2009 Learning Center

Chair: Dmitry Oleynikov, M.D.
Co-Chair: Allan Okrainec, M.D.

Hours of Operation:

Thursday, April 23, 2000
9:30AM - 3:30PM

Friday, April 24, 2000
9:30AM - 3:30PM

Saturday, April 25, 2000
9:30AM - 1:30PM

The Learning Center is a set of educational classrooms where 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

Station 1: NOTES®

Coordinator: Kai Matthes, MD, PhD.

Natural Orifice Translumenal Endoscopic Surgery (NOTES®) is an emerging research area of minimally-invasive surgery. For the NOTES® Station of the SAGES learning center, a novel ex-vivo simulator is used to provide a realistic training experience using commercially available laparoscopic and flexible endoscopic devices. The ex-vivo model consist of a complete porcine peritoneal cavity explant, which is harvested from the meat production industry, thoroughly cleaned, embalmed and modified to closely resemble human anatomy. The tissue provides a realistic tactile feedback, which is essential to assess and train in new techniques such as NOTES®. Laparoscopic surgeons without flexible endoscopic experience can learn how to operate a flexible endoscope and how to establish transgastric, transvaginal or transcolonic access in order to perform a peritoneal exploration. For the more advanced ‘digestivists’ with flexible endoscopic experience, organ resection (appendectomy, cholecystectomy, distal pancreatectomy, nephrectomy, liver lobe resection, hysterectomy, oophorectomy) or gastrointestinal anastomosis techniques (gastrojejunostomy, partial gastrectomy, colectomy) will be simulated.

Objectives:

At the conclusion of this activity, the participant will be able to:

Perform translumenal access of the peritoneal cavity by using a transgastric, transcolonic or transvaginal approach using flexible endoscopes with or without laparoscopic assistance
Perform NOTES® appendectomy, cholecystectomy, distal pancreatectomy, nephrectomy, liver lobe resection, hysterectomy, oophorectomy
Perform a secure closure of the translumenal access port using various techniques such as t-tags, clips or sophisticated closure devices
Review the limitation of currently available standard endoscopic devices and the advantage of additional laparoscopic ports for visualization and retraction using a hybrid-NOTES® approach

Station 2: Laparoscopic Ventral Hernia Repair

Coordinator: Limaris Barrios, MD

Laparoscopic ventral hernia repair has become a very commonly performed procedure. Both virtual reality and box trainer hernia modules will allow participants to practice and become facile with this technique. This station will utilize an angled scope, and all the equipment necessary to perform the repair. Participants will place the mesh in the defect and subsequently secure it with sutures and a tacker. Participants and proctors will be able to monitor their progress.

Objectives:

At the conclusion of this activity, the participant will be able to:

Understand normal anatomic relationships for ventral hernia repair.
Practice mesh deployment and fixation techniques.

Station 3: Basic Instrumentation

Coordinators: Gretchen Purcell, MD, PhD; Robert O. Carpenter, 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:

At the conclusion of this activity, the participant will be able to:

Demonstrate the ability to set up and troubleshoot basic laparoscopic instruments.
Describe the mechanical and physiologic basis for the operation of devices used in minimally-invasive surgery.
To show proficiency in using basic laparoscopic instruments through practice.

Station 4: 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:

At the conclusion of this activity, the participant will be able to:

Describe the key steps for intracorporeal suturing and knot-tying.
Practice intracorporeal suturing and knot-tying in inanimate and virtual reality environments.
Demonstrate proficiency compared to “experts”.

Station 5: FLS

Coordinator: Melina Vassiliou, MD

This station will introduce participants to the Fundamentals of Laparoscopic Surgery (FLS) didactic and technical skills modules. FLS was designed to teach the physiology, fundamental knowledge, and technical skills required to perform basic laparoscopic surgery, and is a joint ACS/SAGES program. Participants will use the interactive web-based format and the lap trainer boxes to become familiar with the program while working on their laparoscopic knowledge and skills. This station will also give new program directors the opportunity to have hands-on time with the module and to learn about the Covidien Educational Fund.

