Surgery simulators effective at training surgeons

Training surgeons with computer-based "surgery simulators" may create better surgeons and safer surgeries, according to a new study by NewYork-Presbyterian Hospital.

The study found that surgical residents trained with the device -- a mannequin-like model with a lifelike interactive anatomy -- scored uniformly higher than their peers in performing an interventional technique to repair blockages in the legs.

The presentation is scheduled for presentation on Thursday, April 20, 9:35 a.m., at the 126th annual meeting of the American Surgical Association in Boston.

The double-blinded study also found that residents trained on simulators performed the procedures faster and more accurately and their use of a fluoroscope (similar to an X-ray) was more limited.

"We have really come a long way from the 'see one, do one, teach one' days of surgery," says Dr. K. Craig Kent, the study's principal investigator. "With simulators, surgeons in training can become very good at a particular technique before actually laying hands on a real patient."

Dr. Kent is chief of vascular surgery at NewYork-Presbyterian Hospital and professor of surgery at Weill Cornell Medical College and Columbia College of Physicians and Surgeons.

When trained with the simulator, residents practice the procedure on the "virtual patient" which lies on an operating table. Just like in a real operating room, the surgeon, surrounded by working monitors, pierces the simulator's "skin" with a needle, inserts a catheter into an "artery," snakes it to the indicated area and executes a repair. Just like with a real patient, what is happening inside the simulator is watched on a monitor -- except that sensors, and not a fluoroscope, provide the images.

The study followed 20 residents of equal ability, divided into two groups -- one trained on the stimulator and the other not. Following training, the participating resident performed two consecutive procedures on actual patients. The surgeries were mentored by attending surgeons who were also grading each resident's performance.

In general, simulators are used to teach interventional techniques -- those in which a catheter is slid into an artery to repair a blockage or weak spot. The number of interventional cases has nearly doubled since 1999 and this trend is expected to continue because minimally invasive procedures, when possible, are much easier on the patient than traditional surgeries.

The study's co-investigators include Drs. Rabih Chaer, Brian DeRubertis, Stephanie Lin, Harry Bush, John Karwowski, Daniel Birk, Nicholas Morrissey, Peter Faries and James McKinsey -- all of NewYork-Presbyterian Hospital.

The surgical simulator studied is the Procedicus VIST™ Interventional Endovascular Simulation, manufactured by Mentis Inc., of Winnetka, Ill.