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The High Communication Wetlab: A Unique Innovation in Teaching Ophthalmic Surgery
The High Communication Wetlab: A Unique Innovation in Teaching Ophthalmic Surgery M.E. ZIRM and E.S.ROSEN* Fallmerayerstr. 3, A-6020 lnnsbruck, Austria and '1 0 StJohn St., Manchester M3 4DY
The continuous development of new surgical techniques and the need for efficient surgical education of ophthalmologists have inspired the development of the High Communication Wetlab (HCW). The HCW is a highly efficient, audio-visual teaching, learning and practising facility which is part of the European Cornett II Project on Innovative Ophthalmic Surgery (INOS), also supported by the European Society of Cataract and Refractive Surgeons (ESCRS). The International Institute for Experimental Surgery and its scientific consultant board consisting of leading ophthalmic surgeons are the project leaders. Keywords: Innovative Ophthalmic Surgery (INOS) Project; Intraocular imaging techniques; Intraocular surgery teaching techniques; High Communication Wetlab (HCW); Synchronous Film Video Technique (SFVT)
INTRODUCTION
human cadaver eyes in a system which helps create conditions as close to surgical reality as possible can existing problems in the education and further training of ophthalmic surgeons be solved [1-3].
It is inconceivable that a pilot would be permitted to fly an aircraft without his performance having been amply tested at the controls of a flight simulator. It is also necessary for experienced pilots to go back to a flight simulator before flying a new aircraft. Part THE INOS PROJECT of the pilot's education is an evaluation of his skills in the management of simulated problem situations. On 18 December 1991 the European Society of The education and training of surgeons in surgical Cataract and Refractive Surgeons (ESCRS) declared techniques and procedures should be taken equally their participation in the European Innovative Ophseriously. Worldwide, young surgeons have to thalmic Surgery
Eur J Implant Ref Surg, Vol4, September 1992
146
M.E. Zirm, E.S. Rosen
worldwide unique innovation in applied ophthalmological research, teaching and practice of intraocular surgical procedures. It represents a mature and refined development of principles also adopted by Miyake [4] and Apple l5l. The SFVT system's main advancement over the 'Miyake Technique' is that it introduces absolutely realistic operating conditions for learning and practising all intraocular surgical procedures !including laser coagulation), as well as solving scientific problems [61. In addition to observing an operation normally from the outside, it allows the user to follow the procedure from the inside through the window in the SFVT-Eye Holder. The SFVT-Eye Holder is the heart of the system. Human, pig or rabbit eyes are mounted on a clear plastic disk after removal of the rear third of the globe, introducing a revolutionary posterior perspective on previously hidden aspects of eye surgery. Intraocular pressure can be adjusted at will. The SFVT-Practice Head is a lifelike plastic head-mould to secure the SFVT-Eye Holder and includes an apparatus that simulates the retinal red reflex in the pupil for realistic surgical conditions. The SFVT-Video Practice Head (VPHl also encloses an ingenious halogen lighting and videocamera microscope system which provides real-time
video monitor coverage and documentation of all surgical procedures from within the eye. The SFVT-Microscan Table incorporates the SFVT-VPH into the perfect high-tech version of the complete SFVT System including two microscopes, video cameras and video monitors, a video mixer and the SFVT-illumination unit. The SFVT System is an ideal tool for passing on surgical knowledge in a wetlab course setting. Up to now it has been difficult for a course instructor to teach and evaluate the progress of a larger number of surgeons without the support of qualified assistants. One solution to this problem is an audio-visual teaching facility called the High Communication Wetlab (HCWJ developed by the International Institute for Experimental Surgery. The equipment of this HCW combines the direct audio of a speech laboratory with modern video technology. On a split monitor the instructor can simultaneously observe all six to nine surgical theatres as monitored and recorded by video cameras on the surgical microscopes. Individual supervision and guidance of each course participant during the performance of surgery is achieved by the instructor through the switching of his monitor from one surgical theatre to
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Video Practice Head + Microscope + TV Camera Video Tape Recorder Digitizer Headset ~ Video Routing Switch_e_r _ _ _ _ _ _ _ __, VTR
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Eur J Implant Ref Surg, Vo/4, September 1992
The High Communication Wetiab
147
Fig. 2 Overview of a HCW course showing the working stations equipped with TV monitors.
another. The instructor is also connected to the course participants via Intercom microphones and headsets !Fig. ll. Each course participant also has a private monitor on which he can follow the instructor's procedure. The learner can thus be guided through an operation step by step by the instructor. Each surgical theatre can also be displayed on all monitors simultaneously, should this be of educational value. The instructor can speak to each participant individually or to all communally. The surrounding noise environment is substantially reduced through the use of headphones (Figs 2, 3). It is also possible for the instructor to draw on the video display on each course participant's monitor in order to demonstrate, for example, the length and direction of an incision. With the SFVT-Surgical System and a video cassette of the instructor's operation, the course participant can practise and improve his competence of the procedures taught on his own time and as often as he wants to. FUTURE DEVELOPMENTS
An additional application of the HCW technology now being discussed is its use in conjunction with modern telecommunication systems, especially with cable transmissions and satellites as in video conferences. Since the instructor and the course participants are solely connected via audio-visual electronics there is no need for close physical proxEur J Implant Ref Surg, Vol 4, September 1992
Fig. 3 Dr Zirm teaching on the SFVT-Practice Head in the HCW . He and his assistants are wearing Intercom headsets.
