Minimally Invasive Surgical Training—Initial Experience in Hungary Tam´ as Haidegger * , Veronika G¨ odri * , Gy¨ orgy F´ abry * , Gy¨ orgy Saftics † , Bal´ azs Lengyel ‡ , J´ ozsef S´ andor † , Gy¨ orgy W´ eber † , Bal´ azs Beny´ o * and Zolt´ an Beny´ o * * Laboratory of Biomedical Engineering, Dept. of Control Engineering and Information Technology, Budapest University of Technology and Economics (BME – IIT), Hungary Contact: see www.iit.bme.hu † Dept. of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary ‡ Surgical Planning Laboratory, Brigham & Women’s Hospital, Boston, USA Abstract—Minimally Invasive Surgery (MIS) is a popular alternative to open procedures in many cases, reducing patient trauma and operation risk. On the other hand, it requires a highly skilled surgeon with a significant amount of practice. Despite the fact that various simulators have been developed in the past years, there is a significant demand for inexpensive and more accessible training platforms with alternative ways of use. We have designed and developed the Apollo multi-functional training system, especially targeted for the Central European region. It provides a useful, yet affordable solution for the practice of laparoscopic surgery. The system can be used as a simulator for a variety of open and MIS procedures. Skill assessment studies were Conducted to set up the critical score margins for the accompanying curriculum. MIS training and theoretical education on modern medical technologies—including robotic surgery—have been successfully introduced in the MD program at the Semmelweis University in Budapest. I. I NTRODUCTION Laparoscopy has fundamentally changed a thousand-year- old concept in medicine twenty years ago, when it was introduced into clinical routine [1]. Supported by numerous studies, it had become well accepted that patients undergo- ing laparoscopic treatment have less post-operative pain, less complications and can expect shorter hospitalization. On the other hand, laparoscopy has significantly increased technological complexity, leading to complaints on fatigue and discomfort during the procedures. Data from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) revealed that laparoscopic instruments suffer from inadequate ergonomic design [2]. With the advancement of MIS, the development of training methods became necessary—to learn surgical skills outside the Operating Room (OR). Technical skill acquisition is divided to two parts: cognitive and the psychomotor skills. Notably, experts have automated most of the psychomotor skills (e.g. knot tying, grasping, pick- and-place manoeuvres) and better focus on the cognitive part, understanding the anatomy (perception) and avoiding complications (forecasting). Simulation is an effective training to perfect psychomotor skills without risking patient safety. MIS training systems (simulators) are typically either inan- imate Box Training Systems (also called box trainer, pelvic trainer) or Virtual Reality (VR) trainers. Studies have pre- sented no significant differences between the two systems in terms of providing the appropriate skills [3], [4]. The Fundamentals of Laparoscopic Surgery (FLS) program was initiated in 2004 by the SAGES along with a structured educational program to teach and assess basic knowledge and technical skills, unique to laparoscopic surgery [5]. The FLS technical skill training is based on the McGill Inan- imate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks [6]. The program distributed (online) methodology, didactic teaching material and guidelines along metrics for verification. FLS is also endorsed by the American College of Surgeons (ACS), and is used widely around the world [7]. FLS provides an opportunity for medical students, surgical residents, and practicing physicians to learn the fundamentals of laparoscopic surgery and also to test their cognitive and technical skills. The basic FLS exercises include peg transfer, endo-bagging, cutting, suturing with intra-corporal knot-tying and assistance practicing [5]. II. THE APOLLO BOX TRAINER The financial constraints of the healthcare systems in the Central European region call for affordable and practical alternative solutions to VR trainers. This lead to the concept Fig. 1. The Fundamentals of Laparoscopic Surgery reference tasks. (Courtesy of SAGES.) Proceedings of the 2011 SCATh Joint Workshop on New Technologies for Computer/Robot Assisted Surgery July 11-13, 2011, Graz, Austria 1