"Almost as operating on a real patient"—Interview with Roger Härtl

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The technical advances in simulator technology today provide highly realistic training environments. One of the educational highlights at this year's Davos Courses is the Advanced Level Simulated Bioskills Course. It is the first time that AOSpine is offering this kind of training in Davos. The simulators used in the course are state-of-the-art simulation models that provide high fidelity procedure training.

 

​Based on artificial materials with realistic anatomical structures, soft tissues, intraoperative bleeding system and authentical haptic that are very close to life like, the simulator is almost as realistic as a real patient. The simulator models allow the surgeons to pull, stretch, twist, punch, cut, mill and more. In comparison with virtual reality systems the operating surgeons use conventional surgical instruments.

 

Based on artificial materials with realistic anatomical structures, soft tissues, intraoperative bleeding system and authentical haptic that are very close to life like, the simulator is almost as realistic as a real patient. The simulator models allow the surgeons to pull, stretch, twist, punch, cut, mill and more. In comparison with virtual reality systems the operating surgeons use conventional surgical instruments.

Together with Roger Härtl, a new patient case with spinal canal stenosis was developed in addition to the already existing modules discectomy or sequestrectomy. For this surgery, the spinal canal stenosis can be operated with the so-called „crossover technique“using a surgical microscope. This allows training not only for novice surgeons but also for experienced surgeons on the simulation system. The Advanced Level Simulated Bioskills Course will set new standards in practical learning and let the participants experience the newest technical innovations in practice.

 

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What is your experience with the bioskills simulator and why do you feel that they are important for surgery training?

The future of this simulator is almost without limits. More advanced versions will allow surgeons to practice implant insertion, and combine it with microsurgical decompression procedures. Also, 2D and 3D navigation techniques would ideally be trained on these simulators. By using a simulator, surgical training would not require a sterile environment, special preparation or x-ray, and so could be done in a lecture hall, classroom or lab. Also, the simulator is suitable for surgeons with all levels of experience. For example, surgeons can train in the very basic applications of microscopes and drills, or in more advanced procedures that may entail an over-the-top decompression or contralateral foraminotomy.

 

​This simulator is the only method that I am aware off that facilitates surgical training in a very realistic setting outside the operating room or cadaver lab. The simulator features a detailed replica of the muscle tissue, the bone, the Dura and the ligamentum flavum, which provides a very similar environment to what the surgeon experiences in a real human being.The simulator also has a bleeding function, which adds to the authenticity of the surgical experience. The main benefits of the simulator are that the surgeon can practice a complete procedure from skin incision to closure, with all the steps required in a real surgery.

 

How does the haptic experience of a simulator compare to real surgery?

This simulator is the only method that I am aware off that facilitates surgical training in a very realistic setting outside the operating room or cadaver lab. The simulator features a detailed replica of the muscle tissue, the bone, the Dura and the ligamentum flavum, which provides a very similar environment to what the surgeon experiences in a real human being.

 

The simulator also has a bleeding function, which adds to the authenticity of the surgical experience. The main benefits of the simulator are that the surgeon can practice a complete procedure from skin incision to closure, with all the steps required in a real surgery. Another advantage is that the simulators are identical, and therefore the procedure can be taught in a very standardized way.

 

 

How long have you been using the simulator and what do you practice/train most?

I have been using the simulator for approximately one year, primarily at spine meetings. I find that the current model is most helpful for teaching minimally invasive spinal surgery techniques, especially MIS laminectomy with "over- the- top" decompression. The unilateral approach for bilateral decompression and a contralateral foraminotomy can also be taught very effectively with this simulator.

I also envision that other important techniques such as endoscopic procedure will be taught and trained with these simulators in the future.

 

​In my opinion, surgical simulation will dramatically improve surgical education. We will move increasingly away from cadaver labs and towards more realistic, safer and cleaner, and cost-effective techniques to train our future surgeons.

 

In your view, how will surgical simulation change surgical education?

In my opinion, surgical simulation will dramatically improve surgical education. We will move increasingly away from cadaver labs and towards more realistic, safer and cleaner, and cost-effective techniques to train our future surgeons.

 

 

What are your expectations for the simulated bioskills course in Davos this December?

My hope for the course in Davos is that the simulator will guide enthusiastic and open-minded surgeons in learning the basic skills involved in MIS surgery. Namely, the use of a microsurgical drill and the microscope, and how these can be utilized to facilitate and improve the safety of MIS surgery. I hope that the very professional, clean and pleasant environment provided by these simulators will enhance communication and interaction and camaraderie among the surgeons.

 

 

This Advanced Level Simulated Bioskills Course is designed for experienced surgeons wanting to develop their skills in minimally invasive spine surgery (MISS) and of the operating microscope, and who are keen to gain greater proficiency in lumbar decompression and instrumentation on artificial bones and simulated specimen. Through intensive, 1:1 hands-on sessions at the bioskills simulator, participants will engage in surgical techniques and strategies for a range of procedures. With a 3:1 ratio between faculty and participants, the teaching level will be exceptionally high. The course will also include blended learning with pre-course online learning resources, virtual tutorials and access to practical videos, didactic sessions with ample time for discussion.

 

The Course will be chaired by Roger Härtl (USA). Luca Papavero (Germany) will be the Educational Advisor. The Faculty will consist of Andreas Korge (Germany), Harry Gebhard (Switzerland), Avelino Parajon (Spain) and Stephen Theiss (USA).

 

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Roger Härtl, Chairperson of the Advanced Level Simulated Bioskills Course on the new educational highlight. Roger Härtl is Professor of Neurological Surgery, Director of Spinal Surgery and Director of Weill Cornell Medicine Center of Comprehensive Spine Care in New York, USA.