MITIE Robotic training lab blends technology, imaging and surgery

The MITIE Mission

SHARING MEDICAL KNOWLEDGE HERE AND AROUND THE WORLD

BY PATTI MUCK

Somewhere in Costa Rica, a patient awaits arrival of the latest laser technology to vaporize his enlarged prostate. Dr. Carlos Calvaso, at Hospital CIMA in San Jose, is trained and ready to treat patients with the powerful 120-watt GreenLight™ High Performance System laser as soon as it arrives.

The experienced urologist has treated prostate conditions for years, but he learned how to use the newest, most advanced technology at the Methodist Institute for Technology, Innovation and Education — MITIE,™ for short. In a two-day session in MITIE’s temporary headquarters, Calvaso joined urologists from around the world for a series of lectures, live surgery observations and hands-on practice using GreenLight laser in bull prostates.

“No hospitals in Latin America or anywhere have a lab like The Methodist Hospital,” Calvaso says.

GreenLight uses a small fiber inserted into the urethra through a cystoscope. Laser energy heats the prostate tissue and vaporizes the enlarged portions. The procedure opens the channel for urine flow without the negative side effects associated with more traditional invasive surgery. (See LEADING MEDICINE, Vol. 3, #3 for more information on GreenLight.)

“I appreciated the ability to watch live operations and see how difficult cases were handled,” Calvaso says. “The lab was very useful for us — it is an important issue in Latin America.”

Calvaso is one of about 500 physicians who have trained at MITIE in the last year. Sessions like this reflect MITIE’s mission to share medical knowledge and raise the bar for health care professionals in every specialty. “That’s what we’re here for,” says Dr. Brian Dunkin, medical director for MITIE and head of endoscopic surgery at Methodist. “We’re here to train the world.”

Methodist urologist Dr. Ricardo Gonzalez helped acquire this latest technology and led the May sessions, which were attended by 30 urologists from eight countries. Methodist has since become a center of excellence for treatment and training with GreenLight laser.

A conference room was used for didactic and video instruction and discussions. Those in attendance then watched Gonzalez perform four live surgeries telecast from the main urology operating room, during which they could ask questions in real time.

INANIMATE SKILLS LABORATORY

A neurosurgery team practices establishing an airway while protecting the “patient’s” spine from injury.

THE PROCEDURAL SKILLS LABORATORY

Dr. Brian Dunkin (right) teaches a new procedure in flexible endoscopy to a gastroenterologist.

Mini-MITIE

Since MITIE set up temporary headquarters within the last year, doctors from around the state, nation and globe as well as nurses, allied health care professionals and medical residents from Methodist, have used the 17,000-square-foot facility.

Using the training space and stateof-the-art equipment, they have learned and practiced everything from airway and sedation management to sophisticated robotic mitral valve surgery and radiofrequency ablation for esophageal disease.

Dunkin affectionately refers to MITIE’s temporary headquarters as “Mini MITIE.” When The Methodist Hospital Research Institute building opens in 2010, “big” MITIE expands to 40,000 square feet and will include a virtual hospital, 15 procedural training stations, five research operating rooms, six conference rooms and a med-presence room for high quality remote viewing of

THE PROCEDURAL SKILLS LABORATORY

This area contains multiple mini-operating rooms where hands-on training takes place for all types of surgical and endoscopic procedures.

MITIE RECENTLY RECEIVED ACCREDITATION ONE COMPREHENSIVE EDUCATION INSTITU AMERICAN COLLEGE OF SURGEONS

the operating room and other procedural areas. Administrators and their industry partners already are developing and designing areas with all boom-mounted equipment, including imaging screens and visual training aids.

“MITIE is a fermentation vat for creative ideas,” says Dr. Barbara Bass, chair of Methodist’s Department of Surgery and executive director of MITIE. “Even in its current form, MITIE really is unprecedented.”

MITIE focuses on primary learners as well as experienced physicians, nurses and other health care professionals, who must retool to keep up with technological advances in their fields.

“When you come to MITIE, you don’t just come and perform a procedure,” Bass explains. “You have the opportunity to see surgeons in practice who use this on a regular basis. The more clinical experience you can link to retooling, the more real it becomes.”