M.E. Zlrm, E.S. Rosen
148
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Fig. 4 Satellite transmission of a HCW course. The schematic drawing shows the set-up of the course facilities.
Fig. 5 Satellite transmission of a HCW course. The schematic drawing shows the set-up of the course director's station.
imity, thus allowing a course to be taught by an instructor from another continent or courses to be simultaneously taught in different countries. A highly qualified surgeon on a strict timetable need thereby no longer leave his place of work to hold a course. This provides a strong time-saving incentive for the surgeon as well as a financial bonus for the course participants: first cost-benefit analyses show a substantial advantage in having, for example, a course in Europe taught by an instructor from the U.S.A. instead of flying him over the Atlantic (Figs
ACKNOWLEDGEMENTS
4, 5)
We wish to express our gratitude to Dr L. Buratto for pioneering the use of the HCW, to Dr P. Condon and Dr P. Sourdille for their encouragement and support and to Hans Pilger for his technical assistance. All SFVT and HCW products and technologies are patent pro· tected or patent pending.
REFERENCES 1 DJ Apple et al. Ophthalmology, 1990; 97: 810. 2 E Rosen. Editorial. Eur. J. Implant Ref. Surg., 1990; 3: 167. 3 WF Maloney. Ocular Surgery News, International Edition, August 1991, pp. 34-35. 4 K Miyake. Posterior chamber lenses: experimental studies. Cataract and Intraocular Lens Surgery. P. Ginsberg (Ed.l, 1985; 133. 5 DJ Apple. Intraocular Lenses. Williams & Wilking, Balti· more, 1989. 6 ME Zirm. Eur. J. Implant Ref. Surg., 1990; 2: 169.
Eur J Implant Ref Surg, Vo/4, September 1992
The continuous development of new surgical techniques and the need for efficient surgical education of ophthalmologists have inspired the development of the High Communication Wetlab (HCW). The HCW is a highly efficient, audio-visual teaching, learning and practising facility which is part of the European Cornett II Project on Innovative Ophthalmic Surgery (INOS), also supported by the European Society of Cataract and Refractive Surgeons (ESCRS). The International Institute for Experimental Surgery and its scientific consultant board consisting of leading ophthalmic surgeons are the project leaders. Keywords: Innovative Ophthalmic Surgery (INOS) Project; Intraocular imaging techniques; Intraocular surgery teaching techniques; High Communication Wetlab (HCW); Synchronous Film Video Technique (SFVT)
INTRODUCTION
human cadaver eyes in a system which helps create conditions as close to surgical reality as possible can existing problems in the education and further training of ophthalmic surgeons be solved [1-3].
It is inconceivable that a pilot would be permitted to fly an aircraft without his performance having been amply tested at the controls of a flight simulator. It is also necessary for experienced pilots to go back to a flight simulator before flying a new aircraft. Part THE INOS PROJECT of the pilot's education is an evaluation of his skills in the management of simulated problem situations. On 18 December 1991 the European Society of The education and training of surgeons in surgical Cataract and Refractive Surgeons (ESCRS) declared techniques and procedures should be taken equally their participation in the European Innovative Ophseriously. Worldwide, young surgeons have to thalmic Surgery
Eur J Implant Ref Surg, Vol4, September 1992
146
M.E. Zirm, E.S. Rosen
worldwide unique innovation in applied ophthalmological research, teaching and practice of intraocular surgical procedures. It represents a mature and refined development of principles also adopted by Miyake [4] and Apple l5l. The SFVT system's main advancement over the 'Miyake Technique' is that it introduces absolutely realistic operating conditions for learning and practising all intraocular surgical procedures !including laser coagulation), as well as solving scientific problems [61. In addition to observing an operation normally from the outside, it allows the user to follow the procedure from the inside through the window in the SFVT-Eye Holder. The SFVT-Eye Holder is the heart of the system. Human, pig or rabbit eyes are mounted on a clear plastic disk after removal of the rear third of the globe, introducing a revolutionary posterior perspective on previously hidden aspects of eye surgery. Intraocular pressure can be adjusted at will. The SFVT-Practice Head is a lifelike plastic head-mould to secure the SFVT-Eye Holder and includes an apparatus that simulates the retinal red reflex in the pupil for realistic surgical conditions. The SFVT-Video Practice Head (VPHl also encloses an ingenious halogen lighting and videocamera microscope system which provides real-time
video monitor coverage and documentation of all surgical procedures from within the eye. The SFVT-Microscan Table incorporates the SFVT-VPH into the perfect high-tech version of the complete SFVT System including two microscopes, video cameras and video monitors, a video mixer and the SFVT-illumination unit. The SFVT System is an ideal tool for passing on surgical knowledge in a wetlab course setting. Up to now it has been difficult for a course instructor to teach and evaluate the progress of a larger number of surgeons without the support of qualified assistants. One solution to this problem is an audio-visual teaching facility called the High Communication Wetlab (HCWJ developed by the International Institute for Experimental Surgery. The equipment of this HCW combines the direct audio of a speech laboratory with modern video technology. On a split monitor the instructor can simultaneously observe all six to nine surgical theatres as monitored and recorded by video cameras on the surgical microscopes. Individual supervision and guidance of each course participant during the performance of surgery is achieved by the instructor through the switching of his monitor from one surgical theatre to
PC
Videoprojector
D 13 14 15 16
Splitmonitor
W§SSS§SSSSSSSSSSSSS§SSS§SS§SSSS§SSSSSSSSSS\\1
~
Video Practice Head + Microscope + TV Camera Video Tape Recorder Digitizer Headset ~ Video Routing Switch_e_r _ _ _ _ _ _ _ __, VTR
c=J
Eur J Implant Ref Surg, Vo/4, September 1992
The High Communication Wetiab
147
Fig. 2 Overview of a HCW course showing the working stations equipped with TV monitors.
