The da Vinci and similar robotic surgical systems have gained a solid reputation as helpful colleagues, facilitating complex procedures for numerous surgeons. But what if robot-assisted minimally-invasive surgery also could provide cosmetic benefits?
A French-based cancer research institute is testing the da...
As robotic surgery proliferates across the globe, a handful of research scientists are leading the charge for high-quality training. No consensus exists yet on the best teaching methods, but one thing is clear. Robotic surgery is a major departure from all other surgery before it, in its use of remote operation, robotic arms, and team communication that is not face-to-face. Accordingly, training has to be revamped.
Techniques First Used in the Military
“The paradigm of see-one, do-one, train one no longer fits in learning robotic surgery,” Roger Smith, PhD, robotic scientist and Chief Technology Officer at Florida Hospital Nicholson Center, Celebration, Florida, told MedicalExpo e-Magazine. Relying on simulation techniques first used in the military, Nicholson is able to train many cost-effectively. The Nicholson Center is a major hub for research and training in robotics. It houses the largest medical robotics simulation center in the world.
The training program uses da Vinci robots from Intuitive Surgical, da Vinci Skills Simulator or “backpack” along with Mimic Technologies dv-Trainer software. With grants from the US Department of Defense and an unrestricted grant from Intuitive Surgical, makers of the da Vinci Robot, Smith’s team is leading the way towards standardized, education and training for robotic surgeons.
Smith and robotic scientist Alyssa Tanaka at Nicholson described the unique challenges that robotic surgery poses in operating safely in an interview with MedicalExpo e-Magazine. Notably, the surgical team does not work face to face, as the lead robotic surgeon and assistant are looking at consoles, with other members of the team across the room at the bedside. Part of the training is geared towards making sure that team members are working in accordance with the World Health Organization Safety Checklist.
Trainees are taught “how to interact, to close loops, and how to check back for assistance during surgery,” said Tanaka.
The stakes are high when doing robotic surgery in the abdomen and errors must be avoided. Therefore, a very routinized briefing, intraoperative, and recovery checklists are used to ensure all team members are on the same page.
Besides sitting at a remote console to operate robotic arms and foot pedals that guide the surgery, “robotic arms permit far more freedom of movement and strength than human hands,” added Smith.
Simulators Teach Fine Tissue Manipulation, Control
Even though the Nicholson Center has 6 da Vinci robots, the training is done with simulators primarily, which offer students far more engagement in how they will work than would six robots spread over many trainees. “We are able to put seven core exercises into one device that is portable, storable, and reusable and doesn’t tear up,” Smith said.
The simulators do a great job of manipulation.
The training approach is often compared to video games, but the similarities are more in terms of it having a video game graphics engine and its basic input mechanics, according to Tanaka. Students are asked to pick up reach in and grab some colored clips, pick up a ring without disturbing a blood vessel, and with the foot peddle, they are taught to cauterize a very small area.
da Vinci simulator (Courtesy of Intuitive Surgical)
Students do develop facility, as in a game, with tests like “ring and rail” or “suture sponge”, said Tanaka. “What we are looking for is learning to do this better over time,” she explained.
Basic skills covered include knot tying, dissection, and suturing, which become progressively more difficult. Skill acquisition is broken down into three areas: cognitive, psychomotor, and team communication. Ergonomics are also important because robotic surgeons sit at a console for long periods of time doing surgery.
The curriculum is discussed at the Fundamentals of Robotic Surgery webpage at FRSurgery.com. With further research and testing, Smith and Tanaka hope that specialty societies endorse the training and use it for credentialing.
Same-day hip replacement is a new procedure which allows patients to receive an endoprosthesis without having to spend the night in the hospital. Such accelerated treatment is possible by combining the highly-efficient minimally invasive anterior approach total hip replacement method with meticulously organized...
Could virtual reality be a complementary therapy to reduce pain and stress in cancer patients? That’s the question Mélanie Péron will try to answer at this year’s Paris Doctors 2.0 & You Conference, May 26 and 27. Founder of the Effet Papillon (Butterfly Effect) social enterprise, she will present her Bliss project.
MedicalExpo e-magazine: What is Bliss and how did the project begin?
Mélanie Péron: Bliss is a real-time 3D application designed to meet the getaway needs of those in a weakened state. It’s inspired entirely by my own experience accompanying a patient isolated in a sterile room—the 18 months my partner was undergoing treatment for leukemia. Remember that such rooms are physically isolated and cannot be opened. The patient is in another world, a sort of bubble. I was the only one allowed in, and only dressed like an astronaut in a double-layer suit. In such a situation, communication is difficult and the isolation can make you crazy. The patient doesn’t know if he/she will survive. There’s the fear of death and extreme tiredness due to the chemo and radiation therapy. It’s important to remain positive. Doctors say that’s half the battle.
We intend to plunge users into a very calm virtual universe that is dreamlike and highly imaginative.
That made me look for a solution that would cut through the isolation and provide another way to communicate. At the time, I had friends who played a lot of real-time strategy games, like Warcraft. I thought it would be terrific to recreate such an environment. That was the starting point in 2010. I approached the engineers at Laval Virtual and told them I wanted to create a dreamlike virtual world where people wouldn’t feel isolated. In 2011, after four months of work with six engineering students, we proposed a prototype to Laval Virtual. The effect was tremendous.
ME e-mag: How does it work?
Mélanie Péron: At first, we used 3D computers. But since the technology has evolved so much, we decided to use smartphones and headsets to create therapeutic virtual reality. We were looking for a mobile solution available to everyone that patients could use in the waiting room, during painful treatments or when experiencing acute stress to reduce pressure and pain.
