SAGES 2006 Learning Center

Chair: Gretchen Purcell, MD, PhD
Co-Chair: Benjamin Schneider, MD

Hours of Operation

5:30 PM – 7:30 PM Thursday, April 19, 2007
10:00 AM – 4:00 PM Friday, April 20, 2007
10:00 AM – 2:00 PM Saturday, April 21, 2007

The Learning Center is a set of educational classrooms where Surgical Spring Week attendees can gain knowledge and practice skills relevant to minimally invasive surgery. Station coordinators instruct individuals and small groups on topics that range from basic instrumentation to advanced laparoscopic skills. Participants may visit one or more stations that address their educational objectives and spend whatever time is necessary to meet their learning objectives.

Our goals are to continue the traditions of innovation and excellence at the SAGES Learning Center, to increase participation through aggressive promotion and scheduled events, and to improve the attendee experience with enhanced organization of the center, augmented staffing, and explicit educational goals for each station. Our theme is “Everyone Has Something to Learn,” and we will strive
to create a range of stations that can provide new information and techniques to minimally-invasive surgeons at all levels of expertise – from trainees to seasoned practitioners.

2007 Learning Center Stations

Station 1: Basic Instrumentation

Coordinators: Gretchen Purcell, MD, PhD, Richard Nguyen, MD, Stacie Perlman, MD

Laparoscopic instruments are the tools that make minimally-invasive surgical techniques possible. This station provides instruction on the assembly, use, and troubleshooting for basic laparoscopic tools including staplers, suturing devices, and instruments for coagulation and cutting. Participants can view educational videos, receive one-on-one instruction, and use trainers to practice techniques with various devices.

Objectives:

To learn how to set up and troubleshoot basic laparoscopic instruments
To understand the mechanical and physiologic basis for the operation of devices used in minimally-invasive surgery
To gain experience using basic laparoscopic instruments through practice

Station 2: Suturing

Coordinators: Zoltan Szabo, PhD, Neal Seymour, MD

Participants receive intense hands-on suturing including intracorporeal techniques with instantaneous feedback. Laparoscopic tissue handling and complex suturing maneuvers will also be demonstrated. Virtual reality suturing simulators will be used to allow “virtual” suturing practice – no suture required, just a fancy videogame with needle driver handles instead of joysticks. Trainees will be able to compare their scores with established expert levels for both types of simulators.

Objectives:

To learn the key steps for intracorporeal suturing and knot-tying
To practice intracorporeal suturing and knot-tying in inanimate and virtual reality environments
To demonstrate proficiency compared to “experts”

Station 3: Flexible Endoscopy

Coordinator: Brian Dunkin, MD

Virtual reality simulators have become state-of-the art for teaching flexible endoscopy. Upper and lower endoscopic procedures can be simulated, including ERCP. Tactile feedback is available, as well as patient vital signs and pain indices. Participants will have the opportunity for hands-on practice using simulators to perform diagnostic and therapeutic maneuvers. A variety of case scenarios will be available including gastrointestinal bleeding and polyps. Endoscopic ultrasound modules will be available.

Objectives:

To acquire basic skills required for safe and effective upper and lower endoscopy
To learn techniques for managing upper gastrointestinal hemorrhage environments
To learn techniques for snare polypectomy

Station 4: Video Editing

Coordinators: Alfonso Torquati, MD, Alex Gandsas, MD

Presentation of operative videos has become an essential skill for the academic surgeon. At this station, participants will learn to use tools for capturing, titling, and editing digital videos.

Objectives:

To become familiar with software for video editing
To practice the essential skills of video preparation

Station 5: SAGES Videos and Specialty Procedures

Coordinators: Jonathan Pierce, MD, Basil Yurcisin, MD, Guido Sclabas, MD

This station will showcase expert presentations of both core laparoscopic procedures and specialty operations from fields such as surgical oncology, thoracic surgery, trauma, and pediatric surgery. At least two prominent surgeons will be scheduled for each hour to host video presentations and to interact one-on-one with station participants. A schedule will be published in advance to give SAGES attendees many reasons to return to the Learning Center.

The SAGES TOP 14 videos, SAGES Grand Rounds series, and the SAGES Pearls videos will be shown and available for individual viewing. Topics will include flexible endoscopy, diagnostic laparoscopy, laparoscopic cholecystectomy, Nissen fundoplication, inguinal hernia repair, ventral hernia repair, splenectomy, adrenalectomy, right hemi-colectomy, sigmoid colectomy, Roux-en-y gastric bypass, and adjustable gastric band placement.

This station also will offer one-on-one instruction about specialized surgical techniques in general, thoracic, and pediatric surgery. Specialist surgeons will present video clips and photos that illustrate surgical procedures.

Objectives:

To learn the techniques of the core laparoscopic surgical procedures
To learn the techniques for specialty surgical procedures
To meet and learn pearls from experts in minimally-invasive surgery

Station 6: Procedure Specific: Featuring Common Bile Duct and Laparosocopic Inguinal Hernia Repair

Coordinators: Mark Watson, MD, Benjamin Poulose, MD, Vivian Sanchez, MD

Laparoscopic common bile duct (CBD) exploration has proven effective but is difficult to learn. Participants will view the SAGES Top 14 video describing CBD exploration, use an interactive CD, and practice the procedure using the latest teaching models available. Trainees will use flexible choledochoscopes, cystic duct balloon dilators, and baskets to retrieve CBD stones.

