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How Can Surgeons Practice?

Surgical Simulators Provide a Helpful, Virtual Training Ground

New York (Aug 21, 2009)

Young male surgeon stands in corridor

You might think that your kids could fly a plane based on the training they receive playing video games. In reality, they probably couldn't. But, in the field of vascular surgery, surgical simulators with simulated patients are allowing resident surgeons to become very good at a particular technique before actually laying hands on a real patient.

About Vascular Surgeons and Simulators

Vascular surgeons operate on veins and arteries outside of the heart, focusing on removing blockages in blood vessels in the lower extremity; carotid arteries in the neck; and repairing aneurysms of the aorta, often in diabetics and smokers. Surgical simulators – computerized systems that enable surgeons to learn in a virtual environment – can help students train, and give practicing surgeons an opportunity to learn new or practice less common procedures, such as those for the carotid artery (in the neck) or renal artery (in the kidney).

"With the traditional teaching method in surgery, you learn only what you see in your own hospital during your residency," explained vascular surgeon Rajeev Dayal, MD. "So you may end up with limited knowledge of how to manage conditions that you don't see as frequently."

Endorsement for Vascular Simulators

Training using surgical simulation tools is supported by the American College of Surgeons and the Accreditation Council for Graduate Medical Education as a means of filling gaps in knowledge in a safe and efficient manner. "The simulator enables us to make sure surgeons are adequately trained to perform the procedures they are credentialed to do," noted John Karwowski, MD – also a vascular surgeon.

How Simulated Surgery Works

Just like in a real operating room, the surgeon is surrounded by monitors and catheters. Surgeons pierce the simulator's "skin," then snake the catheter through the artery to the target area. Simulators mimic the use of fluoroscopy (an x-ray surgeons use to see inside the body), and the surgeon watches what is happening on a monitor. In addition to technical complications created by the simulator during the procedure, users are presented with realistic medical management challenges when planning for the case such as administration of drugs and device selection.

Surgeons can also load imaging data from a real patient (such as a CT scan) into the system and "rehearse" a procedure digitally before doing the real operation. "For a simulator to be really useful, it has to present possible outcomes, how to manage them, and how to move through decision trees," said Dr. Karwowski. "Simulation allows us to deal with potential pitfalls in a case so we don't have to figure them out on the fly in the OR." The benefits of simulation for vascular surgical training were demonstrated in two studies published by NewYork-Presbyterian Hospital surgeons.

The Future for Vascular Simulators

The future role of simulation in the training of surgeons is expected to continue to grow, as previous studies showed that students trained on simulators achieve better outcomes; perform faster, more accurate procedures; and use less fluoroscopy, which is better for patients. "We have to be able to provide surgeons with a well-rounded training program in as safe a manner as possible. The only way to do this is with more simulation, not less," said Dr. Dayal.

Faculty Contributing to this Article:

Rajeev Dayal, MD is an Assistant Attending Surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center, the Bi-Campus Director of Carotid Stenting at NewYork-Presbyterian Hospital, an Assistant Professor of Surgery at Columbia University College of Physicians and Surgeons, and an Adjunct Assistant Professor of Surgery at Weill Cornell Medical College.

John Karwowski, MD is an Assistant Attending Surgeon and the Interim Site Chief in the Division of Vascular Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, an Assistant Professor of Surgery at Weill Cornell Medical College, and an Adjunct Assistant Professor of Surgery at Columbia University College of Physicians and Surgeons

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