Patient Robots
On whom to study as a surgeon
Maxim Russo, <url>Many things are best learned by trial and error.
Even after reading a lot of books, it is impossible to become any skilled pianist or carpenter, start playing billiards or master judo wrestling. Practice is needed. After repeated repetitions, the movements will become accurate, the brain will learn to make quick decisions, and as a result, billiard balls will start falling exactly into the pocket or wonderful music will flow from under your fingers.
But there are things for which learning by trial and error is still undesirable. It is unlikely that anyone will send a detachment of untrained sappers to a minefield, hoping that the one who survives will become a highly qualified specialist. The patient will be unhappy if a medical student tries to treat him by trial and error. This means that in teaching those professions on which life depends, a stage of joint work with a professional is necessary. An instructor is sitting next to the pilot cadet, the student is assisting an experienced surgeon in the operation. But there will definitely come a time when a young pilot will go on a solo flight, and the doctor himself will pick up a scalpel. In order to prepare a person for the transition to independent work, many simulators and simulation programs have been created that put him in a working situation, but an error in handling them does not entail the victims that would occur in real life.
One of the first to use simulators in the training of doctors was resorted to in medieval China. Special mannequins with small holes in different parts of the body have been preserved. When the mannequin was dressed, the holes were hidden under the clothes. The future doctor, mastering the acupuncture method popular in Chinese medicine, had to remember exactly the location of the points to which the needle should be directed in order to get the needle into the holes of the mannequin without seeing them. In Europe of the XVII – XVIII centuries, wax sculptures of people with open internal organs were often used to train surgeons. There were special dynasties of masters who supplied medical faculties of universities with such exhibits. They can still be seen in museums of the history of medicine. But they were still visual aids, not simulators for novice doctors. In the XX century, devices appeared that allow to work out a specific manipulation, for example, intubation. Such a simulator reproduced the device of the human larynx, but did not give the feeling of working with a living patient that was so necessary in the preparation of a doctor.
One of the first simulators that simulate working with a patient was "Harvey", created in 1968 at the University of Miami.
Developer Dr. Michael Gordon gave him this name in honor of his favorite teacher. "Garvey" looks outwardly like a lying patient, a man (although they never made his legs). In its first version, it was able to demonstrate 25 different parameters of a living patient: breathing, blood pressure, pulse, heart tones and noises. Examining and listening to "Harvey", the student learned to diagnose changes in cardiac activity. Now an improved version of this simulator is used both in teaching students in the general training course and in an in-depth program in the field of cardiology. Comparative studies have demonstrated the effectiveness of this method. Medical students who have been trained using a simulator show better results on tests than the control group.
An event in the development of medical simulators was the appearance in 1988 of the computer game Life & Death. This program helps the surgeon to learn how to work with his hands, but teaches him to make decisions in a real-time environment, based on information about the patient's condition. The player must make a diagnosis (a set of diseases in the first version of the game: kidney stones, arthritis, appendicitis and aortic aneurysm) and carry out treatment, if necessary – surgery. The game has received many positive reviews, updated versions have been released, including neurosurgical operations.
In addition to the studies of the effectiveness of the "Harvey" mannequin, general comparative studies of the results of students' training with the help of simulators and the traditional method, only by books, were carried out, of course. They are led by a specialist in medical simulators, Dr. Bharath Chakravarthy from the School of Emergency Medicine at the University of California, Irvine. In particular, according to one of the studies, in groups of students where simulators were used, the average score on the tests was 4.03 points out of five, and among students who studied from books, 3.05 points.
Surgical operation simulators are most popular when preparing doctors for laparoscopic operations, as additional difficulties arise during such operations. The surgeon does not receive tactile feedback, since his hands do not touch the patient's organs. Moreover, manipulations in laparoscopic surgery are counterintuitive, for example, the movement of the instrument to the right corresponds to the movement of the surgeon's hand to the left. Another difficulty is the need to perform actions in three-dimensional space, using a two-dimensional screen as a guide. In some natural science museums and centers of entertaining science, visitors are offered a relatively simple task: using manipulators that are used in laparoscopic surgery, to unfold a candy wrapper. If you come across such an attraction, try to do it, and you will see how difficult it is the first time.
