GIE: training before ever entering the operating room

Prostate is a gland of the male reproductive system. Prostate cancer occurs in mature men. Think about the fact that approximately 30% of men over 50 suffer this type of cancer. Fortunately, if it is decteted early, it can be treated successfully. Survival rates are very high. Over 92% of diagnosed patients live more than five years after being operated on. Nevertheless, this cancer is still the second death cause for men, next on the list behind lung cancer.

Moreover, the surgical processes for this condition pose the usual problems and complications of open surgery: possible infections and a long recovery. Nowadays there is intense research under way in order to develop mininimally invassive technique, that avoid large incisions and suture. For example, cryogenic surgery allows doctors to inject through the urethra liquid nitrogen (at very low temperature) that actually burns cancer cells. Problem is that it is very difficult to control both the amount of liquid gas used and where it is applied, which can result in collateral injuries or partial removal of the malignant cells. Both mistakes could result in inconveniences for the patient or a need for a second operation.  Because of that there is a tendency to stick to more conservative techniques, which brings us back to the problem of open surgery.

Our work, instead,  is directed towards overcoming the drawbacks of non-invasive techniques. What we do is to help doctors refine their operating technique… before they ever enter the operating room. In fact, there is another non-inavsive technique, different to the cryogenic one, that uses a microscalpel to reach the prostate through the uretrhra. It actually works more like a incredibly tiny garden hoe than a proper scalpel. Doctors do stick this tool in the mass of cancer cells and draw it backwards, actually peeling off the bad tissue, like someone using a hoe in the soil of his garden, if at an incredible small scale.

The techinque involves introducing through the patient’s urethra both the scalpel, a fiber optic camera and like and a jet of water that is used to remove the discarded cells.

This is a highly effective treatment with little secondary effects. However it hinges critically on the ability and experience of the surgeon. A badly located cut of the hoe could damage permanently a sphincter or perforate the prostate capsule.

Surgeons new to this technique have a big difficulty since it is impossible to train with a live patient in front of you and it working as a side surgeon to a more experienced one is too risky and brings little learning, since most of the technique reolves around a fine sensing of the behaviour of the surgical tool. No experienced surgeon can make for a novice’s fault since there is almost no room, nor time for a repair, as it it is usually the case in open surgery.

This is where our work comes in and it is crucial. We work to develop computerized simulators so that future surgeons can operate once and again until they become proficient with this technique… without ever having to operate a real person. What we do is to create a prototype for learning.