A well-trained surgeon will have to go through the simulation phase in the future
April 8, 2021
By Klaudia Latosik
Simulation using virtual reality is an absolute novelty in Poland. In the USA and France, Sweden, Denmark and Germany, it was already introduced several years ago. Training with simulators reduces the time to acquire clinical skills, increases patient safety, and reduces potential complications. Klaudia Korecka from the Upper Silesian Child Health Center in Katowice told us about her experience in working on the LAP Mentor laparoscopic simulator.
Have you had any contact with training using medical simulation? If so, with what and how often?
Training courses using medical simulation in the field of surgical techniques in Poland are new. At the beginning, medical simulators of virtual reality should be distinguished from mechanical trainers, also known as box trainers. Simulation using virtual reality is an absolute novelty. This is mainly due to highly specialized equipment, which must be developed by both doctors and engineers – some must provide information from real operations, so that others can create a complex graphic that reacts to all the movements of the trainee. Advanced technology translates into the price of such devices, which is why in Poland I have not had the opportunity to use virtual reality simulators at the stage of my training so far. During the six-year specialization in pediatric surgery, I participated in one course, where mechanical trainers were available, the task was mainly based on simple manipulations with laparoscopic tools and, if necessary, learning laparoscopic sewing (we tried to sew a chicken thigh then). Being in the 6th year of studies – in 2006 at the Foundation for the Development of Cardiac Surgery in Zabrze, I participated for the first time in a surgical workshop for students, where it was possible to perform simple movements on a mechanical trainer (translating appropriate loops on the screws with laparoscopic tools) – I still remember my fascination today. The task consisted mainly of simple manipulations with laparoscopic tools and possible learning of laparoscopic suturing (we tried to suture a chicken thigh then).
Simulation using a virtual reality image is the next step. In the world – mainly the USA, European countries such as France, Germany, Sweden, Denmark experienced the moment of introducing the simulation a few or a dozen years ago. The first scientific publications available in scientific databases, such as PubMed, emphasizing the role of simulation in surgical training, date from 2000-2010. Currently, by entering the keyword “laparoscopy simulation”, the search engine gives about 2400 records. There are no Polish nor Eastern European publications on this topic.
What are your general impressions as a specialist in the field of surgery after the first training sessions on the surgical simulator Lap Mentor?
I must start with the fact that I am a huge fan of laparoscopy. I started my specialization training in one of the best children’s laparoscopic centers in Poland – the Department of Surgery for Child Developmental Defects and Traumatology in Zabrze, Medical University of Silesia, is a place that can boast a laparoscopic splenectomy performed for the first time in Poland in 1993.
In my training, I had the opportunity to learn laparoscopy as the basic surgical access – for example, I started learning to remove the appendix via laparoscopic approach and I feel most comfortable using this approach.
Being a fan of laparoscopy, what would my impressions of LAP Mentor be? only positive. I regret that those several years ago, when I started working, I could not exercise using a virtual simulation. LAP Mentor is perfect for learning the individual stages of the procedure, it allows you to make mistakes, which will be meticulously summarized even when it comes to the report of proper tissue management (you cannot tear the tissues). Basic procedures such as appendectomy and cholecystectomy are well developed. The cholecystectomy procedure is presented in various anatomical variants – as it happens in life, the appendix, in turn, has its own different stages of the inflammatory process. It is known that these situations affect the difficulty, and thus safety, during the performed operation. Additionally, LAP Mentor shows you how to perform rare procedures such as cholangiography step by step. The possibility of using various types of staplers (linear, with adjustable angle or even a circular stapler) is also noteworthy. Devices of this type are in fact very expensive, in pediatric surgery, due to its specificity, they are rarely used, so it is even more important to know how to use such a tool in the operating field to make it effective and well-used. I also like the use of sound signals as it happens during the operation and the feeling of the so-called releasing the tissues being cut. I do not use computer games, so repeating after others, I can only say that with time in some modules computer graphics will probably require some refreshing, although personally it does not bother me at all,
How do you evaluate the potential of LAP Mentor in terms of training surgeons? If you had access to this type of simulator at the time you started your specialization, would it help you acquire new skills faster or more effectively?
I am convinced that a well-trained surgeon will have to go through the simulation phase in the future. It has started, technical progress is everywhere in everyday life and in medical equipment, so it must also complete education. Learning surgical procedures in a good training center has a significant effect on trainee performance. The first stage is to assist the master during the procedure, the second stage is to perform the procedure under the master’s supervision, and the third stage is to perform the procedure yourself. Depending on the degree of difficulty of the procedure, the appropriate number of treatments should be performed – this is called learning curve. LAP Mentor allows us to flatten this learning curve. Libraries of modules also show cases that occur sporadically in life, which we rarely encounter, and we must have knowledge and experience. The simulation opens the eyes to the mutual relations of anatomical structures that are variants of normal anatomy as well as developmental variants, thanks to which the orientation in the operating field and anatomy is immediate – this is what it is all about. If we know the anatomy well, we feel safe there.
I am currently finalizing my second specialization in pediatric urology – I am happy with the Nephrectomy module that we have on our LAP Mentors. I was surprised after the kidney was removed from the final report, which concluded that I had not mobilized my spleen well enough. It forced me to analyze the image itself and talk to an expert on how to do it. I wish I could practice the other urological options yet.
Can LAP Mentor training help you acquire clinical skills faster? Do you think that they can also increase patient safety and reduce the number of potential complications, especially in the early stages of a surgeon’s career?
To briefly answer – to each part of the above question – yes, of course. The patient’s safety should be emphasized. No surgical procedure is completely complication free. It’s like medications that can have different side effects. Nobody wants to expose anyone to complications on purpose. They result from the so-called human error, equipment or inadequate assessment of the clinical situation. LAP Mentor in its reports gives specific errors made by the operator, e.g. tissue damage or the degree of obliteration of the supplied vessels. I believe that the analysis of the report is an important part of learning with LAP Mentor. Is it equipment for a novice surgeon? I must say that even an expert wants to prove himself. Individual modules were developed by surgeons from various centers – France, Israel, and the USA. The performance of the procedure by an expert is a kind of “sparring” of the masters. Nice to see it.
Do you think that training with the use of a surgical simulator can also reduce the time needed to acquire new skills / methods by experienced surgeons (e.g. an experienced surgeon training on the LAP Mentor simulator equipped with the Nissen Fundoplication module) and increase patient safety thanks to the practical possibility of practicing combat methods? with complications typical for a given method?
Surgical experience depends on the number of procedures performed. It’s like the number of hours pilots spend in the air. LAP Mentor can help you gather experience regardless of the procedure. In the hands of an experienced surgeon (expert), it will remain a rather great device, which he had not had the opportunity to get to know before. He will probably say with a hint of jealousy how much technology gives young generations.
Over the last 5-6 years, there has been a clear decrease in the number of people taking the specialization examination in general surgery. Could the inclusion of learning on simulators in the training of surgeons could contribute to greater interest in this specialization?
Unfortunately, I don’t think so. The choice of a surgical specialization, especially in surgery, is nowadays influenced only by the fascination in this field of medicine. This profession has lost its prestige, is associated with many sacrifices, giving little in return. Today, young people want to earn great money right after graduation, they want to have time for their families, themselves, their hobbies, and children want to be YouTubers. Specialization in general surgery is another matter, it is hours spent at the operating table, uncertainty related to often unjustified claims and the lack of time, the more we study it. The simulation will attract surgery enthusiasts, because it is valuable and attractive in itself. It has all the advantages that good training gives, but you must have this surgical spark within you.
Thank you for the conversation.