Simulation Training in Laparoscopy and Robotic Surgery

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2 Simulation Training in Laparoscopy and Robotic Surgery

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4 Hitendra R.H. Patel Jean V. Joseph Editors Simulation Training in Laparoscopy and Robotic Surgery

5 Editors Hitendra R.H. Patel, MD, PhD Department of Urology and Endocrine Surgery, University Hospital North Norway Tromsø Norway Jean V. Joseph, M.D., MBA Department of Urology University of Rochester Medical Center for Robotic Surgery and Innovation Rochester New York USA ISBN ISBN (ebook) DOI / Springer London Heidelberg New York Dordrecht Library of Congress Control Number: Springer-Verlag London 2012 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

6 To my wife Venita for all her support over the last 15 years.

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8 Foreword The editors are commended for bringing together the very latest ideas and evidence on simulation training in laparoscopic and robotic surgery from pre-eminent authors in this emerging field. The book is very well structured, with each chapter commencing with an abstract and key words, whilst a key points section alerts as to what the reader might expect to learn. It is very well referenced with citations of traditional printed publications and also some to some useful websites. The introduction reminds us of the countless lives saved by the introduction of basic checklists and teamwork training across the aviation industry, which has become an examplar for safe working practice. Subsequent chapters cover human factors in general. The importance of non-technical surgical skills and the current state of laparoscopic, robotic and minimally invasive surgery training. The role of virtual reality simulation is discussed, with contributions on how the addition of binocular 3D vision and haptics increases fidelity. Many advances in surgery result from lessons learned on battlefields, and novel ideas on trauma simulation from the military are shared. Finally the value of distance learning, multimedia, e-learning and telementoring is scrutinised, something that is particularly appropriate for generation Z who are about to enter surgical training. This book is a great read and will bring surgeons of any specialty up to date on surgical simulation in general, particularly in laparoscopic and robotic surgery. The Joint Committee on Surgical Training, representing the four UK and Irish Surgical Royal Colleges, is currently mapping the requirements for simulation within the Intercollegiate Surgical Curriculum Programme for trainees. The Colleges and a variety of other educational providers are working hard to provide simulation courses to keep up with new technological developments in this area. This book assists with that effort by providing ample evidence of emerging knowledge and pedagogy to support the role of simulation training in surgery. Simulation has become a vital part of surgical training with see one, do one being replaced by sim many before doing one (for real), and it is now also beginning to take its place within selection and assessment procedures. I heartily recommend this book to today s generation of trainers and trainees. England Professor Mike Larvin vii

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10 Preface What would the surgical experience be like if every surgeon routinely goes through a warm-up period with the surgical team before embarking on a surgical procedure, similar to what athletes and musicians do prior to performing? One can only speculate on the value of such exercise on the harmony of the operating theater, the surgeon s comfort with the procedure, the surgical outcome, and ultimately the overall patient experience. In the quest to deliver the best and safest care, upholding the oath to do no harm, our objective remains to limit the impact of surgical intervention and eliminate variables, which by de fi nition can impact the surgical care we deliver. Simulation-based training, which is heavily used in a number of nonmedical disciplines, promises to be a paradigm shift in medicine and surgery, as its value in medical or surgical education comes to the fore. Simulation offers a platform where a surgeon, or care team, can actually rehearse, learn, improve, or maintain their skills in a safe and stress-free environment. The aim of our book is to allow anyone with an interest in training or education within surgery, an opportunity to understand the subject. The latest evolution in surgery has been minimally invasive surgery, thus the emphasis in the book has taken examples from this fi eld, notably the greatest advance of robotic surgery. The fl ow of the book takes the reader through the art of educating a surgeon using a variety of techniques from Queen Mary University of London to Imperial College London. A cutting-edge chapter on trauma and simulation learning points from the 7/7 London bombings shows a real insight into how important training is for those thankfully rare moments. This highlights the value of education with simulation. We then traveled through Europe to understand the historical aspects of training in minimally invasive surgery, by an expert surgical innovator of the modern generation (University of Tuebingen). History generally shows that nothing is actually new. Often packaging changes, but the elemental facts remain unchanged. Simulation with modern technology has often been thought of as technology based, such as computer simulators. The University of Indiana has completed a study using a robotic training device which has become the fastest selling training system of its kind in the world. However, when it was being designed, the very process of design is a form of simulation and learning. ix

11 x Preface This led to the important aspect of understanding where simulation training is performed at the highest level the airline industry. Checklist for surgery via the World Health Organization is now mandatory in many hospitals across the globe; however, the emphasis on team training in the clinical setting (again a powerful human simulation) is sparse. The nontechnical aspects of this type of training are elegantly brought to the reader from the University of North Norway. An international telemedical center at the University of North Norway contributes aspects related to continuous learning through simulation and importantly mentoring through this type of initiation learning (or proctoring). This is an exciting and expanding subject, which has stimulated a signi fi cant advance in recent months. Of particular interest is the portable learning system for surgeons or their teams to use as an aide memoir or even as a core-learning tool. Ultimately, we think this latest tool will be the future way of teaching and learning for both doctor and patient. Tromsø, Norway Rochester, NY Hitendra R.H. Patel Jean V. Joseph