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Curious: The Sixth Seminar by Young Researchers II

Endoscopic Surgical Education by Utilizing Simulations

• Ryota Tanaka spoke about “Endoscopic Surgical Education by Utilizing Simulations” at young Japanese researchers’ seminar, which was held on January 25 at the Japan Information Center of the Consulate General of Japan at Chicago.
• Tanaka is a surgeon and teaching staff at the Kyorin University Hospital in Tokyo and currently has worked at NorthShore University Healthsystem as a postdoctoral fellow.

• In recent years, endoscopic surgery has become common. How is it different from open chest surgery or open abdominal surgery? How are surgeons trained for manipulating endoscopic tools?
• In the conventional surgery, surgeons directly see a patient’s organs and operate on them by using forceps, scissors, and other instruments. On the other hand, surgeons watch a monitor and operate on organs by using endoscopic tools in the endoscopic surgery. Because of the two-dimensional feature of the monitor, surgeons need to imagine the depth of organs when they use a forceps, for example. Tanaka said that surgeons were required to have special skills for the endoscopic surgeries.

• In recent years, robotic surgery has also been available. It provides surgeons with the three dimensional images, and they operate on a patient by using robotic arms, hand controllers and other instruments. Although the symptom example numbers have increased in the U.S., a 2014 FDA report said that 71 patients died in 2012 by robotic-surgery-related causes. Tanaka said that the main cause of the deaths was massive bleeding.
• According to Tanaka, robotic surgery was developed in the U.S. for casualty care on the battlefield where immediate surgery is not available. When a wounded solder is carried into a robotic surgery room, a surgeon can operate on him from a remote place. For instance, Tanaka can operate on a patient in Kyorin University Hospital even if he is in Chicago. He said that the robotic surgery was good for prostate surgery.

• The biggest merit of endoscopic and robotic surgery is minimally invasive surgery. When surgeons perform open chest surgery, they cut about a foot of the patient’s chest and make enough room to insert a hand by pushing rib bones to both sides. In the endoscopic and robotic surgery, making some holes in a patient’s chest is good enough to insert tools. Thus, the patient’s recovery is faster. Tanaka said, “I think that we have to make our efforts to move toward less invasive surgery; thus, I have devoted myself to establish a training system for endoscopic surgery.”

• The endoscopic surgery requires new skills. When a surgeon moves a tool to left, the tip of the tool moves to right because it has a fulcrum point at the edge of the hole in a patient’s chest. Besides, a surgeon has to control the tool by watching a monitor. Moreover, a surgeon has to manipulate an endoscopic camera in order to focus on a critical point in a timely manner. Tanaka said that an efficient training system hasn’t been established yet, so he has been studying it.

• Simulator

• Similar to the flight simulator, the FLS simulator was developed for endoscopic surgeons. It presents unexpected situations such as massive bleeding. In the U.S., a candidate must pass the simulation test to become a surgeon. This requirement was set in 2010. Tanaka said that Japanese surgeons would
• be required to clear the similar training program to become qualified to perform endoscopic surgery.
• In the U.S., many other training programs which use a gastric camera, large intestine endoscope, and animal organs and bodies, are available.

• Tanaka has developed a simulation model by using a pig’s lung, which is similar to a human’s. His model not only improves personal skills, but also raises surgeons’ skills as a team. He emphasized the importance of keeping motivation for skill up and giving feedbacks.

• By the way, what is an appropriate training period for endoscopic surgeons? A psychologist said that if you want to become a world-class chess player, you have to be trained in your young days.
• Tanaka started to learn playing saxophone when he arrived in Chicago two years ago. His teacher is a skillful jazz musician who would practice it more than 10,000 hours to become a professional. Tanaka practiced it, but his practice time was 365 hours when he did it an hour per day. His experience indicated how the musician devoted himself to practice.
• Although Tanaka’s music improvement was slow, some friends said, “You are better than a year ago,” and he was pleased.
• It is uncertain how many hours are needed to train endoscopic surgeons, but objective evaluations and clear goal setting are needed to keep learning motivation. Tanaka said, “Improving endoscopic surgical skills is not achieved by simply spending hours of accumulating experience. We need to promote ingenuity for efficient training. I have been working on it.


Ryota Tanaka