Vitrectomy simulator helps reduce learning curve for trainees

With the EyesI ophthalmosurgical simulator, students can improve their surgical technique for vitrectomy within hours, a surgeon says.

A computerized vitrectomy surgery simulator has shown promise in early tests as a useful learning tool for vitreoretinal fellows.

“This system has a high potential for accelerating the learning curve of surgeons in training. It will likely reduce the danger of complications when vitreoretinal fellows are first exposed to real-life surgery,” said Klaus Lucke, MD, ChB, at the American Society of Retinal Specialists meeting in New York.

Safer, more realistic

Dr. Lucke said the system, the EyesI ophthalmosurgical simulator (VRmagic GmbH) is a valuable tool for teaching fellows the art of vitreoretinal surgery.

“Vitreoretinal surgery is a complex set of procedures, placing very high demands not only on the conceptual understanding but also on the manual dexterity of the surgeon,” he said.

Historically, fellows have been trained in wet labs or in live surgical situations, neither which is ideal for training purposes.

“Wet labs mimic reality rather poorly, and live surgical situations raise the risk of complications,” Dr. Lucke said.

The EyesI simulator removes the risk of live surgery, while providing a surgical scenario that is more realistic than what students encounter in wet labs, he said.

“This ‘cybertrainer’ can safely teach a vitreoretinal student bimanual technique, navigation within the posterior segment and proper technique with respect to peeling maneuvers. Students also learn control of foot pedals,” Dr. Lucke said.

By learning these techniques in advance (and relegating them to the subconscious) surgeons-in-training can focus on the more demanding aspects of the procedure once in live surgery.

The EyesI simulator transmits instrument positions within the artificial eye by sensors onto a personal computer that calculates views of the operation scenario and projects stereoscopic images of the posterior segment into a stereomicroscope mimic.Trainees can watch on their computer screen as objects are picked up and manipulated with their mock vitreous cutter or endgripping forceps. A module for membrane peeling also allows students to simulate peeling the membrane over the macula. (Images courtesy of VRmagic GmbH.)

Mock surgery

EyesI technology, a system of hardware and software components, was modeled after airplane pilot training simulation systems.

“Pilots have been using these simulators for years. Now the ideal advantages of simulation have been brought to ophthalmology,” Dr. Lucke said.

Vitrectomy students insert mock instruments through two small sclerostomy-like openings into an artificial eye and human head model. Instrument positions within the artificial eye are transmitted by sensors onto a personal computer that, based on anatomical and biomechanical data, calculates views of the operation scenario and projects stereoscopic images of the posterior segment into a stereomicroscope mimic.

“The image is presented to the ‘surgeon’ by two organic LED displays,” Dr. Lucke said.

EyesI technology, a system of hardware and software components, was modeled after airplane pilot training simulation systems.

Trainees can watch on their computer screen as objects are picked up and manipulated with their mock vitreous cutter or endgripping forceps. A module for membrane peeling also allows students to simulate peeling the membrane over the macula.

The EyesI is ideal for learning theory and practice, Dr. Lucke said. The simulator presents medical background information on the trained procedures in the form of video footage, images and text. Students are guided step-by-step in hands-on training through the techniques required to perform a certain procedure.

“A gentle touch of the retina can result in blanching, or a strong contusion can turn into a reddening, which simulates a hemorrhage,” Dr. Lucke said.

Students at the June European vitreoretinal training school organized by Dr. Lucke in Bremen, Germany quickly forgot they were not performing live surgery.

“It’s amazing how quickly the fact is forgotten that one is dealing only with a simulation. Injuring the retina results in true anxiety,” he said.

During the simulation, the accuracy and precision of a student’s technique can be measured and displayed on the computer screen.

Improved performance

Scores for accuracy of technique between experienced surgeons and novices were “astonishingly different,” Dr. Lucke said. “The level of performance in various test modules was significant.”

However, once students repeatedly practiced the procedure, their outcomes improved.

“Students improved their performance within a few hours of training,” Dr. Lucke said.

The EyesI is commercially available. It is being constantly improved and further developed, according to the company. New simulation models become available on a regular basis.

For Your Information:

• Klaus Lucke, MB, ChB, can be reached at Universitätsallee 3D, 28359 Bremen, Germany; (49) 421-201-280; fax: (49) 421-201-2850; e-mail: k.lucke@retina.to; Web site: www.retina.to. Dr. Lucke has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

• VRmagic GmbH, makers of the EyesI Ophthalmosurgical Simulator, can be reached at B6, 23-29C, 68032 Mannheim, Germany; (49) 0621-181-2765; fax (49) 0621-181-2591; Web site: www.vrmagic.com.