A new Surgical Simulation and Technology Center at the University of Maryland Medical Center, one of only a few hospital-based centers of its kind in the United States, will open on December 6, 2006. The center brings together a diverse group of experts to solve important challenges in surgery, such as how to improve and expand minimally invasive surgical procedures that enhance patient care, how to advance the design of surgical instruments and how to redesign operating rooms to prevent surgeons from suffering from shoulder and neck injuries.
In addition to being a high-tech training facility for surgical residents and experienced surgeons, the University of Maryland Surgical Simulation and Technology Center will be a center of research on a wide range of issues. Surgeons from different specialties are collaborating with computer scientists, experts in artificial intelligence, visualization, database and wireless technology, electrical and biomechanical engineers, kinesiologists, surgical educators, human factors experts, cognitive psychologists, and medical units from the U.S. Air Force and the U.S. Army.
“As surgeons, we are problem solvers, but we have immense challenges in terms of using new technology to advance patient care, surgical education and research,” says the director of the new Surgical Simulation Center, Adrian E. Park, M.D., who is head of general surgery at the University of Maryland Medical Center, and professor of surgery at the University of Maryland School of Medicine.
“Surgeons tend to be conservative and slow to adopt new procedures and practices from other disciplines,” says Dr. Park. “But today, best practices in medicine require that we take additional steps to maximize patient care.” With that in mind, Dr. Park says surgeons are beginning to recognize the value of reaching out to other experts to help enhance the tools and performance of surgery and surgical education.
He says the drive to establish such an all-encompassing facility comes partly from the near simultaneous explosion of knowledge in many fields. “Our goal is to take advantage and be a part of this innovation,” says Dr. Park. “So, besides being engaged in education and training as other centers are doing, we are also going to be engaged from the outset in evaluating, researching and investigating the best technologies to achieve those goals.”
The Surgical Simulation Center will give surgeons new tools to practice and enhance their skills. “Rehearsal is a key to learning,” Dr. Park says. “Pilots do this, astronauts do this. In surgery, we’ve only recently begun to rehearse procedures on a small scale, but newer technology is helping us do this in a bigger way,” says Dr. Park.
“Our new Surgical Simulation and Technology Center is another step in our continuing commitment to improve patient care,” says Stephen T. Bartlett, M.D., chief of surgery at the University of Maryland Medical Center and professor and chairman of surgery at the University of Maryland School of Medicine.
“This is truly an innovative facility that will make our educational program a unique national center of excellence. Dr. Park has recruited an outstanding team to work in the center, and we are looking forward to the advances that result from their efforts,” Dr. Bartlett adds.
Gerald Moses, Ph.D., former chief of the clinical applications division at the U.S. Army’s Telemedicine and Advanced Technology Research Center says, “While there are other simulation centers in the country, the University of Maryland Simulation and Technology Center has extraordinary capability and unbounded potential to become the premier simulation center for hospital-based training. This is due to the center?s unique approach to the ergonomic study of surgery, the blend of multiple disciplines to study and understand surgical training, its dedicated staff and commitment to excellence.”
The facility has been in development for five years and has received support from numerous individuals and institutions, including Stryker Endoscopy, the Swirnow Charitable Foundation, the U.S. Army, the U.S. Air Force and the Verizon Foundation. It is located on the seventh floor of the University of Maryland Medical Center, where the hospital?s previous operating rooms were located before a new surgical facility was built in the Harry and Jeanette Weinberg Building.
HIGHLIGHTS OF THE CENTER:
Life-like patient simulators for surgical and resuscitation training
In one room of the center, surgical residents use advanced, life-like simulators to learn and practice the techniques of laparoscopic surgery. This equipment tracks each student?s progress in a variety of tasks to show where improvement is needed. Another room has state-of-the-art computer-controlled mannequins to train civilian and military health care professionals in the resuscitation and care of soldiers on the battlefield or civilians in a mass casualty incident.
The Nation’s First Surgical Ergonomics Program
Researchers will assess the movement of surgeons during minimally invasive (laparoscopic) surgery. These techniques have revolutionized patient care. But for the surgeon, laparoscopic surgery may mean holding instruments at awkward angles for many hours and craning the neck to see video on a monitor that shows images from a camera placed inside the patient?s body. The result, for many surgeons, is neck and shoulder pain and carpal tunnel syndrome.
In a survey of 200 surgeons conducted by researchers at the University of Maryland Surgical Simulation and Technology Center, nearly 90 percent reported numbness, stiffness, fatigue and pain that they attributed to performing laparoscopic procedures.
To develop strategies to improve surgical ergonomics, researchers are employing a system similar to one used in Hollywood to produce computer generated animation by recreating human movements and facial expressions. The system makes it possible to analyze how the surgeon moves in order to refine techniques that avoid pain and fatigue. Information from this research may lead to improved surgical technology as well as operating room layout.
Surgical Imaging to Enable Surgeons to “Rehearse” Operations
Scientists are looking at new ways to improve surgical accuracy with imaging display technology. Some of this research involves 3-D imaging; some encompasses what is called image registration?fusing or coupling images to make surgery more precise.
The technology will improve the surgeon?s ability to rehearse a procedure and understand the unique aspects of the patient?s anatomy before the operation begins. Dr. Park says images from any source, such as CT and MRI scans or sonograms, can be used to visualize the anatomy in unique ways, all the better to anticipate the steps to be taken during the actual procedure. “It?s not just assuming that you?re going to find anomalies in the anatomy, it’s envisioning them with real data, the patient’s own data, to prepare before the operation begins,” says Dr. Park.
New Tools to Enhance Surgical Judgment
Specialists at the Surgical Simulation and Technology Center are developing an unscripted, sophisticated, artificial intelligence program called the Maryland Virtual Patient. The program is part of an effort to help new and experienced surgeons fine-tune their surgical judgment to be best able to handle complex cases. It is a so-called “cognitive simulator” in an early phase of development, which, when fully designed, will incorporate the full anatomy and physiology and show how an organ and cells respond. The program will react to a course of action a physician decides to take.
“These judgment components are an essential part of training,” says Dr. Park, “and I think we?re going to be uniquely positioned to cover that important part of the spectrum.”
High Speed Networking Capability
The Surgical Simulation and Technology Center is capable of sending and receiving high resolution video, audio and data to and from anyplace in the world, providing real-time links with operating rooms, conference centers and other venues. These interactive connections make it possible for students in a remote location to see an operation performed by a master surgeon while they ask and receive answers to their questions.