Laparoscopic gastric banding is a common surgical treatment for morbid obesity and the most critical factor in the success of the operation lies in the hands of the surgeon – who needs the proficiency and skill to insert slender, handheld tools into the body of the patient. A team of interdisciplinary researchers, led by Rensselaer Polytechnic Institute, has recently won a US$2.3 million federal grant to develop a touch-sensitive virtual reality simulator that will realistically replicate how performing a gastric band operation feels – making it ideal for developing and teaching fundamental surgical skills and for assessing physicians wanting to be certified as a laparoscopic surgeon.

Being proficient at using remote control tools to perform minimally invasive laparoscopic procedures is critical in successfully performing laparoscopic surgery. Although there are only a handful of basic tasks needed to successfully perform the operation – for example tying knots, cutting in very specific patterns and stitching – becoming skilled in these surgical techniques takes time and practice. This new testing and training system that uses haptic technology – or touch feedback – will allow surgeons to practice and refine the surgical skills needed to perform a laparoscopic procedure in their own virtual operating theater.

Practice makes perfect

Professor Suvranu De, associate professor in the Department of Mechanical, Aerospace, and Nuclear Engineering at Rensselaer. and his team of researchers received a four year grant from the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health to develop new hardware and software that will be used as a training and testing device. De, an expert in multiscale computer modeling and haptics, said that physicians who performed less than 100 laparoscopic procedures had more complication rates when compared to experienced surgeons.

“We want to give surgeons the best tools possible, so they can better hone their skills and successfully treat their patients,” said project leader De. “Just as training on virtual reality simulators has shown to be highly effective for jet pilots, we know that physicians show increased success in surgery the more times they perform it. We’re creating new tools that make it easier than ever for them to practice. These same tools will also be used in certification tests to make sure surgeons have all the required skills mastered before they start operating on patients.”

Tool of the trade

The system will feature laparoscopic tools that will be connected to equipment similar to that used in actual surgical situations. The monitor will display realistic computer generated models of the simulation screen and the user will interact with the simulation by vision and touch. The haptics technology will help the user to feel how cutting and stitching real tissue feels – they will feel lifelike toughness, sponginess and resistance. The simulator will also be automated and will guide the user to perform the correct actions of surgical procedures.

De said his team expects that the new system will eventually change the way of surgical education and assessment. The virtual reality simulator could test users against board-certified standards – maybe eventually over the Internet. After the development of the system the team will test and validate its usefulness as a training tool at the Carl J. Shapiro Simulation and Skills Center at Beth Israel Deaconess Medical Center in Boston.

De is working with Professor Daniel B. Jones from Harvard Medical School and human factors engineering expert Caroline G. L. Cao, associate professor of mechanical engineering at Tufts University.

See Rensselaer Polytechnic Institute for more information.