Core Principles

Valor

Innovation

Impact

 

Current Problem

Hysteroscopy is a branch of laparoscopic surgery used in obstetrics and gynecology. Diagnostic and operative hysteroscopies range from visualizing the uterus without the need for abdominal incisions to extracting malignant polyps. Hysteroscopy has evolved from the 1965 introduction of the contact hysteroscope by Marleschki to play a major role for OBGYN training. For example, female sterilization, undergone by 345,000 women every year in the U.S., is increasingly dependent on hysteroscopy.

While hysteroscopy simulations exist, no system exists that incorporates haptic feedback with a quantitative means for measuring competency of surgical skills.  Previous simulations are entirely virtual with no way to quantitatively measure surgeon ability and progress.  With the problem defined as such, our team defined three major needs for the design of a new hysteroscopy simulator. The first need mandated that the system must be able to provide quantitative and qualitative summaries to the persons assessing the students learning the hysteroscopy techniques. The second need illustrated the requirement for the system to be fully immersive, especially regarding touch feedback, or haptics. The final need required the system to be able to be modified to perform different tasks or accommodate future changes.

Hysteroscopy complications are more common for operative procedures than diagnostic ones. “The most common complications of operative hysteroscopy are perforation of the uterus, fluid overload syndrome, bladder or bowel injury and intra-operative hemorrhage.” ¹ Operator error and inexperience accounts for the vast majority of the errors in comparison to mechanical failures.¹ A Harvard Medical Practice study demonstrated that surgical operative adverse events account for 48% of all adverse clinical events and 74% of these operative adverse events were preventable.² Recent studies have found that dedicated hysteroscopy simulation training of first and second year residents improved their surgical skills and dry-lab performance skills, as assessed by the Objective Structured Assessment of Technical Skills (OSATS), to the level or above the level of third and fourth year residents.³

1. Aydeniz B et al. A multicenter survey of complications associated with 21 676 operative hysteroscopies. European Journal of Obstetrics & Gynecology and Reproductive Biology.104(2002): 160–164.

2. Rassweiler et al. Classification and Detection of Errors in Minimally Invasive Surgery. JOURNAL OF ENDOUROLOGY. 2011. 25(11): 1713–1721

3. Rackow et al. Deliberate Practice Improves Obstetrics and Gynecology Residents’ Hysteroscopy Skills. Journal of Graduate Medial Education. 2012. 4(3): 329–334.