UCLA researchers develop training tool

UCLA researchers have created a new instrument that can be used as a surgical teaching tool and can also be used by expert doctors to direct medical procedures at remote locations.

Researchers at the UCLA Henry Samueli School of Engineering and Applied Science, in collaboration with UCLA’s Center for Advanced Surgical and Interventional Technology, have developed a guided laparoscopic instrument that can be used by expert laparoscopic surgeons to guide novice surgeons at a different location.

Laparoscopic surgery is a minimally invasive type of surgery which can be performed on the abdominal area. Surgeons cut small incisions and insert surgical tools through these incisions to perform the surgery instead of cutting a larger piece of tissue to fit their hands inside the patient.

“Instead of using your hands, you’re using these very long wand instruments. It takes time and practice, typically years, to really become an expert at that procedure,” Gregory Carman, researcher and professor of mechanical and aerospace engineering, said.

The guided laparoscopic instrument is a telementoring system whereby an expert surgeon can use video conferencing tools to provide real-time guidance to an on-site novice surgeon while the novice surgeon is performing the surgery.

Both surgeons have similar stations and see the same video. At the master station, the motion of the instruments used by the expert are tracked by sensors. This tracked path of motion is then used to guide the novice by restricting the novice from making movements with the tools that don’t follow the tracked path, Petros Faloutsos, researcher and professor of computer science, said.

“As long as (the remote surgeons) have the teleconnection through the instrument they use, I can actually guide them using my hands,” said Erik Dutson, an assistant clinical professor of surgery at UCLA’s David Geffen School of Medicine and an expert in laparoscopic surgery.

Expert surgeons such as Dutson can direct surgeons near battlefields. Laparoscopic surgery can be beneficial on a battlefield because it is less invasive and has a shorter recovery time.

“Let’s say you’re in Iraq and they may not have those experts. They have a novice guided by someone who is an expert. The expert doesn’t have to be in Iraq,” Carman said.

The guided laparoscopic instrument is suitable for such situations because it is transportable.

“As you go further back from the front line (of battle) there is more and more care available. … It would allow fairly expert hands to push fairly close to the battlefield,” Dutson said.

“Soldiers have to be flown back from Iraq all the way back to Germany. This may allow us to have more technologically advanced equipment and patient care available closer to the battlefront,” Dutson added.

The instrument can also be used as a training system.

“As it stands, it is a hybrid between the traditional training boxes and the PC-based virtual-reality training systems,” said Vasile Nistor, a graduate student in the UCLA Department of Bioengineering and a fellow researcher, along with Brian Allen, a graduate student in the UCLA Department of Computer Science.

Traditional training programs usually come in one of two forms.

Trainees either use the surgery training box, which is a plastic object representing the human abdomen, or they use a virtual simulation where joysticks simulate the surgical tools, Nistor said.

“With this system, you combine the simplicity of the box and you use real (surgical) instruments,” Nistor added.

The expert surgeon can use the instrument to guide the novice surgeon’s tools.

Currently, the research team is developing a kinesthetic force-feedback interface for the instrument.

With this, the expert surgeon maps the path of motion for the novice surgeon using this guiding instrument, and the kinesthetic force-feedback interface will prevent the novice surgeon from moving the surgical tools out of the range of this path by applying pressure on the tools. The expert surgeon can then prevent a potentially harmful motion by the novice surgeon, Nistor said.

“The expert can draw the prescribed procedure on the video interface, and the kinesthetic force-feedback interface will effectively guide the trainee’s hands into the proper instrument pathway, and therefore they would experience an accelerated learning curve,” Nistor added.

The surgical movements of Dutson were recorded in order to have a benchmark from which trainees’ skill level can be measured.

“We’re starting to evaluate the training tool. We’re at 10 to 20 percent of where we want to be,” Carman said.

The instrument will continue to be developed in the next two years. The project is funded by the U.S. Army Telemedicine and Advanced Technology Research Center.