2008 Learning Center

Chair: Benjamin Schneider, MD
Co-Chair: Vivian Strong, MD

Hours of Operation

5:00 PM - 7:00 PM Thursday, April 10, 2008
9:00 AM - 4:00 PM Friday, April 11, 2008
9:00 AM - 2:00 PM Saturday, April 12, 2008

The Learning Center is a set of educational classrooms where attendees can gain knowledge and practice skills relevant to minimally invasive surgery. Station coordinators instruct individuals and small groups on topics that range from basic instrumentation to advanced laparoscopic skills. Participants may visit one or more stations that address their educational objectives and spend whatever time is necessary to meet their learning objectives.

2008 Learning Center Stations

Station 1: NOTES™ Simulator

Coordinator: Angelo Tortola

The Natural Orifice Transluminal Endoscopic Surgery (NOTES™) simulator allows participants to use endoscopic devices to practice maneuvers specific to NOTES™ applications. Instruments passed through a natural orifice can be navigated through a simulated body cavity to perform tasks with the unique challenges of retroflexion, altered horizons, and instrumentation in-parallel. Participants and proctors will be able to monitor their progress through a timer and a fixed camera-view.

Objectives

To practice maneuvers unique to NOTES™ applications with off-the-shelf endoscopic devices.
To become familiar with the technical challenges specific to NOTES™.

Station 2: Laparoscopic Weight Loss Surgery

Coordinator: Shawn Tsuda, MD

The learning curve for gaining proficiency in weight-loss procedures may be shortened with an effective simulator. The Laparoscopic Adjustable Gastric Band Simulator allows participants to introduce a laparoscopic adjustable band, “run” the tubing, place the band in its correct anatomic position, and fixate the port into the subcutaneous tissue. The technical aspects of laparoscopic adjustable gastric band placement may be enhanced by simulation and allow a greater preprocedural understanding for the trainee and expert alike. A virtual laparoscopic gastric bypass trainer will similarly allow for participants to familiarize themselves with the steps and techniques necessary to perform gastric bypass.

Objectives

To learn laparoscopic adjustable gastric band anatomy, structure, and function.
To practice the basic steps of placing a laparoscopic adjustable gastric band.
To learn the steps and techniques necessary to understand laparoscopic gastric bypass surgery.

Station 3: Laparoscopic Ventral Hernia Repair

Coordinator: Limaris Barrios, MD

The laparoscopic ventral hernia repair has become a very commonly performed procedure. Both virtual reality and box trainer hernia modules will allow participants to practice and become facile with this technique. This station will utilize an angled scope, and all the equipment necessary to perform the repair. Participants will place the mesh in the defect and subsequently secure it with sutures and a tacker. Participants and proctors will be able to monitor their progress.

Objectives

To learn normal anatomic relationships.
Practice mesh deployment and securing techniques.

Station 4: Basic Instrumentation

Coordinator: Gretchen Purcell, M.D., Ph.D.

Laparoscopic instruments are the tools that make minimally-invasive surgical techniques possible. This station provides instruction on the assembly, use, and troubleshooting for basic laparoscopic tools including staplers, suturing devices, and instruments for coagulation and cutting. Participants can view educational videos, receive one-on-one instruction, and use trainers to practice techniques with various devices.

Objectives:

To learn how to set up and troubleshoot basic laparoscopic instruments.
To understand the mechanical and physiologic basis for the operation of devices used in minimally-invasive surgery.
To gain experience using basic laparoscopic instruments through practice.

Station 5: Suturing

Coordinators: Zoltan Szabo, Ph.D., Neal Seymour, M.D.

Participants receive intense hands-on suturing including intracorporeal techniques with instantaneous feedback. Laparoscopic tissue handling and complex suturing maneuvers will also be demonstrated. Virtual reality suturing simulators will be used to allow “virtual” suturing practice – no suture required, just a fancy videogame with needle driver handles instead of joysticks. Trainees will be able to compare their scores with established expert levels for both types of simulators.

Objectives:

To learn the key steps for intracorporeal suturing and knot-tying.
To practice intracorporeal suturing and knot-tying in inanimate and virtual reality environments.
To demonstrate proficiency compared to “experts”.

Station 6: Flexible Endoscopy

Coordinator: Brian Dunkin, M.D.

Virtual reality simulators have become state-of-the art for teaching flexible endoscopy. Upper and lower endoscopic procedures can be simulated, including ERCP. Tactile feedback is available, as well as patient vital signs and pain indices. Participants will have the opportunity for hands-on practice using simulators to perform diagnostic and therapeutic maneuvers. A variety of case scenarios will be available including gastrointestinal bleeding and polyps. Endoscopic ultrasound modules will be available.

Objectives:

To acquire basic skills required for safe and effective upper and lower endoscopy.
To learn techniques for managing upper gastrointestinal hemorrhage environments.
To learn techniques for snare polypectomy.

Station 7: SAGES Videos and Specialty Procedures

Coordinators: Jonathan Pierce, M.D., Basil Yurcisin, M.D., Guido Sclabas, M.D.

This station will showcase expert presentations of both core laparoscopic procedures and specialty operations from fields such as surgical oncology, thoracic surgery, trauma, and pediatric surgery. At least two prominent surgeons will be scheduled for each hour to host video presentations and to interact one-on-one with station participants. A schedule will be published in advance to give SAGES attendees many reasons to return to the Learning Center.

