One of the many consequences of the current pandemic was that classes had to be canceled at all levels. It is a measure to guarantee the protection of young people and activities have gradually begun to be resumed. Although from the adversities several opportunities arose. One of the most innovative was the development of an immersive laparoscopic simulator created for the resident training. The most attractive thing is that it is a model created entirely in our country.
In this case, experts from the Institute of Applied Sciences and Technology (ICAT) of the UNAM were in charge of the work. The objective is that medical students from this university can continue their surgical training during the confinement caused by the COVID-19 pandemic.
How does it work?
“Many surgeries were canceled inside the hospital, and out of that need came the idea of a simulator that allows residents to enter the operating room, without being inside the facilities,” said Fernando Pérez Escamirosa, a member of ICAT’s Intelligent Systems Group and the person in charge of the project. This plan was made possible by the support provided by the surgery area of the “Federico Gómez” Children’s Hospital of Mexico, where it has already been used since April 2020.
“We started by designing a virtual operating room, some transfer tasks, cutting and, in the end, we managed to do a complete procedure.”
So far, the immersive laparoscopic simulator is enabled to perform a cholecystectomy or gallbladder removal. Although it can also be adapted to other surgical procedures.
The programming was in charge of Eduardo Ruiz, a graduate of the Computer Engineering career at UNAM, who modeled it in 3D so that it would be like a real one.
All the work behind the simulator
To achieve this, he dedicated almost a year to the complete programming. As previous work, he went to the hospital on several occasions and witnessed the surgeries. “We were in the operating room, measurements and photos of all the devices were taken. Photogrammetry techniques were used to apply textures, so that it was a setting that enveloped you, so that you really felt that you were inside the operating room”.
Being a tool to provide surgical skills to future surgeons, Eduardo Ruiz integrated the distractors that can occur in a real surgery: the sound of monitors, the voice of the nurse or a ringing telephone, among others. The simulator consists of 3D glasses and two sensors to manipulate medical instruments.
According to the head of endoscopic surgery at the Children’s Hospital, Ricardo Ordorica Flores, before the pandemic, his area was already concerned that surgeries be safer, to achieve this, students had to be given skills and abilities; “They needed to be pre-trained and this simulator is a good tool to do it,” he explained.
Currently, it is used by 35 students in the laparoscopic surgery area of that hospital. This allows them to continue their practices without the risk of becoming infected, and despite the fact that a large number of operations have been cancelled.
David Medina Álvarez is a student at the UNAM School of Medicine, a general surgery resident at the Adolfo López Mateos Hospital and one of the users of the simulator. He states that at first it is difficult to perform laparoscopic surgery due to depth perception. Although this simulator helps very well to identify that gap and, through training, it is easier to perceive depths on a screen that only has two dimensions. This helps, when it comes to real surgery, to make it easier to have a notion of the movements that are made.
The simulator, he said, is friendly to the user and, above all, to people from Medicine who are not very familiar with the Engineering or Computing environment. “I recommend the use of these types of tools and trainers, because they allow a person to have a first contact with these procedures without using many resources or even being in front of a patient.”
Due to its good results, it is planned to expand its programming to a multiplayer mode, so that the surgeon and anesthesiologist can interact at the same time.