another. The instructor is also connected to the course participants via Intercom microphones and headsets !Fig. ll. Each course participant also has a private monitor on which he can follow the instructor's procedure. The learner can thus be guided through an operation step by step by the instructor. Each surgical theatre can also be displayed on all monitors simultaneously, should this be of educational value. The instructor can speak to each participant individually or to all communally. The surrounding noise environment is substantially reduced through the use of headphones (Figs 2, 3). It is also possible for the instructor to draw on the video display on each course participant's monitor in order to demonstrate, for example, the length and direction of an incision. With the SFVT-Surgical System and a video cassette of the instructor's operation, the course participant can practise and improve his competence of the procedures taught on his own time and as often as he wants to. FUTURE DEVELOPMENTS
An additional application of the HCW technology now being discussed is its use in conjunction with modern telecommunication systems, especially with cable transmissions and satellites as in video conferences. Since the instructor and the course participants are solely connected via audio-visual electronics there is no need for close physical proxEur J Implant Ref Surg, Vol 4, September 1992
Fig. 3 Dr Zirm teaching on the SFVT-Practice Head in the HCW . He and his assistants are wearing Intercom headsets.
M.E. Zlrm, E.S. Rosen
148
[High Communication Wetl~
High Communication Wetlab I
-~-~~------· ··~ ~-------------~----~---~
Satellite Transmission
Satellite Transmission
Satellite Transmission
1 Teacher
Technical assistant r· ---1
I SoundlromT"""""r
I
!_-,--1
• -~-
w...l~ODE~ .t::::!t:;=~'
-
~_.__
i Audioi
----·1
Amplifier
: I
.
- +' ,--·------·
r:ctJ~ -SP
lnternattonal lnstttute for Experirnental Surgery
lnternattonal lnstttute for Expermwntal Surgery
Fig. 4 Satellite transmission of a HCW course. The schematic drawing shows the set-up of the course facilities.
Fig. 5 Satellite transmission of a HCW course. The schematic drawing shows the set-up of the course director's station.
imity, thus allowing a course to be taught by an instructor from another continent or courses to be simultaneously taught in different countries. A highly qualified surgeon on a strict timetable need thereby no longer leave his place of work to hold a course. This provides a strong time-saving incentive for the surgeon as well as a financial bonus for the course participants: first cost-benefit analyses show a substantial advantage in having, for example, a course in Europe taught by an instructor from the U.S.A. instead of flying him over the Atlantic (Figs
ACKNOWLEDGEMENTS
4, 5)
We wish to express our gratitude to Dr L. Buratto for pioneering the use of the HCW, to Dr P. Condon and Dr P. Sourdille for their encouragement and support and to Hans Pilger for his technical assistance. All SFVT and HCW products and technologies are patent pro· tected or patent pending.
REFERENCES 1 DJ Apple et al. Ophthalmology, 1990; 97: 810. 2 E Rosen. Editorial. Eur. J. Implant Ref. Surg., 1990; 3: 167. 3 WF Maloney. Ocular Surgery News, International Edition, August 1991, pp. 34-35. 4 K Miyake. Posterior chamber lenses: experimental studies. Cataract and Intraocular Lens Surgery. P. Ginsberg (Ed.l, 1985; 133. 5 DJ Apple. Intraocular Lenses. Williams & Wilking, Balti· more, 1989. 6 ME Zirm. Eur. J. Implant Ref. Surg., 1990; 2: 169.
Eur J Implant Ref Surg, Vo/4, September 1992