Virtual Surgery Surgeons-in-training hone their skills with 3-D "virtual surgery" techniques at the Center for Advanced Surgical Technology.

The 61-year-old patient has checked in for tests at Indiana University School of Medicine. She complains of severe coughing, no doubt exacerbated, perhaps even caused, by a forty-year addiction to cigarette smoking. The decision is made to perform an endoscopic procedure so that physicians might find the source of her cough and other potential health problems.

David F. Canal, MD, associate professor of surgery, gingerly winds the bronchoscope tube through the patient's nose through the vocal chords. He looks intently at the screen, monitoring the magnified long and winding road to the right bronchus. As the tube passes through the trachea, Dr. Canal slows as he comes to the fork in the road, the carina, a cleft-like structure that separates the openings to the two bronchi, the gateways to the lung. The patient coughs a few times because of the endoscope, a natural response during such procedures.

"Okay, we need a few shots of lidocaine, please," Dr. Canal says to surgical research associate, Lisa Fisher. She presses a button a couple of times, anesthetizing the area, and the coughing subsides. He continues his journey and soon finds what he's looking for: a small, dark growth looms on the screen.

The jaws of the forceps pop open from the head of the scope and he moves it near the base of the growth. He snips and clamps onto the tiny mass. "There's a little blood. Looks like we got a good biopsy here," he says, as he slowly withdraws the device and completes the procedure.

Ordinarily, the biopsy would be on its way to pathology. But no growth has been removed in this case nor will there be any diagnosis, treatment and outcome. In fact, there is no patient, save for the virtual one that exists in the computer program. It's one of the training modules at the IU School of Medicine's Center for Advanced Surgical Technology, the newest addition to the Department of Surgery, which opened late summer 1999.

"We sought to take advantage of the best technology on the market and enhance the education of our surgical residents and medical students," says Jay Grosfeld, MD, Lafayette F. Page Professor of Surgery and chairman of the Department of Surgery.

"The center is an extension of our ongoing mission to provide meaningful and lasting hands-on training for future surgeons." The inanimate nature of the equipment also reduces the need for animal subjects used in surgical training. The center was made possible by a $600,000 grant from U.S. Surgical Corporation, a subsidiary of Tyco International Limited. Funds were used to purchase some of the most sophisticated computer hardware and software available, incorporating 3-D interactive graphics, or "virtual reality."

The Tyco grant also has allowed the School to acquire equipment and models used to practice minimally invasive procedures such as laparoscopy, endoscopy, thoracoscopy and suturing techniques. Also, there is an arm model in which residents and medical students can practice inserting intravenous solutions.

Dr. Canal oversees operations at the center and is assisted by Ms. Fisher. Most of the physicians using the center are general surgery residents at IU, Riley and Methodist hospitals of Clarian Health, who must complete a six-year residency program, while others continue additional post-graduate training in plastic, pediatric and cardiovascular surgeries.

Dr. Grosfeld says that other technologies being taught include the use of intraoperative ultrasound, acquisition of sentinel lymph nodes in assessing the spread of cancer, and intraluminal vascular stenting techniques for vascular surgery.

"What residents stand to gain most here at the center is a deepened appreciation for exploring time-trusted practices along with becoming comfortable with new surgical techniques and developing technology used in the OR today," Dr. Canal notes.

Medical students also participate at the center, primarily learning suturing and IV techniques. Further, there are plans to include IU School of Nursing students in future training modules.

Ultimately, what the Center for Advanced Surgical Technology provides is virtual preparation for the real world of the operating room. "Our goal always has been to develop highly competent and confident surgeons who can bring something of value to their communities and the patients they serve," says Dr. Grosfeld. "The center is another vehicle to help them reach their destinations."