Simulators are used not only in teaching students. Experienced doctors can now resort to them, planning the scenario of the upcoming operation. Moreover, nowadays simulators allow not only to discuss the general course of the operation, but also to take into account the characteristics of a particular patient. The first such experience took place in 2009 in Halifax, Canada, when Dr. David Clark first performed a virtual operation to remove the tumor using a simulator simulator and a computer model of the patient's brain, and the next day successfully removed this tumor.
The Kazan company "Eidos-Medicine", which is part of the cluster of biomedical technologies of the Skolkovo Foundation, produces a number of simulators and simulators designed to train doctors. Among them is a robot simulator of the patient ENSIM-RP.01, which allows you to teach how to provide assistance in emergency situations. It realistically conveys the anatomical structure of the human body, and the skin covering the ENSIM looks and feels like human skin. The robot is connected wirelessly to a computer used by a teacher who controls the student's work.
ENSIM is able to show symptoms of a number of conditions that a doctor faces during resuscitation. Among them are anaphylactic shock, angina with cardiac arrest, myocardial infarction of various types, heart failure with the development of pulmonary edema, insecticide poisoning, asthma attack, rupture of the spleen with pneumothorax, puncture wound of the chest, subdural hematoma and others. Depending on the patient's condition and the doctor's actions, the robot changes its physiological characteristics. When bleeding, for example, blood pressure drops, tachycardia begins, and so on.
For diagnosis, the doctor can listen to breathing at 14 points, heart tones, intestinal peristalsis, Korotkov tones (blood pressure indicator). The pulse is felt at 14 points. It is possible to record ECG, body temperature, blood and other indicators.
Another training complex based on this robot – ENSIM RPA-01 – is designed for anesthesiologists. The robot is able to recognize not only the medicine that the doctor gives him, but also the dose, and depending on this, change the vital parameters accordingly: pulse, pupil response to light, open / closed eyes, depending on whether the patient is conscious. Moreover, the robot does not behave the same every time. The instructor can choose one of 25 variants of the patient's physiology: a healthy young man, a chronic smoker, a strong male soldier, an elderly grandmother, a pregnant woman and others - in each case, the robot will demonstrate the patient's characteristic reaction to the actions of the anesthesiologist.
As explained by Lenar Valeev, CEO of Eidos-Medicine, medical simulators are equipment that allows you to simulate in detail all stages of surgical operations, while reproducing all the tactile sensitivity that the surgeon feels when working with his hands. All types of complications, both general and surgical, are displayed. Such a simulator offers to fully work out all the stages of endosurgical surgery, together or separately.
According to him, only a few companies in the world produce virtual endosurgical complexes. At the same time, Eidos-Medicine is the only company that serially produces simulators in Russia.
In addition, the company cooperates with the leading medical universities of the country and is going to expand the geography of supplies. "Currently, we supply equipment to the First (I. M. Sechenov First Moscow State Medical University) and the Second Med (N.I. Pirogov Second Medical University), as well as to the scientific and medical complex "Moniki", all of them are also our partners and participate in the development. Last year, the delivery of simulators took place inside Russia, this year we sent the equipment to Istanbul, a little later it is planned to deliver simulators to the United States," said Valeev. According to him, the company's turnover in 2013 exceeded 200 million rubles.
The company, in particular, has developed a hybrid simulator that has no analogues, combining a patient robot, a surgical simulator, surgical and anesthetic racks. All this allows you to work out the joint actions of the entire medical team: resuscitators, anesthesiologists, surgeons and assistants.
He said that Russian simulators have an advantage not only in terms of cost, but also in terms of quality characteristics. "Some of our complexes have no analogues in the world, and some of them are significantly superior to foreign analogues," he added
Portal "Eternal youth" http://vechnayamolodost.ru12.005.2014