Surgical Simulator, the LaparoscopyVR™: Procedural Skills
The LapVR™ procedural skills modules include
Laparoscopic Adhesiolysis "Lysis of Adhesions"
Module
The surgical simulator's Adhesions Skill requires appropriate safe bowel
manipulation with one hand while using the other to cut adhesions using
scissors or a cautery tool. The adhesions will vary in thickness and location
requiring activity in all planes. The concept of traction in cutting is
reinforced, as well as the concept of holding a tissue taut in order to
improve cutting ease.
Laparoscopy RtB Module
The goals for the LapVR™ Surgical Simulator's RtB Module are to
develop technical and cognitive skills and dexterity for inspection, manipulation,
and measurement of the bowel. These are procedural skills commonly needed
during trauma, general, OB/GYN, bariatric, and colon-rectal surgery.
The RtB procedural skill allows for a student to use different two-handed
techniques such as hand-over-hand and side-by-side. The LapVR RtB module
is the only simulation with bowel mesentery. Adding the mesentery adds
an extra layer of realism to how a surgical resident would manipulate
and measure the bowel. This bowel / mesentery interaction is a very important
experience to assist in the understanding of proper manipulation of the
bowel to avoid injury.
Virtual Laparoscopy RtB Training Objectives
The RtB surgical simulation module builds laparoscopic skills, helping
the user:
- Learn to choose from different measuring options
- Improve dexterity in the hand-over-hand technique
- Inspect the bowel and find pathology
- Learn how to carefully handle the mesentery and bowel
- Use a stapler on the bowel
- Learn to choose the correct and most efficient approaches to handling
anatomical deviations
- Learn to choose the surgical method most appropriate for the patient
presentation
- Identify areas of strength and those needing improvement by using
an automated end-of-practice assessment
- Obtain confidence in performing laparoscopic RtB surgical procedures
before introduction to real patient scenarios
Virtual Laparoscopy Suture
and Knot Tying Module
The LapVR surgical simulator's Suturing and Knot Tying Module includes
procedural skill training in stitching and tying, as well as essential
skill training in needle driving and knot tying. The module comes with
needle driver trocar handles and the new pistol grip handles that include
a trigger mechanism. Both handles are equipped with QuickChange adapters
allowing fast and easy tool changes.
The Suturing and Knot Tying Procedural Skill provides training in simple-interrupted,
continuous, horizontal mattress, and loop ligation suturing with knot
tying in a realistic anatomical environment. See the Essential Skills
section for a description of its rudimentary needle
driving and knot tying skill exercises.
Simple-Interrupted Stitch
The Simple Interrupted Stitch Knot Tying procedural skill requires the
user to close an opening in a simulated bowel using a series of interrupted
stitches. The user must tie each stitch using a proper knot. Each throw
of suture — whether crossed in front of or behind the other length
of suture — is recognized by the software, giving the user important
feedback. This is a free-play exercise with the option for the administrator
to include a visual aid/overlay to assist in proper suture placement.
The bowel will show blanching and bruising from rough handling. Complexity
is added by adjusting parameters for enterotomy size, bowel/tissue integrity,
and suture strength.
Simple-Interrupted
Stitch.
Click to view larger image.
Continuous Stitch
The Continuous Stitch procedural skill requires the user to close an enterotomy
in a simulated bowel using a continuous stitch. A pre-tied anchor knot
is present and may be used to maneuver the bowel. After introducing the
needle, the user is to place the first stitch at the apex of the enterotomy
opposite the pre-tied knot and work toward it. The pre-tied knot is intended
to be used to tie the final knot of the continuous stitch. The throws
of the suture — whether crossed in front of or behind the other
length of suture — are recognized by the software, giving the user
important feedback. This is a free-play exercise with the option for the
administrator to include a visual aid/overlay to assist in proper suture
placement. The bowel will show blanching and bruising from rough handling.
Complexity is added by adjusting parameters for enterotomy size, bowel/tissue
integrity, and suture strength.
Continuous
Stitch.
Click to view larger image.
Horizontal Stitch
The Horizontal Stitch Procedural Skill requires the user to close a small
enterotomy in a simulated bowel using a single horizontal stitch. This
stitch consists of two deep simple-interrupted stitches placed side by
side and tied together. The throws of the suture — whether crossed
in front of or behind the other length of suture — are recognized
by the software, giving the user important feedback. This is a free-play
exercise with the option for the administrator to include a visual aid/overlay
to assist in determining proper suture placement. The bowel will show
blanching and bruising from rough handling. Complexity is added by adjusting
parameters for bowel/tissue integrity and suture strength.
Loop Ligation
The Loop Ligation procedural skill requires the user to ligate an actively
bleeding vessel using a delivery catheter with a preformed loop snare.
The user must position the grasper inside the loop, then grasp the blood
vessel. The vessel is then held while the snare is positioned. The trigger
mechanism in the laparoscopic handle is used to tighten the snare’s
one-way slip knot to form a hemostatic ligature. The administrator may
select to have a target visible on the vessel. If no target is selected,
this is a free-play exercise. Blood loss during the procedure is tracked
onscreen. The blood vessels in the simulation are subject to damage from
rough handling.
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