mimic reports in a Puget Sound Business Journal Article that their domestic sales have doubled and their international sales have tripled in 2012, with projections for 2013 expected to exceed $10 million in overall sales.



Cauterizing blood vessels on a robotic surgery simulator.

Robotic surgery training simulators teach surgical trainees the cognitive and motor skills that are required to operate robotic surgical systems, and preform robotic surgery at a high level of success.

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Epidural Training Simulator Reduces Risks and Improves Success

The Poole Hospital in England, working with Bournemouth University's School of Design, Engineering and Computing, has developed an epidural training simulator, that allows for the precise training of a delicate clinical procedure. Epidural anaesthesia involves an injection into the patient's epidural space, the area outside of their spinal cord, but inside the vertebral canal of the spinal column. Since an epidural injection is a difficult procedure to preform, and involves a number of serious risks to the patient if done incorrectly, an interactive 3D training simulator that will help reduce the number of epidural failures is a natural choice.


Stereoscopic 3D Epidural Anaesthesia Training Simulator 

One of the hardest parts of an epidural procedure is monitoring the location and depth of the needle during the injection. This skill is crucial to a successful procedure. If the needle advances too far it will puncture the dural sac and cause leakage of cerebrospinl fluid, potentially resulting in :

• Debilitating headaches.
• Nerve damage.
• Bleeding.
• Paralysis.

Clinicians must learn to perceive which tissue layers the needle tip is passing through by feeling the resistance on the needle, a process known as haptic feedback. By including haptic feedback, the simulator allows trainees to learn to feel this resistance, and develop a visuospatial awaremess of spinal anatomy. The training simulator allows operators to see 3D visualizations of bone, tissue layers, ligaments, and the epidural space. The training simulator provides a safe and risk-free environment to learn the procedure, and ensures a higher level of patient safety.

A recently published book titled, Practical Applications in Biomedical Engineering, includes a chapter titled, Biomedical Engineering in Epidural Anaesthesia Research. Written by the doctors who worked on the epidural training simulator (Dubey, Vaughan, Wee, and Issacs), the epidural training simulator is discussed at length. Topics include:

• Epidural procedure and challenges of clinical simulation.
• Modelling and needle insertion forces.
• Pressure measurement for realistic epidural simulation.
• 3D spine modelling for epidural training.
• 3D visualization of epidural procedure.

The chapter concludes that through the use of 3D training simulators, that achieve a high level of realism and accuracy, epiduralists will receive better training, leading directly to increased patient safety by reducing the risk of failure. Medical training simulators help to reduce the learning curve, improve the success rate of procedures, and lower the potential risk to patients.

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Video Games Used to Treat Pain

An article in last Sunday's New York Times titled, Specialists See Tools to Treat Pain in Video Games, explains how the Children’s National Medical Center in Washington D.C. is using motion sensor-based video games to treat pain. The hospital's new Pain Medicine Care Complex, a program dedicated exclusively to managing pain for infants, children, and teens has recently started using Microsoft Kinect-enabled video games, that allow players to interact through their body movements and gestures. Coupled with this off-the-shelf gaming hardware, is a custom software application that not only allows the user to control the game through their skeletal movements, but it monitors and records the user's skeletal data for further research. The application allows players to manage their pain, while it measures and tracks it at the same time.


Pain Medicine Care Complex

The program tracks 24 points on the user's body throughout their session, compiling data about their movements as well as the angles, distance, speed, and frequency at which those movements are made. While discussing the program in the article, Dr. Sarah Rebstock, a pediatric anesthesiologist and program director of the Pain Medicine Program, says:

“Since it’s digital information, we can manipulate it, understand it, analyze it. So from a research perspective, it’s a treasure trove of information that would help us formulate new metrics in order to treat these patients.”

The program immerses and engages users to the point where they are no longer focusing on their pain, while at the same time using stretching and strengthening techniques borrowed from yoga and physical therapy to increase patients range of motion and overall strength.

