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New USF lifelike simulators respond like patients in surgery

TAMPA — The model for training surgeons once was, "See one. Do one. Teach one."

Trouble is, seeing one surgical procedure doesn't mean you've seen all the ways that operation can turn out. Better to see as many as possible and practice a lot before touching a real live patient.

That's where the University of South Florida Health Simulation Center at Tampa General Hospital comes in.

The new $1.5 million center is the first of its kind in the Southeast, say USF administrators. It features more than a half-dozen high-tech simulators that allow medical residents — young doctors completing their training — and physicians to practice techniques, critical thinking and decisionmaking skills.

"I wish I had had this when I was a resident," radiologist James Lefler said Wednesday as he worked with a resident inserting a catheter into the artery of a virtual patient named Simantha.

One screen over Simantha showed the placement and movement of the probe. Another displayed heart rate, blood pressure and other vital signs.

Simantha can be programmed to react to the administration of different drugs in various doses. It also can mimic what happens when, for instance, a doctor is placing a stent to prop open a clogged blood vessel and the patient has a stroke.

In contrast, during Lefler's own residency, he used to go to the radiology lab in the middle of the night and use a human skull to practice placing a patient's head in just the right position for an X-ray. The downside was, the practice exposed Lefler to radiation.

Across the hall, a hysteroscopy simulator lets gynecologists practice procedures such as cutting fibroid tumors from the uterus. Currently, a common way to teach that is to use a pig's bladder with a piece of tissue sewn into it, said Dr. Larry Glazerman, USF's director of minimally invasive gynecologic surgery.

"It's a much, much better teaching tool," he said.

The hysteroscopy simulator at USF's center is the first installed in North America and only the second in the world, said Stefan Tuchschmid, the chief executive of VirtaMed in Zurich, Switzerland, the manufacturer. It costs $70,000 to $100,000.

Typically, the simulators in the USF center don't mimic the kind of surgery in which the surgeon cuts the patient open. Instead, they simulate laparoscopic or endoscopic procedures. That's where doctors insert a thin probe with a videocamera and perhaps some instruments on its tip through a small incision to perform a procedure.

Depending on the simulator, the patients can seem remarkably lifelike. Their chests rise and fall with each breath. Some talk about what they're feeling. One gags if you insert a tube in its throat the wrong way. It also registers pain.

And the simulators' instruments give the doctors a tactile sense of what they're encountering inside the body. If they bump a probe into the wall of an organ, they feel it. Or if they accidently cut open a blood vessel, they see the blood.

"If the patient's bleeding, you still get the high anxiety that you would get in real surgery," said Dr. Renee Bassaly, who is in the first year of a three-year fellowship in urogynecology.

But Dr. Alexander Rosemurgy, director of general surgery at the USF College of Medicine, said one thing he does not want is for a virtual patient to die, even though they can be programmed to do that.

Instead, he said he would stop a simulation before that happens and go to the place in the procedure where things started to go wrong to review what happened.

Rosemurgy said he doesn't want people leaving the simulations saying, "I killed 10 people today. How many did you kill?"

"There's no reason to simulate bad care," he said. "We want to simulate great care."

The goal is not only to teach doctors what they need to know to do the procedures, but also what they need to watch for that could go wrong, and to prepare them to react.

During an open house Wednesday, doctor after doctor compared the surgical simulators to flight simulators pilots use.

More than one said US Airways pilot Chesley "Sully" Sullenberger landed his Airbus jet in the Hudson River safely because he had practiced emergency landings over and over again.

"It's not practice makes perfect," Rosemurgy said. "Just like in sports, it's perfect practice makes perfect."

New USF lifelike simulators respond like patients in surgery 03/04/09 [Last modified: Wednesday, March 4, 2009 11:49pm]
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