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Biomedical subjects

Richard M Satava

Publications and source records attributed to Richard M Satava.

At least 19 recordsLinked to original sources
PubMed2006

Robotics in colorectal surgery: telemonitoring and telerobotics.

Surgery has just passed through the laparoscopic surgery revolution, with validation of the advantages for the patient evaluated painstakingly; however, laparoscopy is a transition phase to fully information-based surgery, which only can be accomplished when hand motions are converted to information through robotic surgery systems. The main advantage is using such systems to integrate the entire surgical process. The components that will allow such a transition exist in other industries that use robotics, so it is more a matter of applying these engineering principles to surgery, rather than inventing new technologies. Robotics cannot only improve the performance of surgery, but is providing access to surgical expertise in remote and underserved areas through telementoring, teleconsultation, and telesurgery. Colorectal surgeons should seize the opportunity to begin to use surgical robotic systems in those niche areas and procedures that have proven to be of significant benefit to the patient and are cost-effective. Over time, with the development of even more advanced systems it will become more advantageous to use robotics on a routine basis.

Colon↗
PubMed2005

Identification and reduction of surgical error using simulation.

In recent years, the question of medical errors has received increasing attention. To minimize or avoid errors, it is important to understand both the error itself and the factors leading up to it, as well as the type of error that has been committed. Simulators, which have gained increasing importance in surgical training, can also be useful to "teach" errors, learn from them and develop strategies to avoid them - all of this in a safe environment free from any risk for patients. In this contribution, the nature of errors and their role in simulator training are discussed in detail.

Journal Article↗
PubMed2005

Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training.

SUMMARY BACKGROUND DATA: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision METHODS: A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program. RESULTS: VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations. CONCLUSIONS: VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills.

Attention↗
PubMed2005

The scientific method is dead--long live the (new) scientific method.

The scientific method has been the mainstay of scientific inquiry and clinical practice for nearly a century. A new methodology has been emerging from the scientific (nonmedical) community: the introduction of modeling and simulation as an integral part of the scientific process. Thus, after the hypothesis is proposed and an experiment is designed, modern scientists perform numerous simulations of the experiment. An iterative optimization of the design of the experiment is performed on the computer and is seen in virtual prototyping and virtual testing and evaluation. After this iterative step, when the best design has been refined, the actual experiment is conducted in the laboratory. The value is that the modeling and simulation step saves time and money for conducting the live experiment. The practice of medicine should look to the tools being used by the rest of the scientific community and consider adopting and adapting those new principles.

Computer Simulation↗
PubMed2004

Future trends in the design and application of surgical robots.

Beyond current laparoscopic surgery is the emergence of robotic surgery. The power of this type of surgery is converting both vision and hand motions into electronic signals (video and telemanipulation), which completes the transition of surgery from the Industrial Age to the Information Age. Other advances include replacing scrub and circulation nurses with robots, miniaturization, biosurgery, "intelligent" instruments, and energy-directed rather than mechanical surgical tools. These modalities will supplement-but not totally replace-current forms of surgery such as open conventional, minimally invasive, endoluminal, and interventional.

Equipment Design↗
PubMed2003

Robotic surgery: from past to future--a personal journey.

A review of the history of robotic surgery--from its beginnings in a collaboration of engineers, computer scientists, and a plastic surgeon from Stanford Research Institute (SRI) and the NASA-Ames Research Center to the next generation of systems on the drawing board in the Department of Defense--provides a rich and colorful look at the author's participation in its development. Although Dr. Satava has participated in the development of other systems (orthopedic, ophthalmologic, and neurosurgical) that have contributed to the current distribution of robotic, computer-aided, and image-guided surgical systems, this article focuses on the development of the telemanipulation systems used for thoracic, abdominal, and pelvic surgery. Based upon emerging technologies, speculation is provided on the next generation of systems.

Clinical Competence↗
PubMed2003

Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures.

BACKGROUND: Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a surgeon to acquire and master. Although assessment technologies have been proposed, precise and objective psychomotor skills assessment of surgeons performing laparoscopic procedures has not been detailed. STUDY DESIGN: Two hundred ten surgeons attending the 2001 annual meeting of the American College of Surgeons in New Orleans who reported having completed more than 50 laparoscopic procedures participated. Subjects were required to complete one box-trainer laparoscopic cutting task and a similar virtual reality task. These tasks were specifically designed to test only psychomotor and not cognitive skills. Both tasks were completed twice. Performance of tasks was assessed and analyzed. Demographic and laparoscopic experience data were also collected. RESULTS: Complete data were available on 195 surgeons. In this group, surgeons performed the box-trainer task better with their dominant hand (p < 0.0001) and there was a strong and statistically significant correlation between trials (r = 0.47 - 0.64, p < 0.0001). After transforming raw data to z-scores (mean = 0 and SD = 1) it was shown that between 2% and 12% of surgeons performed more than two standard deviations from the mean. Some surgeons' performance was 20 standard deviations from the mean. Minimally Invasive Surgical Trainer Virtual Reality metrics demonstrated high measurement consistency as assessed by coefficient alpha (alpha = 0.849). CONCLUSIONS: Objective assessment of laparoscopic psychomotor skills is now possible. Surgeons who had performed more than 50 laparoscopic procedures showed considerable variability in their performance on a simple laparoscopic and virtual reality task. Approximately 10% of surgeons tested performed the task significantly worse than the group's average performance. Studies such as this may form the methodology for establishing criteria levels and performance objectives in objective assessment of the technical skills component of determining surgical competence.

Adult↗
PubMed2003

The operating room of the future: observations and commentary.

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

Forecasting↗
PubMed2003

Biomedical, ethical, and moral issues being forced by advanced medical technologies.

Technology is rampant, exponentially growing beyond the bounds normally comprehensible by the human mind. Many of these technologies are so fundamentally disruptive that they challenge the very practice of science. Discoveries once unimaginable except in science fiction are appearing at such a rapid rate that there is no time to evaluate their moral and ethical implications in a deliberate and measured fashion. Genetic engineering, human cloning, tissue engineering, intelligent robotics, nanotechnology, suspended animation, regeneration, and species prolongation are but a few that will revolutionize what it means to be human and what the ultimate fate of the species may be. Unless these issues are addressed at this time, we shall face the consequences of an uncontrolled and unprepared future.

Biomedical Technology↗
PubMed2002

A methodology for objective assessment of errors: an example using an endoscopic sinus surgery simulator.

A well-proven methodology (the modified Delphi method) was used to generate a first-order approximation of errors that should be measured in a virtual reality surgical simulator (the ES3). The methodology and the errors derived were crafted in such a way as to be generalizable. Although some of the error measures are specific for sinus surgery, the same type of methodology can be used for other otolaryngologic, general, and [table: see text] subspecialty surgical procedures. The value of this process is that it can provide a uniform framework for investigators in surgical education and training to establish error measurements in their particular procedures or disciplines and to generate data and outcomes that are comparable, interoperable, and sharable with other investigators. Admittedly, the process is time consuming and rigorous, but it does provide a solid scientific basis to generate evidence-based data for the validation of training methods and for outcomes analysis.

Clinical Competence↗
PubMed2002

Virtual reality training improves operating room performance: results of a randomized, double-blinded study.

OBJECTIVE: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. SUMMARY BACKGROUND DATA: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. METHODS: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). RESULTS: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). CONCLUSIONS: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Cholecystectomy, Laparoscopic↗