Objectives:

At the conclusion of this activity, the participant will be able to:

Describe the components of the FLS program
Explain some of the preoperative, intraoperative, and postoperative considerations fundamental to laparoscopic surgery

Station 6: TOP GUN

Coordinator: James “Butch” Rosser, MD

The Top Gun Laparoscopic Skill Shootout Station will allow participants to establish and enhance basic laparoscopic skills and suturing ability. All participants can gain skill advancement no matter their baseline. The station will feature the validated “Rosser TOP GUN” skill development stations developed by Dr. Rosser and made famous at Yale. To date, over 6000 surgeons have participated around the world. Instructors will show tactics and techniques that will transfer readily into the clinical environment. In addition, participants will be completing for slots in the Top Gun Shoot Out that will crown one SAGES 2009 TOP GUN.

Objectives:

At the conclusion of this activity, the participant will be able to:

Review, list and recite the Rosser suturing algorithm
Perform dexterity skills and suturing exercises using the “Rosser TOP GUN” training stations
Compete with other surgeons in the Top Gun Shoot Out (no CME credits will be given for this competition)

Station 7: Laparoscopic Common Bile Duct Exploration

Coordinator: Benjamin Poulose, MD

At this station, participants will gain exposure to the laparoscopic transcystic method of common bile duct stone management. The station utilizes the latest in inanimate model technology to simulate an actual situation for the management and retrieval of common bile duct stones.

Objectives:

At the conclusion of this activity, the participant will be able to:

Identify the indications for laparoscopic common bile duct exploration.
Describe the necessary equipment utilized during laparoscopic transcystic common bile duct exploration including common bile duct access instrumentation, choledochoscopy, and stone retrieval methods.
Work as part of a simulated operating room team to perform laparoscopic transcystic common bile duct exploration.

Station 8: Intraoperative Ultrasound

Coordinators: Leonardo Villegas, MD; Junji Machi, MD
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.

Objectives:

At the conclusion of this activity, the participant will be able to:

Describe basic ultrasonography techniques.
Review how ultrasound may be used to diagnose and treat biliary and pancreatic disease.

Station 9: Laparoscopic Weight Loss Surgery

Coordinators: Shanu Kothari, MD, John Morton, MD

The learning curve for gaining proficiency in weight-loss procedures may be shortened with an effective simulator. The Laparoscopic Adjustable Gastric Band Simulator allows participants to introduce a laparoscopic adjustable band, “run” the tubing, place the band in its correct anatomic position, and fixate the port into the subcutaneous tissue. The technical aspects of laparoscopic adjustable gastric band placement may be enhanced by simulation and allow a greater preprocedural understanding for the trainee and expert alike. A virtual laparoscopic gastric bypass trainer will similarly allow for participants to familiarize themselves with the steps and techniques necessary to perform gastric bypass.

Objectives:

At the conclusion of this activity, the participant will be able to:

Review laparoscopic adjustable gastric band anatomy, structure, and function.
Describe the basic steps of placing a laparoscopic adjustable gastric band.
Explain the steps and techniques necessary to perform laparoscopic gastric bypass surgery.

Station 10: Laparoscopic Colectomy Simulator

Coordinator: Deborah Nagle, MD

Laparoscopic colectomy has increasingly been accepted as a treatment option for both benign and malignant disease. Given its potential advantages curricula that might shorten the learning curve are of great interest. Learners participating in this station will verbalize, understand and demonstrate proficiency in the technical steps of laparoscopic sigmoid colectomy.

Objectives:

At the conclusion of this activity, the participant will be able to:

Verbally enumerate the steps of a laparoscopic sigmoid colectomy
Demonstrate the key steps of a laparoscopic sigmoid colectomy on a colon simulator.
List the common technical problems or challenges in laparoscopic sigmoid colectomy and ways to address them

Station 11: Fundamentals of Endoscopic Surgery (FES)

Coordinators: Brian Dunkin, MD; Thadeus Trus, MD

Come get hands-on experience on the newly developed Fundamentals of Endoscopic Surgery (FES) testing platform. FES is the flexible endoscopy equivalent of FLS (Fundamentals of Laparoscopic Surgery) and will be the first validated testing platform for gastrointestinal endoscopic skills. This station features two Simbionix virtual reality simulators loaded with the FES testing modules. Come practice your endoscopic skills with the help of expert proctors, or throw your hat into the ring to pit your skills against others in an FES shootout. The winner of the FES shootout will receive a SAGES Top 14 DVD video set.

