DR ELLIOT STREET, CO-FOUNDER OF INOVUS MEDICAL, DISCUSSES HOW THE SURGICAL TRAINING MODEL IS EVOLVING TO MEET THE NEW DEMANDS OF THE COVID-19 PANDEMIC, AND HOW ADVANCED AUGMENTED REALITY AND ADDITIVE MANUFACTURING TECHNOLOGIES ARE PAVING THE WAY.
Surgical simulation-based training for laparoscopic procedures has been gaining steady traction over the course of the last decade. Proving to be an effective and safe learning environment, the new approach to surgical education allows students to perform and record simulated ‘full surgical procedures’, as well as basic skills tasks. Postgraduate medical education is now an even more worthwhile setting for surgical simulation-based training, given the plethora of new skills, technologies, and procedures that are introduced on a regular basis.
There are several factors driving the current demand for laparoscopic surgical simulation-based training.
These include a shortage of surgical training sites to accommodate the increasing numbers of medical students, patient safety and the lack of readily available, extremely expensive, equipment for which to practise on.
However, with the onset of the Covid19 pandemic, medical education stalled abruptly in April of this year. Elective lists and rotations were cancelled, and self-isolation posed a dilemma for the majority of trainee surgeons across the globe, with hospitals becoming out of bounds to all but emergency cases.
With surgeons unable to operate at their usual volumes, they are at increasing risk of skills fade. Social distancing measures have impacted the delivery of traditional surgical training with many simulation centres restricting numbers and contact; meaning that previous approaches to re-skilling surgeons are now not possible.
Over time, people have adapted to e-learning systems based on formalized teaching with the help of electronic resources so while teaching can be based in or out of the classrooms or offices, the use of computers and the internet forms the major component. The adoption of new technology therefore for surgical simulation training has followed this approach in the wake of rapidly growing demand for high fidelity connected learning during and post COVID-19.
Other forms of technology, such as expensive VR systems, have been readily available on the market to offer simulated experiences. However, there is a need to hone skills in a risk-free environment with haptic feedback. The ability for connected learning with outcome focused reporting prior to patient interaction can only truly be achieved through
AR (augmented reality) or MR (mixed reality) where virtual and real environments interact.
As such, there is a real need for companies incorporating connected learning and haptic feedback into product development to offer surgical trainees the opportunity to train remotely, anywhere in the world, whether it be from a simulation centre, hospital or at home. That is what Inovus Medical has pioneered, with support and funding through SBRI Healthcare, funded by NHS England. The system allows patients to connect with their education provider through an online training platform, representing a paradigm shift in haptic realism utilising real feel soft tissue models and real laparoscopic instruments to provide unparalleled functionality.
As mentioned, the need for ‘functional Augmented Reality’ or ‘Mixed Reality’ by merging real feel soft tissue models with digital anatomy and ensuring seamless interaction between both the digital and real environments, promises to provide future, significant value in surgical training.
This new advanced form of simulation allows surgeons to practise a range of procedures across many surgical specialties. Instrument tracking technology enables the capture of instrument handling and performance metrics with performance data displayed on an online platform.
The standard approach, therefore, of the more traditional laparoscopic box trainers, which many trainee surgeons are now familiar with and are widely manufactured and used across the globe, are being brought into the future with the development of ground-breaking technology and connected learning capability.
With the addition of this new technology in advanced simulator production follows the requirement for scalable, affordable, manufacturing capabilities.
MANUFACTURING THE FUTURE
As demand for this new technology and new ways of training increases with more and more surgeons and surgical trainees now being encouraged to train from home so businesses have to source manufacturing techniques to keep up with this increase demand.
Companies, such as Inovus Medical, are now turning to additive manufacturing, which enables the company to produce plastic parts with a finish level equivalent to that of injection molding but without the expensive up-front cost of tooling and manufacturing of injection molds.
The use of SLS technology for manufacturing large scale commercially viable products is not something often seen with 3D printing, a technology that is widely used for rapid prototyping and small-scale projects but has found it difficult to translate into the wider manufacturing sector. However, Inovus Medical has taken a contrarian approach to deployment of the technology allowing the company to use SLS printing as a main stay in its manufacturing processes.
The adoption of new technology therefore for surgical simulation training has followed this approach in the wake of rapidly growing demand for high fidelity connected learning during and post COVID-19.
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Medical Plastics News North America – Issue 16 – October/November/December 2020 – Medical Plastics News