Numerous randomized trials support laparoscopic inguinal hernia procedure’s over conventional herniorrhaphy. Laparoscopic hernia repair remains difficult to learn because of unfamiliar preperitoneal anatomy and a small working space. Participants will view the SAGES Top 14 video describing the TEP repair, use an interactive CD, and practice the procedure using the latest teaching models available.

Objectives:

To become familiar with equipment necessary for CBD exploration
To learn the steps to perform CBD exploration
To identify and recover CBD stones using simulator models
To understand the pertinent preperitoneal anatomy
To learn the steps of TEP repair
To practice mesh deployment and securing techniques

Station 7: Intraoperative Ultrasound

Coordinators: Leonardo Villegas, MD, TBA

This station will focus on Intraoperative Ultrasound techniques and applications. Participants will use the latest ultrasound technology with a new inanimate phantom that was developed to mimic the ultrasound properties of abdominal organs. Instructors will demonstrate and help participants perform intraoperative ultrasound for liver, biliary and pancreatic disease, as well as discuss their
surgical applications.

Station 8: New Technologies for Learning: Featuring DynaMITE: Dynamic Minimally Invasive Training Environment

Coordinators: Matt Ritter, MD, Rajesh Aggarwal, MD, Julian Leong, MD, Michael Chan, MD, Audrey Bell, PhD

This station will familiarize participants with leading edge technology for acquiring and assessing laparoscopic skills. The latest operation-specific virtual reality simulators will be featured. These new simulators allow participants to perform real operations in a safe, virtual environment. The latest motion tracking and eye-tracking systems will also be featured to highlight objective measures for skill assessment in the ever-growing movement towards determining proficiency. Additionally, new technologies for remote presence for virtual patient rounding using 2-way audiovisual mobile communications will be demonstrated. Participants will have the opportunity for hands-on time using all of these cutting edge technologies.

This station will also focus on laparoscopic surgical training and skill assessment. In order to practice the manipulation of laparoscopic tools in a challenging environment, participants will use a dynamic surgery simulator. Participants will perform a laparoscopic training task that involves making accurate contact with a moving target in a physical training box environment.

Objectives:

To become familiar with new operation-specific simulators
To become familiar with new methods for objective skill assessment
To become familiar with new technologies for telepresence
Help participants evaluate their psychomotor skill relative to available baseline data.
Identify areas for self-improvement in psychomotor skill.
This station will also foster improved hand-eye coordination through practicing the dynamic tasks involved.

Station 9: Robotic Surgery

Coordinators: Dmitry Oleynikov, MD, Dimitris Stefanidis, MD, PhD, Ashutosh Kaul, MD

Participants will receive hands-on exposure to the latest technologies in robotic surgery. Telerobotic systems allow the surgeon to comfortably sit at a console and ergonomically manipulate joy sticks to control the robotic instruments. This revolutionary technology eliminates the fulcrum effect associated with laparoscopic surgery, allows motion scaling, eliminates tremor, uses 3-dimensional imaging, and increase range of motion using articulating graspers. Additionally, new in-vivo robots, including deployable robotically controlled laparoscopic visualization systems will be demonstrated. Participants will have sufficient time to gain a hands-on appreciation for these technologies.

Objectives:

• To become familiar with the robotic surgical interface and operating system
• To compare robotic surgery with conventional laparoscopy
• To become familiar with miniature in-vivo robotic camera systems

Station 10: Minimally-Invasive Operating Room Team Simulation

Coordinators: Kinga Powers, MD, Scott Rehrig, MD, Noel Irias, MD

Simulation brings together operative teams and assesses communication skills and crisis management. Anesthesia has used simulation and debriefing for last decade to practice routine scenarios and trouble shoot rare events.

In 2007, the Learning Center will introduce simulation for the first time. Participants will enter a mock operating endosuite and will be presented with problems to solve in groups of 4. The events will be videotaped and feedback provided afterwards to group. Learning objectives will emphasize principles from SAGES FLS and SAGES Laparoscopy Troubleshooting Guide.

Station 11: Top Gun

Coordinator: James “Butch” Rosser, MD

The Top Gun Laparoscopic Skill Shootout Station will allow participants to both practice and vie for the ultimate trophy – “Top Gun.” The station will feature the “Rosser” stations developed at Yale and well known for requiring significant dexterity. Participants will learn tricks for achieving good scores as they practice for qualifying and final rounds of the Top Gun Shoot Out.

Objectives:

To improve dexterity skills using the “Rosser” stations
To vie with other surgeons in the Top Gun Shoot Out (no CME credits will be given for this competition)

Station 12: Virtual and Augmented Reality Anatomical Simulations

Coordinators: Eric Foo, MS, Andrew Koehring, BS, Thom Lobe, MD, Eliot Winer, PhD

Participants will be exposed to the latest in Virtual Reality (VR) and Augmented Reality (AR) simulation capabilities. Newly created segmentation techniques combined with Virtual Reality allow medical personnel to examine anatomical data at any scale with full 3D viewing and interaction. The provided system will display full-size (approximately 6'x8'), immersive, 3D, portable, VR simulations. AR allows physicians to manipulate actual objects (blocks, cards, etc.) that 3D object models are artificially attached to through image processing. This type of system allows freedom from a keyboard and mouse and allows natural and intuitive interaction with digital objects.

Objectives:

To become familiar with virtual and augmented reality simulators
To practice manipulating 3D objects using the interactive system