Development of Simulation-Based Suturing Training for da Vinci(r) Surgery

Liron Leist, VP, Research, and, Development, Hadar Segal, Senior, Team, Leader, Maya Bloch, Product, Manager. Simbionix USA.

Objective of the technology
Robotic surgery is expected to continue to comprise a growing part of surgery. The demand for surgeons to implement a robotic surgery program in their hospital is growing, leading to the growing need for training. Establishing a robotic program is a tremendous undertaking for any institution, especially in the purchasing and maintenance of the robot.  Providing structured training solutions could help successful and safe integration of robotic surgery.

Simbionix has partnered with Intuitive Surgical® to develop the Simbionix Suturing Module for virtual reality simulation on the Skills Simulator™ for the da Vinci®Si™ System. The module is intended to provide highly realistic and effective tools designed for integration in surgical curricula across multiple disciplines.

Description of the technology and method of its use or application 
The da Vinci Surgical System combines a 3D view of the surgical field with Intuitive® instrument control and EndoWrist® instruments designed to duplicate the motions of the human hand — all of which can be advantageous to a surgeon as he or she sutures. Simbionix developed a Suturing Module for the da Vinci Skills Simulator designed for use on the actual da Vinci console. New simulation technologies were required to enable the complex simulation of the rigid tool-tool interactions, tool-tissue interactions and thread simulation. Stereoscopic view was integrated in the simulation, and an n-Joint tools collision system was developed to simulate the articulating instruments. The simulation was also developed to support any management system to enable integration of objective measurement metrics into existing LMS systems in training programs and to support future standardized curricula.

Preliminary Results
The innovative newly developed simulation technologies enabled the development of highly realistic suturing tasks which can be applied to complex procedural steps. Tasks include following challenging lines and angles including vertical horizontal and diagonal defects, followed by knot tying, continuous and interrupted suture exercises.

Optional interactive guidance is provided for independent learning and skills mastery. Objective performance feedback is designed to facilitate performance de-briefing, benchmark learner performance and facilitate assessment and certification.


Conclusion/Future Direction

The unique physical simulation technology enables simulating suturing, providing a new training paradigm for this complex and rate limiting surgical skill. The simulation allows surgeons to develop the necessary skills so that they may then be able to select the surgical route most suitable and advantageous for the patient. This suturing training solution may be integrated by robotic training programs in training courses and possible future accreditation & maintenance of certification.

Simbionix will continue to work in collaboration with institutions and societies to fulfil the needs of robotic simulation based training, including possible future development of procedural tasks and complete procedure simulation for complex surgical procedures.

We expect the advances in robotic surgery training, based on the new technology will lead to better patient outcomes and improved patient safety.

Figure 1: Simulation-Based Suturing Training for da Vinci® Surgery

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