Multi-Sensor Room Features Interactive 3D Games to Master Pain

Doctor's are able to track a user's movements over time to see those areas where progress is being made, and those that need more attention, in order to tailor a virtual experience towards each patient's specific needs. Dr. Hamid Ekbia, a research professor at Indiana University Bloomington and the Director of the Center for Research for Medicated Interaction, says in the article:

“If we can capture this data that shows the progress of the patient, and allow the therapist to document how the patient is doing and even generate automatic reports, that’s going to provide a lot of savings of money and time.”
 

While the program is currently only available to patients who are at the medical complex, they are currently working to create a consumer version that will allow patients to own the system and use it at their homes.

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Shovel Operator Training Simulator Demo Video

ProMiner Shovel Operator Training Simulator Demo Video

The ProMiner Shovel Operator Training Simulator, a 3D simulator developed by ForgeFX for P&H Mining, increases your company’s bottom line by producing an extremely well trained workforce. Operators become experts in moving more material in less time, significantly increasing the mine’s productivity. The training simulator allows both novice and veteran operators to train in a safe virtual environment, where mistakes become valuable lessons instead of costly mishaps. Training simulators lead to less real-world machine downtime for operator training, and higher overall efficiency levels, by providing a realistic virtual training environment where techniques can be mastered quickly and safely.

ForgeFX, a proud partner of P&H Mining Equipment, a division of Joy Global Inc., specializes in the development of custom 3D training simulators.

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MODSIM World 2013 Starts Next Week

MODSIM World 2013, a multi-disciplinary international Modeling and Simulation Conference and Exposition, begins on April 30th in Hampton Roads, Virginia. MODSIM World is a multi-disciplinary conference for the exchange of modeling and simulation knowledge, research and technology across industry, government and academia.

Modeling and Simulation Conference and Exposition

Areas of focus at the conference and exposition include:

• Defense
• Healthcare/Medicine
• Engineering & Applied Science
• Information Assurance and Cyber Warfare
• Cross-Cutting Applications in Modeling and Simulation
• Education/Workforce Development
• Transportation, and Manufacturing.

The event includes a tour of the NASA Langley Research Center, NASA's oldest field center. Langley Research Center primarily focuses on aeronautical research and is responsible for a number of technology breakthroughs, including the development of the Lunar Landing Facility, that enabled NASA to simulate the effects of lunar gravity.

Conference Highlights Include:

• Education and Workforce Development Track: “Teaching STEM through Modeling, Simulations and Games in Education”.
• Defense Track: "Senior Leaders Perspective on Modeling and Simulation".
• Healthcare and Medicine Track: “An Examination of the use of Simulation for Improving Healthcare Logistics, Learning, Knowledge, and Skills”.
• Homeland Security and Cyber Analytics Track: “Modeling, Simulation and Risk Analysis”.
• Manufacturing, Transportation and Logistics Track: “Simulation-Based Adaptive Decision Support in a Shipyard Environment”.

For more information about this modeling and simulation conference and exposition visit the MODSIM World 2013 web site.

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Operator Training Simulator Supervisor Position Opening

Fircroft, a leading provider of technical recruitment services for the Oil and Gas industries, has an opening for an Operator Training Simulator Supervisor in Houston, Texas. The role is a full time contractor position, that requires 5+ years of Oil and Gas industry and Information Technology experience.

Job Description: Management of Operator Training Simulator (OTS) to ensure that all OTS trainers receive adequate training in all aspects of OTS operation, appropriate to their responsibilities and disciplines, so that the necessary level of competence Plant Operations and Maintenance personnel will be achieved. Ensuring information, data and systems contained in the OTS are accurate and 'up-to-date' with the LNG Plant equipment and processes. To develop training 'scenarios', training material, programs, schedules and delivery methodologies that ensure Plant Operations and Maintenance personnel are competent to perform their respective job/positions tasks and functions. This is a supervisory position, the incumbent is expected to orient, train and develop OTS Trainers on the team; provide appropriate coaching, guidance and supervision.

Full job description: Operator Training Simulator Supervisor

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Distracted Driving Simulator Featured at National Conference on Highway Safety Priorities

This week, at Lifesavers National Conference on Highway Safety Priorities, the largest gathering of highway safety professionals in the United States, Virtual Driver Interactive demonstrated their driver training simulator. This driver training simulator, named One Simple Decision, is the first commercially available simulation-based impaired and distracted driving simulator. The simulator, designed for young drivers, is a good example of gamifying the education experience to keep participants engaged and interested in the material and concepts being presented.