The SAGES TOP 14 videos, SAGES Grand Rounds series, and the SAGES Pearls videos will be shown and available for individual viewing. Topics will include flexible endoscopy, diagnostic laparoscopy, laparoscopic cholecystectomy, Nissen fundoplication, inguinal hernia repair, ventral hernia repair, splenectomy, adrenalectomy, right hemi-colectomy, sigmoid colectomy, Roux-en-y gastric bypass, and adjustable gastric band placement.

This station also will offer one-on-one instruction about specialized surgical techniques in general, thoracic, and pediatric surgery. Specialist surgeons will present video clips and photos that illustrate surgical procedures.

Objectives:

To learn the techniques of the core laparoscopic surgical procedures.
To learn the techniques for specialty surgical procedures.
To meet and learn pearls from experts in minimally-invasive surgery.

Station 8: Laparoscopic Common Bile Duct Exploration

Coordinators: Mark Watson, M.D., Benjamin Poulose, M.D.

Laparoscopic common bile duct (CBD) exploration has proven effective but is difficult to learn. Participants will view the SAGES Top 14 video describing CBD exploration, use an interactive CD, and practice the procedure using the latest teaching models available. Trainees will use flexible choledochoscopes, cystic duct balloon dilators, and baskets to retrieve CBD stones.

Objectives:

To become familiar with equipment necessary for CBD exploration.
To learn the steps to perform CBD exploration.
To identify and recover CBD stones using simulator models.

Station 9: Intraoperative Ultrasound

Coordinator: Leonardo Villegas, M.D.

This station will focus on Intraoperative Ultrasound techniques and applications. Participants will use the latest ultrasound technology with a new inanimate phantom that was developed to mimic the ultrasound properties of abdominal organs. Instructors will demonstrate and help participants perform intraoperative ultrasound for liver, biliary and pancreatic disease, as well as discuss their surgical applications.

Objectives:

• To understand basic ultrasonography techniques.
• To understand how ultrasound may be used to diagnose and treat biliary and pancreatic disease.

Station 10: Laparoscopic Colectomy Simulator

Coordinator: Deborah Nagle, M.D.

Laparoscopic colectomy has increasingly been accepted as a treatment option for both benign and malignant disease. Given its potential advantages curricula that might shorten the learning curve are of great interest. Learners participating in this station will verbalize, understand and demonstrate proficiency in the technical steps of laparoscopic sigmoid colectomy.

Objectives:

To be e able to verbally enumerate the steps of a laparoscopic sigmoid colectomy
To be able to demonstrate the key steps of a laparoscopic sigmoid colectomy on a colon simulator.
To be able to list the common technical problems or challenges in laparoscopic sigmoid colectomy and ways to address them

Station 11: Minimally-Invasive Gynecology

Coordinator: Christopher Awtrey, M.D.

Laparoscopy is well established as a treatment modality for gynecoligic lesions. Gynecologists were instrumental in the development of many of the techniques that ultimately led to the laparoscopic revolution. Learners can developp many of the laproscopic skills necessary for treating diseases of the uterus and adenexa through practice in ex vivo models.

Objectives:

To understand some of the technical skills required to perform basic gynecologic procedures.
To understand the mechanical and physiologic basis of minimally-invasive gynecologic surgery.

Station 12: Top Gun

Coordinator: James “Butch” Rosser, M.D.

The Top Gun Laparoscopic Skill Shootout Station will allow participants to both practice and compete for the ultimate trophy – “Top Gun.” The station will feature the “Rosser” stations developed at Yale and well known for requiring significant dexterity. Participants will learn tricks for achieving good scores as they practice for qualifying and final rounds of the Top Gun Shoot Out.

Objectives:

To improve dexterity skills using the “Rosser” stations
To compete with other surgeons in the Top Gun Shoot Out (no CME credits will be given for this competition)

Station 13: Fundamentals in Laparoscopic Surgery (FLS)

Coordinator: Gerald Fried, M.D.

This station will introduce participants to SAGES Fundamental of Laparoscopic Surgery (FLS) module. FLS is the first national program designed to teach the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery. Participants will use the interactive CD to become familiar with the didactic components and the lap trainer boxes to work on their skills. This station will also allow program directors who are considering using FLS to have hands-on time with the module.

Objectives:

To become familiar with the FLS module.
To learn the key preoperative, intraoperative, and postoperative considerations fundamental to laparoscopic surgery.
To acquire essential skills for laparoscopic surgery.

Station 14: Surgical Visualization

Coordinator: Brent Seales, M.D.

Information cues available in laparoscopy and other forms of minimally invasive surgery are impoverished relative to cues available in open surgery. Acquiring surgical skill in such an environment is extremely challenging. The goal of our project is to develop and test new technologies that will break down the barriers that block more surgeons from attaining and continuing to practice (without injury or pain) high levels of skill in MIS. At our station, participants will have hands-on experience with our training set-up, including a large-scale multiple projector display.

Objectives:

To demonstrate the advantages of several novel rendering and display techniques for reducing the physical, visual, and cognitive stressors associated with MIS.
To introduce features of a cognitive ergonomics toolkit that allow the assessment of outcomes such as a surgeon’s (or trainee’s) mental workload, distress, worry, engagement, and situation awareness.
To demonstrate measurement techniques that capture such physical outcomes as biomechanical stress and strain.