Page 28 - Journal of Laparoscopic Surgery - WALS Journal

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Ashish Saxena 10.5005/jp-journals-10033-1265
ORIGINAL ARTICLE

Smartphone/Tablet-based Laparoscopy Simulation

System: A Low-cost Training Module for Beginners
in Minimally Invasive Surgery

Ashish Saxena

ABSTRACT INTRODUCTION
Laparoscopic surgery is a well-established domain of surgery Laparoscopic surgery is a well-established domain of
and it has become essential for surgical practitioners to be well surgery. It has largely become the standard approach
versed in the technique. It has a steep learning curve which
exists because of a number of additional skills required for a and has gradually surpassed open surgery for most of
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successful transition from open surgery to minimally invasive the abdominal conditions. Therefore, expertise in the
procedures. Hence, it is desirable that a trainee should practice laparoscopy technique has become indispensable for
laparoscopy upon simulation devices before attempting an the optimum career growth of practicing surgeons and
actual procedure on a patient. Two types of simulators are surgical trainees alike.
currently available in the market: box type and virtual reality A steep learning curve exists for beginners in
type. The major limitation in their use is the cost factor involved. 2
These simulators are relatively expensive, which the trainees laparoscopy. This learning curve is attributed to various
in developing countries can ill afford. My efforts were directed newer skills required for a minimally invasive procedure.
at developing a low-cost simulator that is easy to assemble, These skills include depth perception, adjustment
requires minimal investment, and helps in improving depth to fulcrum effect, hand–eye coordination, bimanual
perception and ambidexterity at the same time. I devised manipulation, handling of laparoscopic instruments, and
a simulation system based on smartphone/tablet. These 3
gadgets (smartphone/tablet) are easily available everywhere ambidexterity. Normally, the human eye is adapted to
at a reasonable cost. In the apparatus devised by me, the rear three-dimensional (3D) vision, that is, it can appreciate
camera of a smartphone works as a laparoscopic camera and the depth or distance of an object, along with its length
its screen works as the monitor. Light-emitting diode flash and width. But during laparoscopy, the monitor provides
of the device functions as the light source. The smartphone only a two-dimensional (2D) visual field. The perception
has to be attached to a specially designed box fitted with of depth or distance is lost. It results in severe impairment
accessories to perform various tasks. The practice sessions
can be recorded and used for monitoring and evaluation by in hand–eye coordination, which in turn leads to the
experts. A satisfactory level of elementary laparoscopy training difficulty in instrument handling and may also lead to
can be imparted at a lower cost using smartphone-based inadvertent visceral organ damage.
simulation system. With repetitive exposure to the laparoscopic proce-

Keywords: Box-type trainer, Depth perception, Laparoscopy dures, the surgeon’s eyes get acclimatized to 2D vision,
training, Simulation system, Smartphone, Virtual reality trainer. and gradually attain the dexterity required to handle the
instruments smoothly and perform a procedure safely.
How to cite this article: Saxena A. Smartphone/Tablet-based
Laparoscopy Simulation System: A Low-cost Training Module However, it is preferable that the above-mentioned skills
for Beginners in Minimally Invasive Surgery. World J Lap Surg are acquired outside the operation theater on simulation
2016;9(1):26-29. devices.
Studies have shown that experience gained upon
Source of support: Nil
simulators results in an increase in operator comfort
Conflict of interest: None and patient safety and also reduction in healthcare
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expenditure. It has also been demonstrated that surgeons
who regularly play video games learn laparoscopic skills
Senior Resident faster than their nongamer colleagues. Therefore, it is
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Department of General Surgery, North Delhi Municipal obvious that the importance of simulator-based training
Corporation Medical College & Hindu Rao Hospital, New cannot be overemphasized.
Delhi, India
Corresponding Author: Ashish Saxena, Senior Resident AIM
Department of General Surgery, North Delhi Municipal
Corporation Medical College & Hindu Rao Hospital, New Training in laparoscopy is traditionally imparted with
Delhi, India, Phone: +919654249322, e-mail: docashish4u@ box-type trainer or with virtual reality trainer. Both
gmail.com
of these have been proven to be effective tools for
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