Distracted Driving Simulator

In addition to driving simulators being helpful for young drivers, Saving with Simulators, a recent article in Fleet Owner Magazine, presents several advantages that driving simulators provide to tractor trailer operators. Interviewed in the article is Don Osterberg, Senior VP of Safety and Security at Schneider National. Don says that since they started using simulators in 2005, the carrier's crash rates have been reduced by 32%.

“The ability to use repetition is the key. We can practice things over and over and over in a simulator at a much faster pace than in an actual truck.”

And their is considerable savings that accompany virtual training as well. Don explains that, based on his experience, one hour of simulator-based training equals about four hours of real-world training in an actual truck. One hour of real-world truck training consumes about 2.5 gallons of diesel fuel, so Don calculates that through simulation-based training he can reduce training costs by $40 per hour, based on fuel consumption savings alone.

“There’s also the wear-and-tear we’re saving on transmissions, engines, wheels, and everything else on a real truck – all while providing a way to increase time spent learning to shift, maneuver in poor weather situations, etc,” Osterberg noted. “It’s a win-win-win for us.”

Driving training simulators do not require expensive consumables like diesel fuel and oil, do not increase engine-use hours on real-world equipment, and leave real-world equipment available for billable work.

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Dozer Training Simulator Announced at International Fair for Construction Machinery

If you're going to lead the industry in selling heavy machinery for the construction and mining industries, you'd better have a good plan for providing training solution packages that accompany your equipment. Construction and mining training simulators provide a cost-effective and safe method to train operators quickly, while avoiding the risks associated with novice operators. Training simulators have less of an impact on the environment, are unaffected by restrictions due to emissions, and lead directly to lower fuel-costs.

John Deere Training Simulator

John Deere, the leading manufacturer of agricultural machinery in the world, and a long-time believer in providing training simulators that emulate their equipment and allow operators to quickly master machine controls and safe operation techniques, have just announced a new construction grade control simulator for dozer operators.

John Deere Construction and Forestry, in conjunction with Trimble Navigation, a provider of advanced positioning solutions, announced a new Grade Control Simulator today at the 30th International Fair for Construction Machinery, Building Material Machines, Mining Machines, Construction Vehicles and Construction Equipment. The simulator enables dozer operators to become grade control-certified, rapidly developing a workforce of highly skilled operators that can grade faster and more effectively.

The simulator runs the operator through everything from precise control of the dozer blade, to job-site hazards they'll likely face, to a number of different safety situations. In addition to the platform version of the simulator, a portable version will be available allowing for off-site training in remote locations.

In addition to lowering fuel costs, construction machinery training simulators can help an organization in many ways. Virtual training simulators help companies stand above their competition and attract a younger generation of operators. Training simulators help you avoid damage to your real-world machinery, as well as injury to personnel, often associated with novice operation. When the machinery costs, risks to equipment, and operator safety hazards are high - the best level of training is required, and virtual training simulators provide you with just that.
 

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Cataract Blindness and Simulation-Based Training for Cataract Surgeons

A recently published report, authored by The RAND (Research ANd Development) Corporation, titled "Cataract Blindness and Simulation-Based Training for Cataract Surgeons", provides an assessment of a global campaign, named HelpMeSee (HMS), to eliminate cataract blindness which is endemic in developing countries. Through an inexpensive, quick and effective procedure known as Manual Small Incision Cataract Surgery (MSICS), HMS can plans to provide help to those suffering from blindness due to cataracts. The combination of a shortage of well-trained surgeons who are familiar with this technique, and the fact that approximately one-half of all blindness cases in the world are due to cataracts, is expected to result in more than 32 million people world-wide requiring cataract surgery by the year 2020. So how do you quickly and affordably train surgeons all around the world to preform this procedure? Simple, a portable surgical training simulator that can immediately increase training output and efficacy.


