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VirtaMed revolutionizes a 4,000-year-old tradition

September 28, 2016

VirtaMed is a company that respects the past, whilst looking to the future in surgical training. Technological innovation with patient care at the center are the pillars of VirtaMed’s visionary ideas. Rather than breaking from surgical training traditions, VirtaMed sees itself as improving, developing, and building on these traditions to improve patient care through surgical training.

Many people might presume that endoscopic, or minimally invasive, procedures have been a part of medicine since the 1960s, however the tradition and technique of endoscopy goes much further back in our history. Endoscopic tools have been used since 1700 BCE in Egypt and even in the ash and rubble of Pompeii, archeologists found specula-like devices. Minimally invasive procedures have been preferred to ‘big’ surgery—large incisions—due to shorter recovery time, lower infection rates, and generally less trauma for the patient. The idea behind endoscopy is both a technical skill and a general philosophy that has been adapted from the Hippocratic Oath into Latin; Primum non nocere – first, do no harm. Hippocrates was a strong advocate for minimally invasive surgery. Arguably, this patient-centered philosophy is what is continued throughout contemporary medicine today.

Advances and discoveries in anesthesia, hygiene, and surgical techniques have changed the way surgery is done today. Surgery was previously used only to treat injuries and trauma, rather than as a preventative or elective procedure. The development and the training of endoscopic tools and procedures was paramount in surgical advancement. Endoscopic tools that look closer to what surgeons use today can be credited to Italian-German Philip Bozzini and his Lichtleiter. The Lichtleiter, developed in 1805, had a light container with an optical device and a mechanical part with viewing tubes fitted for different anatomical access (urethra, gunshot tracts, etc.). However, the endoscope was truly revolutionized in 1967 by Harold Hopkins who used large quarts and rod-shaped lenses for better illumination and visibility inside the body cavity.

The notion of ‘first, do no harm’ is a constant in medicine the world over. Yet the question: How do surgeons learn and train in a safe environment for themselves and the patient? Many educational surgical traditions have involved the use of cadavers and hands-on practice in the OR to learn the practices of surgery. The former does not compromise patient safety, however, cadavers can be extremely expensive or even forbidden, and they do not allow surgeons to learn UPRT (Upset Prevention and Recovery Training) techniques. Hands-on experience is vital for surgical training, although patient-risk is always a factor when learning in the OR. The idea of being able to practice endoscopic procedures without any risk of patient harm has been at the core of VirtaMed’s company vision. By creating anatomical models for arthroscopy, urology, and women’s health, VirtaMed helps trainees and surgical educators to learn and train in a risk-free environment. Through the culmination of engineering and medicine, VirtaMed has provided surgeons and trainees with the perfect way learn and practice without the risk of harming the patient: surgical simulation. By using the same tools as in the OR, trainees are able to practice minimally invasive surgery and continue the 4,000-year-old tradition of endoscopy.

Surgical simulation does not stop with VirtaMed’s current simulation products. Denis Steinemann, CTO and Co-founder of VirtaMed, hopes to see virtual reality simulators push surgical boundaries even further. “It would be great to see all surgery trainees certified on a VirtaMed simulator by 2026,” says Denis. "There are really no limits for what VirtaMed can achieve given the right time and funding. We could create simulators to test new surgical tools before they are tested in the OR; we can help create standardized procedures and training with surgeons; and it isn’t impossible to imagine that one day the simulator could provide a full immersion experience into the world of virtual reality.

One of the challenges facing surgical simulation is integrating the use of these ever-advancing simulators into existing medical training curricula around the world. Anne Marie Kaufman RN, BSN who is VirtaMed’s Manager in Simulation Education for the U.S. says, “Everyone believes in surgical simulation. This very well may become a large component of how we will teach and think about medicine in the future. Our next step is to work even closer with training centers to make sure they are using surgical simulation to its full potential.”

The mandated limitation on work hours for trainee surgeons creates a potential problem for learners to gain enough hands-on experience. However, with VirtaMed simulators you have the possibility of performing surgical procedures without OR time. While trainees are on call, they can use simulators and train during their down time. As Anne points out, “Training time is so vital and so precious for trainee surgeons. Without enough hours they cannot be certified, and surgical simulation is a way to help trainees learn and improve at their own pace without the worry of OR time or patient risk.”

Endoscopy training and development has come a long way since 1700 BCE in Egypt. Remembering its place in the history and the future of endoscopy training and research development, VirtaMed is always looking for innovative ways to help surgical training centers to help their trainees. In a hundred years from now, VirtaMed hopes that it too will be remembered for its innovations in endoscopy practices, but also for its continued efforts in improving patient outcomes through better surgical training: driving cognitive and haptic skills - safer, more cost effective, and time efficient.

Specula from Pompeii (approx. 79 CE) (Source)

Bozzini's Lichtleiter (1805)

Philip Bozzini's Lichtleiter (1805 CE)

VirtaMed's first simulator (2006 CE)

VirtaMed's simulators today (2016 CE)