MITIE recently received accreditation as a level one Comprehensive Education Institute from the American College of Surgeons. Its focus on continuing education for surgeons and health care professionals in practice was noted as an area of distinction, Bass says. “Our program was approved without contingency or the requirement for early progress reports — a unique accomplishment.”

This recognition gives MITIE access to a high-end network of shared educational scholarship and unlimited opportunity for valuable research partnerships both here and abroad. Collaborations under way include several joint research projects between Methodist and the University of Houston Computer Science Department.

In just one example, Bass is collaborating in experiments to understand and quantify stress during surgical training and study its link to performance. Using surgical faculty and

resident volunteers, the researchers use thermal mapping to track changes in the face while the volunteers practice laparoscopic procedures.

“The hypothesis is when people are still learning a skill, they show signs of stress,” Bass explains. Finding a metric to measure skill acquisition would provide an important scientific tool in any field, not just surgery, she says.

ENDOVASCULAR SIMULATION SUITE

Samantha is a full patient mannequin simulator on which team training can be performed to treat all types of vascular diseases from the brain to the heart to the aorta.

Samantha and iStan

Hundreds have trained in MITIE’s simulation suite, home of Samantha, a high-tech mannequin with the capacity to offer practice on an unlimited number of medical scenarios. Interventional radiology, catheterization, endovascular procedures — Samantha handles them all and more.

“She can exhibit many different abnormal heart rhythms, blood pressure complications, stroke and even death,” explains Methodist’s

Michael Donovan, director of surgical education for MITIE.

During a recent tour of MITIE’s temporary headquarters in the hospital’s West Pavilion, he talks with an industry representative putting the finishing touches on iStan, a high fidelity, wireless patient simulator.

Not only does iStan have the capability to change into a female patient, but, “His nose can drip blood, he has sites for chest tube insertion, he can even have a urinary catheter placed, if needed. The main point of this device is to train teams on advanced cardiac life support so they can better prepare to help patients in need of their skills,” Donovan says.

Just around the corner at MITIE, two daVinci robots are available for practice in mitral valve repair, prostatectomies and other procedures. Here Dr. Gerald Lawrie, one of the most experienced heart valve repair surgeons in the world, brought his entire operating room team to practice and perfect his own technique for robotic mitral valve repair. MITIE has become one of the busiest robotic training labs in the country.

In another MITIE operating room, leading gastroenterologist Dr. Atilla Ertan learned to perform radiofrequency mucosal ablation using the BÂRRX Halo360 and Halo90 devices. This minimally invasive flexible endoscopy technique is used to heat and remove damaged esophageal tissue. Ertan, one of the world’s leaders in managing diseases of the esophagus, is now considered an expert in the Halo radiofrequency energy ablation system, and Methodist is among the leading centers offering the technology.

Methodist’s surgery and critical care team has taken over one of MITIE’s research operating rooms to set up a mock intensive care unit. Here they work to create a better model to display information. Currently, most critical patient information is located outside the room or on a confusing template that makes interpretation time consuming and difficult. The team believes it can design a way caregivers can stay at the bedside and let technology record data.

Ideally, physicians, nurses and supporting caregivers should be able to access important information and interact with it on a touch panel display at the bedside. It’s one among hundreds of innovative concepts taking shape at MITIE.

“MITIE allows us unlimited creativity,” Bass says. “Its multidisciplinary approach and blending of technology, imaging and surgery are really exceptional.”

One of MITIE’s key research focuses is the development of teleproctoring, where communication and imaging links will allow Methodist experts to walk physicians through a case in real time, no matter where they are in the world.

MITIE offered 16 training programs in the last eight months, not counting the robotic training labs. Dunkin hopes to increase that number to at least 40 in the next year. When “big” MITIE comes on line, the possibilities for training and research are limitless.

AS A LEVEL UTE FROM THE

TELEPRESENCE

An example of the type of audio-visual communication being installed in operating rooms at Methodist.

To learn more about MITIE, visit methodisthealth.com.

Photos courtesy of MITIE