Residents, Practitioners Polish Surgical Skills in State-of-the-art Surgical Simulation Center

A new simulation laboratory in the School of Medicine at the University of Mississippi Medical Center is helping to enhance the skills of surgeons internationally.

Stocked with state-of-the-art computer models and the most up-to-date surgical equipment and information available, the Surgical Simulation Center debuted this academic year to rave reviews from residents, faculty and practitioners alike. Although it was initially designed to train residents how to perform minimally invasive and some open surgical techniques and eventually help practitioners brush up on their surgical skills, the center will play host next month to a delegation of general surgeons from the Democratic People’s Republic of Korea.

“The goal of the visit is to introduce the surgeons to advanced laparoscopic surgery and help them learn new techniques,” said Dr. J.R. Salameh, assistant professor of surgery and director of the Surgical Simulation Center. “They want to see us perform advanced laparoscopic procedures on patients as well as spend time practicing and evaluating their skills in the simulator, and using our video library.”

The delegation will visit the Medical Center for two weeks before traveling to New York to meet Dr. James C. “Butch” Rosser, a world-renowned chief of minimally invasive surgery, director of the Advanced Medical Technology Institute at Beth Israel Medical Center and School of Medicine alumnus (see accompanying story).

In comparison to conventional, “open” procedures in which one long incision is made, laparoscopic, or “keyhole” surgery is a procedure whereby several small, surgical incisions are made. The abdomen is filled with carbon dioxide and a tiny video camera, called a laparoscope, is introduced into the body through one of the incisions. Hollow tubes called “ports” are inserted through the other incisions. Instruments can then be passed through the ports into the body while surgeons watch their work on an external video monitor.

The laparoscopic procedure reduces patient recovery time - from months to weeks in extreme cases - diminishes the risk of infection and limits post-operative pain. Although the surgery itself may be more expensive than the traditional method, the quicker healing time more than makes up for the additional cost.

“You can do pretty much any operation inside the abdomen laparoscopically, from gastric bypass surgery for weight loss to colon resections,” Salameh said. “Faster recovery means shorter hospital stays and fewer charges, and patients are able to go back to work earlier.”

Specifically recruited by Dr. William W. Turner, professor and chairman of the Department of Surgery, to begin the surgical simulation program at the Medical Center, Salameh trained in general surgery at the Georgetown Medical Center in Washington, D.C., before doing special training in advanced laparoscopy at the Baylor College of Medicine in Houston, Texas. After 12 months of planning and procurement, Salameh said the center became a reality under the guidance of Turner, Dr. Dan Jones, vice chancellor for health affairs, and Dr. Wallace Conerly, vice chancellor emeritus.

Located on the fourth floor of the main hospital, the center provides convenient, safe and comprehensive education and training in minimally invasive and open procedures using computer-based simulation and other training models. Residents and surgeons enjoy ready access to a host of books, CD-ROMs and videos of interesting procedures.

The center includes an endoscopic simulator as well that allows residents to practice colonoscopies, upper endoscopies, bronchoscopies and other procedures. As in laparoscopic techniques, the endoscopic simulator involves a computer interface with a computer screen, while the actual scope used on patients is introduced into a model.

“The computer software makes it look like you’re doing a real colonoscopy or endoscopy,” Salameh said. “One of the procedure’s distinct challenges is watching a two-dimensional image while working in a three-dimensional environment. That can take some getting used to.”

Unlike previous methods of training, which depended upon surgeons working directly on patients in the operating room or practicing their skills on cadavers or animal models, the center affords realistic simulations outside the clinical setting with no patient safety issues.

“Errors have no consequences,” Salameh said. “Residents practice different tasks inside a box, instead of in a patient’s abdomen. That’s the only real difference.”

Residents get to work with laparoscopic towers and instruments just like those used in actual operating rooms while watching their work on a monitor overhead.

“They perform all of the tasks they would do in minimally invasive procedures,” Salameh said. “They can clip or cut vessels or even perform the most advanced task of suturing - any number of things that improve their hand-eye coordination and depth perception - and they can even practice with their non-dominant hand.”

The center even plays on the natural competitiveness among residents. “Each year, residents have different tasks to master,” Salameh explained. “We actually have competitions on the simulator that motivate and excite them. We even had some first-year residents performing third-year tasks, simply because they enjoy working with the simulator.”

Versatility is another trademark of the laboratory, which opened just in time in light of a new mandate last fall by the Accreditation Council on Graduate Medical Education limiting resident work-hours to 80 per week. Residents can practice in the simulator outside of regular duty hours.

Dr. Saleem Islam, a pediatric general surgeon who has had extensive laparoscopic experience with children, said the center is ideal for surgical simulations of pediatric cases.

“In children, one must get used to smaller, more delicate instruments and much more delicate tissue,” said Islam, assistant professor of surgery. “There is less room in a child’s abdomen, and this must be incorporated into training.”

For many of Islam’s patients, minimally invasive procedures have a cosmetic, as well as a practical, appeal.

“In children, scars grow with the patient and can become quite unsightly in adolescence,” he said. “Scars on the inside form adhesions after surgery which are reduced tremendously with minimally invasive techniques. This would reduce the long-term rate of bowel obstructions and significantly improve the quality of life.

“There are generally more pediatric applications - resecting bowel, tumors, cysts, congenital lesions - with which surgeons can become familiar and practice before they actually operate.”

Indeed, Salameh likened a surgeon practicing techniques in the center to a quarterback throwing passes on the sidelines prior to taking the field in a Super Bowl.

“Athletes don’t go straight into a championship game without some form of pregame practice,” Salameh said. “We don’t want our residents to perform a procedure on a patient - our ‘championship game’ - without having practiced in a safe environment.

“Whenever a case is assigned, we want the resident to go to the center, review a tape of the procedure and practice it on the simulator. That way, the resident can be as prepared as possible for the procedure.”

Salameh noted that the Korean general surgeons are not the first international visitors to the center; a Syrian surgeon spent a month training in the laboratory shortly after it opened in July. Yet by introducing the delegation to the latest in minimally invasive technology, the Medical Center hopes to have a positive and lasting impact on health worldwide.

“Minimally invasive techniques are only recently coming in to play, even in the United States,” Islam said. “It would be good for the delegation from Korea to be able to see such cases and care so that they may advocate them back home.”

For more information about the Surgical Simulation Center, call Salameh at (601) 815-1294.

- Bruce Coleman (3/1/04)

2004-03-01 00:00:00 2468