Virtual Reality Eye Surgery Simulator Prototype Presented to French Prime Minister

In an effort to provide high-volume training for MSICS, that is portable and affordable, HMS in a partnership with the French Institut National de Recherche en Informatique et en Automatique, have developed a high-fidelity training simulator that allows surgeons to quickly become proficient at the procedure. The simulator provides a highly realistic biomechanical model of the human eye, enabling surgeons to practice the motions of removing a cataract and replacing it with an artificial lens. Surgical training simulators have the potential to dramatically speed up training, they reduce the need for actual patients, and eliminate the need for real eyes to train on. The report lists a number of the simulator software's features including:

• A physics-based computer model, which utilizes the best existing data along with HMS test data to produce high-fidelity simulation of eye geometry, tissue properties, instrument/tissue collision detection, cutting, tissue deformation, and fluids.
• A visualization model, which will use data, including high-definition video of cataract
  surgeries, to create high-resolution, dimensionally accurate, photorealistic, and real-time
  visual images of eyes, eye tissue, fluids, and instruments.
• A haptics model, which will simulate the feel experienced by the surgeon during actual surgeries to deliver a realistic force feedback response.

With the ability to rapidly scale-up new surgical capabilities and capacity, through the use of the new surgical training simulators, the number of cataracts cases world-wide should begin to decline. The RAND report determines that the program has the potential to largely close the backlog of surgical cases in Africa, Latin America, Western Pacific Asia and Southeast Asia. The program also promises to have significant positive impacts on health and productivity, taking into account the estimated costs per year of disability averted, suggests that the intervention would be highly cost-effective.

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VA Medical Center Acquires Virtual Reality Eye Surgical Simulator

The US Veterans Affairs Medical Center in Durham, North Carolina just announced they have acquired a virtual eye surgery training simulator for their Microsurgical Advanced Technique Laboratory. An article in The Herald Sun talks with Dr. Sharon Fekrat, MD, Chief of Ophthalmology at the VA Medical Center, and a practicing vitreoretinal surgeon at the Duke University Eye Center's Albert Eye Research Institute. Dr. Fekrat is a big proponent of the simulator and the hundreds of stages of virtual surgical training it offers.


Surgical Resident Trains on Virtual Reality Surgery Simulator

At a cost of $262,000, the simulator is designed to train ophthalmology residents and fellows on a multitude of surgical tasks. With the clinic performing about 1,000 eye surgeries each year, there is a tremendous demand for training of surgeons who will need to precisely move the tip of a micro focus control instrument around the anterior chamber of the eye during cataract surgery.

“You can start with the basics,” Fekrat said. “But you can’t proceed to the next level until you have mastered the level you’re on. It’s sort of like a video game.”

Surgical simulators allow students to practice complex surgical procedures, on virtual patients, in a safe risk-free setting, where they can master the skills and techniques that will be required for surgery on live patients. Training simulators allow surgeons to develop and refine their hand-eye-coordination, as well as their cognitive decision making surgical skills, leading directly to an improved level of proficiency in the operating room.

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Danbury Hospital to Obtain Ultrasonography/Transthoracic Echocardiology Simulator

Danbury Hospital recently announced that they have been awarded a grant from the Connecticut Health and Educational Facilities Authority (CHEFA) to obtain an Ultrasonography/Transthoracic Echocardiology Simulator. The grant of $71,800 is part of CHEFA's Client Grant Program, and will enable medical staff to train clinicians in the techniques associated with transthoracic echocardiography, and ultrasound guided pericardiocentesis procedural training.  In a Danbury Hospital Simulation Lab press release, Ramin Ahmadi, Chair of Medical Education and Research at Danbury Hospital, is quoted saying:

“As our organization continues to transform care delivery, the importance of training tools such as this Simulation Lab cannot be over-stated. This will allow our clinical teams and resident interns an important opportunity to practice their craft using state-of-the-art simulation. We are so grateful to CHEFA for this financial support and endorsement of our ongoing approaches to quality improvement.”

CHEFA recently announced $1 million in grants to 15 of its nonprofit client agencies throughout the state of Connecticut.

CAE Ultrasonography/Transthoracic Echocardiology Training Simulator

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