Objectives:

At the conclusion of this activity, the participant will be able to:

Evaluate the FES manual skills testing module
Assess his/her flexible endoscopy skills
Develop basic endoscopic skills on virtual reality and real tissue simulation platforms
Evaluate the SAGES flexible endoscopy hands-on training curriculum

Station 12: Simulators for Pediatric Minimally Invasive Surgery

Coordinators: Georges Azzie, MD; Sanjeev Dutta, MD; Melissa McKee, MD

This station will allow participants the opportunity to use prototype simulators for pediatric minimally invasive surgery. Participants will compare and contrast skill sets required on these pediatric simulators with the skill sets taught and tested on the existing adult Fundamentals of Laparoscopic Surgery (FLS) simulator.

Objectives:

At the conclusion of this activity, the participant will be able to:

Practice simulator tasks deemed pertinent to pediatric minimally invasive surgery
Describe differences in performance of similar tasks between adult and pediatric simulators
List limiting factors particular to pediatric minimally invasive surgery

Station 13: Comprehensive Training and Assessment Curriculum (STAC) for Basic Laparoscopic Skills

Coordinators: Teodor Grantcharov, MD; Allan Okrainec, MD

Development and validation of new, evidence-based tools for training and assessment of laparoscopic skills has been a subject of numerous publications. Previous work has demonstrated that several tools can provide an objective and reliable assessment of performance and that skills developed in a simulated environment can be transferred to the operating room. However, very little of this knowledge has been transferred to clinical practice. This station will provide and example of a Comprehensive Training and Assessment Curriculum which incorporates all evidence-based tools and can be implemented in a clinical setting.

Objectives:

At the conclusion of this activity, the participant will be able to:

Present all validated tools for training and assessment of basic laparoscopic skills
Demonstrate how these tools can be integrated into a comprehensive curriculum
Understand the main steps in the implementation of the curriculum in clinical practice
Provide a hands-on training on the different components of the curriculum

Station 14: Single Incision Minimal Access Surgery and New Robotic Technology

Coordinators: Dmitry Oleynikov, MD; Daniel Scott MD; Andrew Wright, MD

Participants will perform single incision minimal access surgery and robotic surgery using the latest technologies. New in-vivo robots, including deployable robotically controlled laparoscopic visualization systems will be demonstrated. These miniature robots are designed to enhance a surgeon’s visualization well beyond the limitations of a conventional laparoscope within the constraints of single incision minimal access surgery by providing a “bird’s eye” downward view and off-axis visualization. Surgeons will learn the strategies behind using conventional straight and new articulating laparoscopic instruments and multi-lumen access ports used during a single incision operative procedure. Participants will have sufficient time to gain a hands-on appreciation and understanding of these technologies by performing both laparoscopic and mini-robot assisted simulated surgical procedures.

Objectives:

At the conclusion of this activity, the participant will be able to:

Learn the advantages of the equipment used to perform single incision surgery
Identify new technology to miniaturize surgical instruments
Compare robotic visualization with conventional laparoscopy for single incision minimal access surgery
Demonstrate new instrumentation and operative strategies for single incision surgery

Station 15: Team Simulations

Coordinator: Shawn Tsuda, MD

Surgeons of today must be leaders of high performance teams to optimize efficiency and safety in the operating environment. High-fidelity simulation allows surgical teams to identify deficits in communication and performance. This station will engage surgeons, endoscopists, anesthesiologists, nurses, surgical technologists in practicing new procedures such as Natural Orifice Translumenal Endoscopic Surgery (NOTES®) and simulating low frequency events such as technical complications and intraoperative crises in a mock endosuite. A debriefing and evaluation of performance using validated tools will promote retention of valuable learning points.

Objectives:

At the conclusion of this activity, the participant will be able to:

Demonstrate team-based techniques in managing technical complications or intra-operative crises.
Identify and interactively discuss deficits in team performance post-simulation
Simulate technical aspects of NOTES® procedures as an operative team