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Replacing the Cadaver for Surgical Students

Wed, 05/22/2013 - 4:06pm
Kasey Panetta, Managing Editor, ECN

The ArthroS from VirtaMed AG offers surgeons-in-training a life-like opportunity to perform surgical procedures on the knee without the need for a cadaver.Surgical simulators are an ideal solution for training surgeons with minimal risk to patient health and safety. This is particularly important when surgeons train for procedures utilizing arthroscopy because it requires the surgeon to perform the surgery while looking at a camera screen instead of the patient. This necessitates extensive training to ensure the doctor is an expert in the method.

Because the consequences of making a mistake during surgery can be dangerous to the patient, it’s important that any practice situation is as accurate as possible to ensure a smooth transition from classroom to OR. Though several surgical simulators are available on the market, the designers at VirtaMed AG found that by combining the box model with a virtual reality simulator, they were able to create a more realistic simulation, which could facilitate a more seamless transition into the operating room.

For now, the simulation, called ArthroS, is available for knee arthroscopy, including diagnostic and therapeutic interventions, but a shoulder model will be available this year.

“Surgeons use original instruments during the simulation, which makes the transition to the operating room as smooth and quick as possible,” says Asta Breitenmoser, marketing manager for VirtaMed AG. The model consists of a box model for tactile feedback from bones or ligaments plus the simulator provides a feedback report so trainees can track improvements and areas that need improvement.

The simulation provides high resolution imagery while the surgeon uses the same instruments used to perform a real surgical procedure. The actual software is state-of-the-art rendering techniques that represent the accurate physical simulation on topologically correct high-quality meshes. The hardware consists of a tracking system that tracks the movement of the surgeon, but also provides her with tactile feedback, says Benjamin Grauer, software engineer. The entire experience allows the surgeons to familiarize themselves with the visuals of a surgery as well as any complications that may arise. Plus, it allows them the opportunity to practice the triangulation—holding the camera and instruments correctly—technique.

In addition, as a result of the virtual reality technology, the simulator can provide the surgeon with an infinite amount of patient cases to practice on whereas a cadaver can only provide one circumstance. So, while the additional cost is higher, the simulator can be used for unlimited training simulations. As an added perk, the technology includes a feature called SimProctor, which uses ghost tools to act as a teacher and guide the trainee through surgeries.

The downside is that, like other simulators, the technology hasn’t quite mastered the feel of cutting through a tendon or muscle. According to Breitenmoser, the general idea is that it’s better to teach no feeling than to teach one that is wrong. The trainees are able to visually see when they cut a tendon and though they’re learning how to visualize the cut—an important aspect of arthroscopy—the actual feeling of cutting is something that is still reserved for the OR.

The simulator was only launched last year, but according to a study from the Balgrist University Zurich in Switzerland, which followed 64 surgeons as they were trained on the ArthroS, the participants found the simulator useful for training and recommended the technology for any orthopedic resident. Additionally, the study found the simulation was able to distinguish between expert and novice users.

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