Mélanie Péron, founder of the Bliss project (Courtesy of M. Péron)
ME e-mag: What exactly do they see when they put on the headset?
Mélanie Péron: Bliss is still in the development stage. But we intend to plunge users into a very calm virtual universe that is dreamlike and highly imaginative. It’s not a question of reproducing reality. That exists already. We propose a choice of several environments, for example, a forest, the seashore, a prairie, a frozen landscape. As the person looks around, there will be visual interactions and elements of the environment will begin to move. The audio element also will be very important.
We want to keep the sessions short—10 to 15 minutes. People are not meant to wear the headset all day. We want to stick with homeopathic doses because it’s somewhat tiring. Also, we don’t want to cut them off completely from the real world.
ME e-mag: Have you already tested Bliss on patients?
Mélanie Péron: Over the course of six months we followed 10 or so women who had just been diagnosed with cancer. We proposed that they use Bliss one week per month as a complement to their chemotherapy. We evaluated their quality of life and the amount of medicine they took. Over the course of treatment, we found that their drug consumption did not rise and their quality of life remained stable. The women didn’t feel worse. In fact, they told us that using Bliss before chemo or a visit to the oncologist relaxed them.
Patients told us that using Bliss before chemo or a visit to the oncologist relaxed them.
At the time, Bliss was on a 3D computer with stereo glasses. I was afraid they wouldn’t be able to handle wearing the glasses because chemo can produce terrible nausea and other side-effects. But it didn’t happen. The study confirmed all our hypotheses regarding the benefits of such complementary treatment, including improvement in the quality of life. It’s as effective or even more so than morphine, and as or more effective than behavioral and cognitive therapy.
Virtual reality has been evaluated, tested and implemented in Quebec and the US for about 10 years to deal with things like social phobias, pain, addiction, sexual aggression and post-traumatic stress.
ME e-mag: What are your medium- and long-term projects?
Mélanie Péron: We’ve launched a crowdfunding campaign to obtain the financing necessary to offer Bliss to hospital patients. We’ve planned pilot projects for September to test it in several establishments. The second step will be to develop Bliss for tablets to reproduce the social aspect we had with computers, where several users could connect, send each other messages, etc. The long-term goal is to develop a clinical evaluation system and research protocols into the benefits of Bliss.
Imagine a temporary “second skin” able to hide wrinkles in a matter of minutes. Scientists at MIT and Massachusetts General Hospital have created a special material that acts as an elastic, artificial skin to hide eye bags and other signs of aging. Further development could enable it to deliver drugs to treat eczema and other skin conditions.
This is not a skin cream or one of the many anti-wrinkle products available on the market. As reported in May in the journal Nature Materials, it is an artificial layer containing a silicone-based polymer which mimics the mechanical and elastic properties of healthy, youthful skin.
The product is applied in two steps. First, users apply a clear gel containing the polymer. When the second gel is added – the catalyst – the polymer forms a cross-linked film that remains on the skin for up to 24 hours.
A second skin to reshape eye bags (Courtesy of MIT)
As it dries into an artificial skin, it pulls on and changes the shape of the natural skin, hiding wrinkles and other signs of aging. The resulting layer is soft, transparent and has good mechanical strength.
According to MIT researchers, tests with human subjects showed that the material reshaped bags under the lower eyelids and enhanced skin hydration. This second skin also could be adapted to provide long-lasting ultraviolet protection.
Concealing Disfiguring Birthmarks
“It’s an invisible layer that can provide a barrier, provide cosmetic improvement, and potentially deliver a drug locally to the area that’s being treated. Those three things together could really make it ideal for use in humans,” explained Daniel Anderson, Associate Professor in MIT’s Department of Chemical Engineering and a member of the university’s Koch Institute for Integrative Cancer Research and Institute for Medical Engineering and Science (IMES).
The product is still undergoing human trials. The manufacturer is working on the medical applications, including the possibility of providing durable ultraviolet protection, as well as concealing birthmarks and treating different types of dermatitis.
FINESSIS showcased its new range of surgical gloves during the Exposanita international healthcare exhibition, 18-20 May in Bologna. These gloves are made using a revolutionary material—Flexylon.
FINESSIS presented its line of Aegis surgical gloves manufactured using an innovative three-layer technology. The two outer layers of thermoplastic elastomer enclose an inner layer containing a disinfecting liquid in droplet-like compartments.
For maximum safety during use, the disinfecting liquid is totally isolated from both the wearer’s skin and the patient. This innovative structure has been designed to offer additional protection in the event of a blood exposure accident involving a hollow needle, a scalpel, a suture needle or any other object.
If a glove is punctured, the pressure on the outer film forces the liquid out. The disinfectant is “released only when it is needed, only where it is needed, and only in the amount that is needed,” according to the FINESSIS website. The company states that the efficacy of these surgical gloves has been demonstrated during in vitro tests conducted with enveloped viruses, including HIV and the human hepatitis C viral surrogate.
Flexylon, a Revolutionary Material
In contrast to other medical equipment, surgical glove technology has remained nearly unchanged. The innovation introduced by FINESSIS is the use of a revolutionary technology to produce the Flexylon glove.
Mechanical protection is provided by its two outer layers of a special composition of high-performance synthetic elastomer. Flexylon is formed as a solid cast film without the vulcanization or crosslinking agents used in conventional glove coatings. This eliminates almost all pinholes and other microdefects.
Aegis gloves are suitable for orthopedics, trauma and high-risk surgical procedures.