BOSTON - At first glance, the virtual reality simulators and flat screen laparoscopic video-trainer stations in the Center for Minimally Invasive Surgery's Technical Skills and Simulation Lab at Beth Israel Deaconess Medical Center (BIDMC) appear like sophisticated videogame machines. But the state-of-the-art equipment is actually helping Harvard Medical School students and residents from Beth Israel Deaconess and Boston's other teaching hospitals improve their video eye-hand skills and acquire basic and advanced laparoscopic skills in a virtual, "patientless" setting.
As New England's most comprehensive educational and research facility for advanced laparoscopic surgery, the Center will provide patients with the best quality of care and educate the next generation of surgeons. Daniel B. Jones, M.D., section chief of minimally invasive surgical services at BIDMC and director of the new Center, says skills training will advance the way surgical education is taught.
Next month BIDMC's MIS Center will host a postgraduate course preceding the American Society for Bariatric Surgery annual conference, this year in Boston. The world's top laparoscopic surgeons will assemble to teach approximately 100 bariatric surgeons the latest in adjustable gastric banding techniques. Jones will perform two cases, which will be transmitted live to observers in a conference room. Designed for patients with morbid obesity, this technique was recently approved by the Food and Drug Administration and, until Jones' arrival, was not readily available in Boston.
The new Technical Skills and Simulation Lab's unprecedented collection of simulators and video trainers provide hands-on learning for a new Harvard Medical School curriculum piloted by BIDMC. Using the virtual reality simulators, surgery residents and third- and fourth-year medical students can practice basic skills and advanced laparoscopic procedures, lower and upper endoscopy, urological procedures; and surgical simulation in common bile duct exploration, total extra-peritoneal (TEP) hernia repair and ultrasound.
Laparoscopy is a minimal invasive surgical technique that allows a surgeon to look inside the body with a tiny telescope that transmits the image to a television monitor. In general, patients benefit from less pain, shorter hospitalization, quicker recovery and smaller scars. But this new modality requires surgeons to learn skills not routinely used during traditional open surgery.
The Center's skills-building curriculum will include performance benchmarks that students and residents and faculty must meet in order to advance to the next level of training. Eventually the curriculum introduced at BIDMC will become part of a national movement to advance the evolving field of minimally invasive surgery.
"The traditional dogma for learning technical skills has been 'See one-Do one-Teach one'," explains Jones, a visiting associate professor of surgery at Harvard Medical School and a national authority on minimally invasive surgery. "By simulating surgery outside of the operating room, we are giving students and residents more time to gain technical experience and efficiency before performing procedures on patients. Providing structured skills-building curriculum in a classroom setting will translate to improved accuracy and speed in tomorrow's operating room."
To complement surgeons' training, BIDMC has designed a multimedia, digital video-library, which is the world's largest repertory of filmed operations accessible at a single academic institution. Students and residents can view actual footage of laparoscopic and general surgeries on-demand, and then reproduce the surgery on video trainers. Practicing surgeons can review "experts" for tips.
In support of the Center, BIDMC is ready to open this month three state-of-the-art minimally invasive operating rooms called endosuites. Equipped with flat screen technology and ceiling booms, the voice-activated suites feature special cameras, scopes, lighting and digitally-enhanced equipment. The endosuites are wired to transmit operative images to a teleconferencing center in the lab so students can easily view the surgical procedure.
In contrast to the conventional setting where clinicians huddled together in one room peering over shoulders in an attempt to view the procedure, the new teleconferencing capability will provide students with real-time instruction of anatomy and surgical procedures. With a push of a button, a student can now visualize the operative field as viewed by the operating surgeon, ask questions and learn.
Eventually the teleconferencing capability will enable BIDMC to telecast real-time operative images to local educational conferences, with patient consent, and increase the availability of advanced laparoscopic surgery to community hospitals throughout greater Boston.
"We have based a large number of programs in many divisions on a minimally invasive approach," said Josef E. Fischer, M.D., Chairman of the Department of Surgery at Beth Israel Deaconess Medical Center and Mallinckrodt Professor of Surgery at Harvard Medical School. "Dr. Jones and his staff provide the glue that hold all those activities together."
Jones has published numerous studies comparing the effectiveness of laparoscopic skills training, authored several manuscripts and textbooks on laparoscopic surgery and developed a group of video-trainers for skills training. He joins BIDMC from the University of Texas Southwestern Medical Center in Dallas, where he successfully established the Southwestern Center for Minimally Invasive Surgery.
Beth Israel Deaconess Medical Center is a major patient care, teaching and research affiliate of Harvard Medical School, ranking third in National Institutes of Health funding among independent hospitals nationwide. The medical center is clinically affiliated with the Joslin Diabetes Center and is a founding member of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox.