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Training of surgeons may take flight into virtual reality

Akin to robotics used by pilots, simulator addresses glaring need

By Henry L. Davis
NEWS MEDICAL REPORTER

February 26, 2010,

 Buffalo researchers unveiled a simulator Thursday to train doctors to perform robotic surgery similar to the way pilots use virtual-reality devices for flight training.

The simulator may fill a glaring need in medicine.

Demand for robotic surgery is growing faster than the ability to train surgeons, and the learning curve is considered steep, requiring dozens of cases to become proficient. In addition, experts say, hospitals are increasingly reluctant to spend $2 million on a robotic surgery unit and use it for training inexperienced physicians.

“While surgical practice does make perfect, we believe that through better training tools, the early learning curve of robot-assisted surgery can be shortened without jeopardizing the safety and welfare of patients,” said Dr. Khurshid A. Guru, director of the Center for Robotic Surgery and a surgeon at Roswell Park Cancer Institute.

Guru developed the hardware and software, together known as the Robotic Surgical Simulator, or RoSS, with Thenkurussi Kesavadas, professor of mechanical and aerospace engineering at the University at Buffalo and head of the school’s Virtual Reality Lab.

The simulator approximates the feel of the Da Vinci Surgical System, robotic equipment made by Intuitive Surgical of Sunnyvale, Calif. The system, which is used increasingly for prostatectomies and gynecologic procedures, is controlled by a surgeon who sits at a console. That means the surgeon doesn’t have the normal sensation of feeling a knife in his hand.

“With robotic surgery, you don’t have feedback, so you feel disconnected from the patient. That takes a lot of training to get used to,” Kesavadas said.

Kesavadas and Guru said hospitals and medical schools should incorporate robotic surgery simulators in the training of physicians in the same way that airlines use flight simulators to reduce pilot error.

Despite the rising acceptance of robotic surgery as a tool to assist surgeons, it is not yet clear whether the costly devices produce better results.

Moreover, results may depend on the proficiency of the surgeon using the robotic system, experts say. Yet it’s not clear, either, how many cases it takes to become proficient on a Da Vinci, although the handful of studies that have been done suggest that it is about 150 procedures.

“In air travel, we need to worry about the pilot, not just the machine,” Guru said. “Similarly, in robotic surgery, it’s critical that we train surgeons more proficiently and more quickly.”

He and Kesavadas founded a spinoff company, Simulated Surgical Systems, in Amherst to commercialize the simulators. The company is testing five units at hospitals across the country, including Roswell Park, and expects the units to go on sale for about $100,000 by early 2011.

The tests will evaluate the device’s performance, similar to the way computer companies release early versions of software, and attempt to identify unexpected issues.

The simulators are designed to offer two levels of training. One level covers basic operations, such as using the controls and developing better hand-eye coordination. The devices also come with training software geared toward specific types of surgery.

The only other company with something similar may be Mimic in Seattle, which developed a basic skills training device for surgeons inexperienced with robotic surgery.

The State University of New York Research Foundation and Health Research Inc., the technology transfer arm of Roswell Park, jointly licensed the technology to Simulated Surgical Systems.

Dr. Robert J. Genco, vice provost and director of UB’s Office of Science, Technology and Economic Outreach, which assists in the commercialization of technologies developed at UB, said the collaboration between Guru and Kesavadas exemplifies the type of high-tech start-up companies the university seeks to cultivate and grow in the Buffalo area.

hdavis@buffnews.com