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Posted on September 23, 2013

Royal College of Surgeons in Ireland adopted surgical simulators in 2003 and has advanced the sector since.

Technology has enhanced medical training immensely, helping future surgeons to hone their skills on virtual patients, practicing common procedures and operations repeatedly in the classroom before performing the real thing.  Trainee surgeons can master procedures such as laparoscopic cholecystectomies (keyhole removal of the gallbladder) through the use of surgical simulators. Mistakes result in poor feedback from a lecturer as opposed to the nightmarish side effects that come with botched surgery on a live patient.

Thanks to the vision of consultant surgeon and National Surgical Training Centre director Prof Oscar Traynor, the Royal College of Surgeons in Ireland (RCSI) is leading the way when it comes to surgical simulators, having adopted the technology in its infancy in 2003, and helping advance it further.  The college has made a significant investment in surgical simulators over the last decade spending more than €1 million on the technology in the last year alone, according to Kieran Tangney, associate director of clinical programs.  The RCSI is also in the advanced stages of the planning process for a new €80 million medical education training facility in Dublin city center, which will include new state-of-the-art surgical simulators and a mock operating room with an adjacent control room.

The mock operating theatre will allow multidisciplinary teams of anesthetists, nurses and surgeons to come together and rehearse complex operations on a “virtual patient.” The lecturers meanwhile can put the team into crisis mode and test their ability to remain calm and collected under pressure, by lowering the blood pressure or raising the heart rate of the virtual patient from the control room, even causing it to go into cardiac arrest.

“There is no question that technology and surgical simulators have made a huge impact on medical training and RCSI has been at the forefront in developing a simulation-based surgical training curriculum,” Mr Tangney said.

Practice makes perfect.

He said trainee surgeons at the college are using simulators to practise specific types of procedures such as a colonoscopy without the use of cadavers or even live patients. The trainee can improve their hand-eye coordination, develop technical skills and master their ability to perform three dimensional actions using a two-dimensional screen as a guide.  “Medicine and surgery is not just about knowledge. There is a huge skills element and you have to hone those skills over time. The simulators give the trainee the opportunity to practice their craft.”  After all, practice makes perfect and hundreds of trainee surgeons at the RCSI are receiving the repeated practice they need to excel in an operating theatre, thanks to these surgical simulators, where they can practice everything from suturing to removing a skin mole.

However, more often than not, the trainees spend their time practicing common operations and laparoscopic procedures, which are performed in Irish hospitals on a daily basis. These include procedures to remove the appendix, colon or gall bladder and hernia repair. Trainees can also simulate gastric bypass, hysterectomy and nephrectomy operations.  “The virtual patient can be pre-programmed with different conditions. For example, it might have a tumor.”

The simulator has a computer screen which displays three-dimensional graphics of the organs being operated on. Various surgical tools are linked to motion sensors and tracking devices so the user’s performance of the operation can be monitored.  The devices have become more and more advanced over the years, and the latest ones now have haptic feedback technology, which allows trainee surgeons not only see and hear the virtual patient, but also feel the sensation of drilling through bone or pressing a scalpel against muscle.

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