Cost-effective training system for laparoscopic and robotic surgery

Laparoscopic instruments

Minimally invasive surgery (MIS) revolutionizes surgical care and treatment by reducing trauma to patients, reducing the need for painkillers, reducing recovery time and hospital stay, and improving cosmetic outcomes. Laparoscopic surgery is performed by entering the abdominal cavity, using a laparoscope to view the cavity and performing diagnostic and therapeutic procedures. The term “laparoscopic” comes from the Greek “laparo” (flank) and “skopein” (to be examined). As surgeons mastered laparoscopic cholecystectomy, they began using laparoscopy for other advanced abdominal procedures.

needle holder

In the past few decades, surgical techniques have developed rapidly due to the emergence of electronics and computers in the medical field. Traditionally, surgery has been based primarily on the formation of wide incisions in the human body.
MIS or laparoscopic surgery involves less pain because the risk of damaging tissue is almost negligible compared to traditional open surgical procedures. Tissue damage is the main cause of postoperative complications, so MIS helps to quickly recover patients and avoid long-term hospitalization. In addition, the chance of infection after surgery is minimized due to the use of smaller incisions. These factors lead to the use of pain medications and reduced hospital stays, which significantly reduces health care costs.

Laparoscopic surgery relies heavily on a variety of electronic and mechanical tools to assist the surgeon in performing all surgical procedures within the constraints of a smaller incision. Recent advances in the field of robotics have also been applied, and now robots are used to help MIS surgeons. Controlling a set of robotic arms, the surgeon can sit in front of their computer console to operate the patient and receive HD video feedback. In this way, not only is the accuracy of the surgery significantly improved, but the fatigue factor of the surgeon may also be reduced.

Due to the above benefits of robot-based laparoscopic surgery, more and more countries are adopting these technologies. The biggest challenge for this trend is that surgeons are still accustomed to traditional methods and require extensive training procedures before using laparoscopy and robotic surgery techniques. Getting this expertise is not very simple, because

Learning and practicing skills in the operating room (OT) is immoral,
When practicing on animals or any other object, it is impossible to master laparoscopic techniques such as hand-eye coordination and depth perception.

Laparoscopic instruments
Computer-based simulators have been proposed as a solution to this problem and are now widely used for training purposes in the West. These simulators allow surgeons to practice their skills in a virtual environment over and over again until they gain a level of expertise, and then they can start practicing in OT with the help of an expert. The problem with this simulator is its huge cost, such as the most advanced simulators for laparoscopic surgery, such as LapSim and ProMIS, which cost thousands of dollars, which makes them very widely used in developing countries like Pakistan. difficult. Commercial Minimal Invasive Surgical simulators, such as LapSim, cost from $50,000. Commercial surgery costs like Da Vinci range from $1.5 million to $2 million, while robotic surgery training systems start at about $100,000. In fact, to the best of our knowledge, Dr. Asif Zafar’s Telemedicine and Electronic Health Training Center at the Holy Family Hospital in Rawalpindi is the only centre in Pakistan to receive such simulators, thus maintaining the only training laboratory for MIS.

Rawalpindi collaborated with the Holy Family Hospital, and the School of Electrical Engineering and Computer Science (SEECS) worked with the Sagrada Familia Hospital to try to solve this problem by developing a cost-effective laparoscopic and robotic surgery training system in Pakistan .
The proposed system can be divided into three main modules. A simulator for laparoscopic training, a set of input controllers for manipulating laparoscopic instruments within the simulator, and a set of robotic arms that will be controlled using these input controllers. The surgeon will be able to physically manipulate the object using the robotic arm. The same exercise will be performed in the virtual environment in the simulator and then executed in reality using the robotic arm. This will allow the user to perform not only laparoscopic surgery but also robotic surgery. The key to the cost-effectiveness of our newly proposed training system is the use of open source tools and software development libraries as well as useful human resources in Pakistan.

The system will feature minimally invasive surgery simulators, robotic surgery simulators and simulators (a set of robotic arms working on mannequins) and input controls with tactile feedback. For the simulator, a video of real life complications and laparoscopic surgery collected by the Holy Family Hospital will be simulated in the simulator. Therefore, the training system will have basic and advanced training.

For robotic arms, commercial systems like Da Vinci have custom robotic arms with custom laparoscopic instruments. We will design our robotic arms around traditional laparoscopic instruments (mass production in Sialkot), which will lead to a very cost-effective system. Our design will significantly reduce costs and will be brand new and built from the ground up.

The project is funded by the National ICT Research and Development Fund of the Ministry of Information Technology and is expected to be completed in June 2013. Once developed, all major hospitals in Pakistan are able to access these training facilities at very affordable prices, which will certainly improve. Pakistan’s health care facilities.

Historically, Sialkot has been the center of development and export of surgical instruments around the world. With the shift from surgery to MIS and robotic assistive technology, the surgical instrument industry in Pakistan has failed to keep pace with global competition. Its 2008-2009 sales were $250 million.

Laparoscopic instruments

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