NCS Hosts Medical Simulation Luncheon Featuring the Nicholson Center for Surgical Advancement
Thurs 20 Oct 2011 - Orlando FL
by Medical Simulation Associates for the National Center for Simulation
Officials representing the Nicholson Center for Surgical Advancement (NCSA), at Florida Hospital Celebration Health today provided an overview of the newly opened 54,000 sq. ft. facility, and an overview of the DoD funded research initiatives, among many planned for the new center, at a luncheon sponsored by the National Center for Simulation. Mr. Sherrick T. “Rick” Wassel, NCSA System Administrator, provided a snapshot of the new center and focused on the positive economic impacts of the organizations programs provide to the local area. While the facility is new, with the Grand Opening ceremony held on Oct 6 attended by numerous representatives from government, industry, academia and the medical profession, the Center is actually celebrating its 10 year anniversary since originally opening in less grand settings.
NCSA is a global destination for training, education, and research and development. The center works with various groups around the world to innovate on strategic visions. NCSA’s vision is to transform healthcare by collaborating with researchers, entrepreneurs, healthcare companies, and physicians. To accomplish this, NCSA works with various stakeholders such as scientists and innovators, medical societies and associations, the military, industry, clinicians and allied health, and academia.
Orlando is the number one destination for health care and association meetings, with clinicians coming here from around the world every few years. NCSA works with the societies well in advance of their meetings to provide training opportunities scheduled around their events. With dedicated robotics training labs with three robots beginning in 2008, NCSA trained over 8000 clinicians in 2010, clearly the largest specialty training by volume globally. Now with 6 robots and associated facilities and infrastructure, NCSA can train up to 20,000/yr, by leveraging web based training, telemedicine, tele-mentoring, tele-education, etc. In addition, NCSA leverages relationships with international partnerships including affiliations in Berlin, Germany; Milan, Italy; Seoul S. Korea; and Israel.
NCSA is working closely with Visit Orlando and various economic development agencies to leverage the NCSA assets to drive international visitors, helping to position Orlando as a serious business destination, and not just a tourist attraction. NCSA, healthcare, and simulation and training technology are key components of what Orlando offers.
Dr Roger Smith, Chief Technology Officer at NCSA (and formerly the Army simulation acquisition agency) then presented information about the research projects NCSA is leading as a result of congressional funding support sponsored by former Congressman Alan Grayson. The major research focus areas are around tele-surgery, simulation, and robotic curriculum development.
Telesurgery deals with how the robot can be used for surgery at great distances, in which the military is very interested. Two focus areas for telesurgery are studying the communications latency impacts on a surgeon operating remotely with a robot on a patient located at a substantial distance away. Communication from the surgeon to the robot are not a major issue, but data coming back the other direction is the big limitation. Dr. Smith explained that the process involves broadcasting HD stereo images back from the robot to the surgeon -- in effect downloading 2 HD movies simultaneously, and that’s where the real communication lag comes in. NCSA is working with surgeons to find out what impact the latency has on their ability to perform a procedure safely. The more latency is tolerable, the greater distance from which the surgeon can safely operate. The project aims to try to understand that constraint and its limits, defining an upper threshold.
Dr. Smith went on to say that latency is a fact of life (a physics constraint) we can’t do much about or eliminate completely. So the project is also working with surgeons to redesign the surgery so it is safe and effective to perform in a latency environment. This is not a new request, as surgery is always being redesigned, for example from open procedures to laparoscopic procedures to robotic surgery--this is just a continuation of that process of evolution to tele-robotic surgery. Dr. Smith explained that redesigning the surgery involves such things as controlling the pace of movement of the surgeons hands which drive the instruments, subdividing the current atomic movements into smaller segments less affected by latency, changing the direction of movements, or introducing new new instruments, etc. Research experiments will initially use a simulator with the latency built in, rather than actual equipment.
NCSA is also evaluating whether surgeons can be trained effectively on simulated hardware to determine what can and cannot be trained. The project is comparing two types of simulations, one using the actual robotic control station and one with simulated control stations. Cost considerations and effectiveness drive the comparison study. The research will also help determine if the simulator can help surgeons perform the surgery better. For example, can having a surgeon practice on real patient data to do procedure rehearsal before the surgery improve surgical performance and outcomes?
An extension of this research is to determine if recording the movements and sequences on real patient data could then be downloaded for automated surgery applications where a surgeon is unavailable and latency unacceptable (e.g., battlefield, submarine, antarctic station, remote locations, etc). NCSA is trying to help identify, understand and prioritize the things that can go wrong in such a process, and what potential problems we may have ability to solve now? The purpose of this research is not an attempt to solve these problems, but rather to generate discussion and a research roadmap for others to work over the coming years, as this capability is a long way off.
Dr Smith highlighted a few other research threads associated with the project. NCSA is working jointly with the renowned simulation visionary, Dr Rick Satava, Univ. of Washington, on the development of national standards for curriculum for robotic surgery to identify the basic training and competency every surgeon should pass in order to retain their certification.
NCSA is also evaluating skills retention for robotic surgeons that may be deployed outside of their specialty with the military. The objective is to determine if any of the existing robotic simulators can help robotic surgeons practice and retain their skills during the deployment, and also to assess the durability of the simulator equipment for that purpose. The answer to this question is driven by recruitment concerns expressed by surgeons who might not otherwise serve in the military.
In closing, Dr Smith provided some insights into future areas of opportunity. Currently, people usually think of the DaVinci robot when they hear robotic surgery. But the definition of what a robot is is changing to cover machine assisted surgery. Robots will take on different forms from what they look like today. A complementary area is redesigning the operating room to accommodate people, new surgical technology, and new information capability.
Robotics and laparoscopic surgical procedures and equipment provide a more natural environment for the use of simulators, making this a more attractive market for development of simulators. Integration of simulation through virtual reality, serious games, and over the web for providing in-hospital skills maintenance training is another growth area.
Lastly, the development of curriculum that effectively integrates lecture, live tissue and simulation is needed. There are very few programs that integrate all three together in the curriculum effectively.
Attendees were given an open invitation to visit the Nicholson Center for a tour by contacting Dr. Smith or Mr. Wassel to coordinate. For those interested, NCSA is providing a post-I/ITSEC professional development seminar on Friday Dec 2. See the I/ITSEC program for details at http://www.iitsec.org/attendees/Documents/06STEM.pdf
For additional information about the Nicholson Center, click here.
