Minimally Invasive Surgery

January 10, 2003

Heather Heilman

It's something like a set of kindergarten toys for developing manual dexterity. The object is to pick up a bean and drop it through a small hole, to move letter- shaped blocks to their corresponding spot on a grid, to tie a knot in a thread.

Only these tasks are much tougher than anything you did in nursery school because you've got to do them by manipulating scopes like those used in laparoscopic surgery, while watching your progress on a video screen. In addition to the six-station video trainer in the skills lab of Tulane's new Center for Minimally Invasive Surgery, there's a virtual reality training system for practicing the same types of motor skills, only this time without the benefit of any feedback save what's on screen.

The center will be a test site for new simulators, and is working with the department of biomedical engineering to develop and refine motion-tracking devices. Laparoscopic surgery, in which scopes are inserted into the body through small incisions, has lots of advantages for the patient over conventional surgery. It's less painful, with a shorter recovery time, and in many cases leads to better results. But for the surgeon, the techniques involved can be tricky.

Yet research shows that training on simulators is better and more effective practice than operating room experience, according to Daniel Scott, director of the center and assistant professor of general surgery. But only a handful of medical schools offer student and residents that kind of training.

"This is a very novel teaching method," said Scott. "There's probably a half-dozen centers in the country doing anything on this level."

Starting this month, residents in surgery, urology and gynecology will build their skills in the training lab before going into the operating room, and medical students will practice in the lab during surgery rotations. Curricula for urology and gynecology also are under development. Of course, there's more to the Center for Minimally Invasive Surgery than the skills lab. It was established in the fall as a joint effort of the medical school and the hospital, which opened two new state-of-the-art operating rooms for laparoscopic surgery.

The new operating rooms are set up for teleconferencing, which will let surgeons interact with doctors in other locations during an operation. But it also will allow surgery to be broadcast live in a classroom. The hospital also acquired the new da Vinci robot, a surgery system that uses a computer interface to allow the surgeon to make more precise, controlled movements than are possible in conventional laparoscopic surgery.

The robot's instrumentation gives the surgeon improved range of motion because of a little "wrist" at the end of the instrument that articulates in any direction needed. And the surgeon watches those movements with the aid of a three-dimensional imaging system. Tulane is currently the only hospital in the area to have this system.

"That will change, but what won't change is our dedication to use it not just for the improvement of patient care, but as a part of our greater mission of education," Scott said. "Our larger goal is to train highly skilled laparoscopic surgeons."

In addition to training students and residents, the center will implement a two-year fellowship program for advanced training in laparoscopic surgery and continuing medical education courses for practicing surgeons.

Heather Heilman can be reached at

Tulane University, New Orleans, LA 70118 504-865-5000