"Living Anatomy Program" Simulator Aims to Revolutionize Surgical Training

BUFFALO, N.Y. - Researchers at the University at Buffalo are combining 21st-century materials and computerized sensors to create a simulator for surgical training with "organs" that feel, smell and respond like living tissue in the human body.

The work is being led by David Fineberg, a clinical assistant professor of surgery and oral and maxillofacial surgery in the UB School of Medicine and Biomedical Sciences, who wants to change the way surgeons train. In the process, he also wants to change the way content is delivered across many industries and disciplines, including the teaching of mathematics and science.

Fineberg's idea took shape nearly 10 years ago when he was a trauma surgery resident at the Erie County Medical Center.

A young woman arrived at the hospital with internal injuries sustained in an automobile accident on the day before she was to be married. The impact had ripped her liver from its tethering vessels and her abdomen was filled with blood. The trauma team worked for three hours in a frantic but futile attempt to save her life.

"I'll never forget that scene," said Fineberg. "It really affected me. I thought, 'If I had had a model to practice that procedure on; if I could learn how to do an operation that poses a high mortality risk, one I may never see until I'm called to do it at 3 p.m. on a Tuesday; if I can find a way to allow people to learn surgery techniques quickly and efficiently, it could save lives.'"

That was in 1993. Today Fineberg is working with UB computer scientists, engineers and sculptors; materials experts; pharmaceutical firms; high-school curriculum coordinators and a veterinary school to create a surgical version of a flight simulator that he has named "The Living Anatomy Program."

In the process, he has come to believe that the technology being developed for a surgical simulator could have applications far beyond that original goal.

"I'm interested in creating a profound depth of immersion into content through a technology platform based on interactive physical/virtual models," said Fineberg. "Users will be able to enter, become immersed in and manipulate computer-generated content in a very natural way by using their hands, an evolution into a human systems approach to interface development.

This can be accomplished with a variety of custom-made physical objects that direct motion of related virtual models."

He sees myriad potential applications, from teaching math and science to high school students, to using simulation to train workers to perform potentially risky tasks -- such as operating industrial machinery -- without actually putting them in harm's way while they're learning.

"I'm looking to change the way content is delivered across all industries and disciplines," he said.

The surgical simulator would showcase the technology's potential and function as a prototype for this human/virtual reality interface.

Prospective surgeons, like all medical students, learn about the body from a cadaver, which is useful, but far from optimal, said Fineberg. "A cadaver is cold, hard and preserved. It bears little resemblance to the living body.

"With a surgical simulator, surgeons in training could learn, for example, how a ruptured spleen feels or how to locate a torn blood vessel in a blood-filled abdomen.

Fineberg and Thenkurussi Kesavadas, Ph.D., UB associate professor of mechanical and aerospace engineering and director of UB's Virtual Reality Laboratory, have begun working toward that goal one organ at a time, with $100,000 in development funds from the New York State Office of Science Technology and Academic Research (NYSTAR).

Organ models, per se, are nothing new, but Fineberg's organs will be unlike anything that exists currently. He will use 21st-century materials and endow the models with computerized sensors to create pseudo-organs that will feel, smell and respond like living tissue in the body.

"This has not been done before," said Fineberg. "You have to have someone who knows what human organs feel like committed to the project to make it work. No one even comes close to our technology of combining these organs with the computer interface.

To date he has made molds of the liver and spleen using cadaveric organs as models, and is now working with Polytek, a materials company, to find polymers that feel like living tissue with which to fill the molds. Washington State University College of Veterinary Medicine is formalizing a relationship with Fineberg to install a lab to use his models as alternatives to live dogs in the training of veterinary surgeons. The University of Ottawa Heart Institute's Medical Device Department has offered engineering assistance and mentoring services on the project.

Translating the tactile information into electronic data falls to Kesavadas. He is helping to capture the properties of human tissue, using his virtual-reality glove, a device that collects data on what the wearer is feeling through sensors located in the glove's fingertips. Kesavadas is creating a database of information that accurately describes the biomechanical properties of soft tissue under various conditions.

Just as flight simulation involves more than manipulating instruments on a panel, surgical simulation, to be truly representative of reality, must recreate the sense of urgency and controlled chaos of the surgical suite.

"There is a complex atmosphere that exists in a surgical setting that must be reproduced for a realistic simulation," Fineberg said. "That includes sound, people walking around, and algorithms of activities that are occurring. A computer-generated environment can capture much of this."

Before the project can reach this point, the model organs likely will have a first life as individual teaching tools. Fineberg plans to market them and the technology platform for a number of uses to generate funds to finish the surgical simulator prototype.

A firm in Rochester is interested in marketing a complete set of organs for teaching biology and anatomy. Veterinary schools also have shown interest in models of dog organs for use in training veterinary surgeons. The spleen model will be marketed to physicians who treat blood-related diseases. Kesavadas is working on a virtual-reality "overlay" of the spleen, which could make it appear to be injured, inflamed or of a particular age.

Fineberg has plans next to produce a "liver trainer," for use by anyone who needs to learn the liver's physiology. A pancreas model will follow.

"What we are working toward is linking spatial position and motion of physical objects with related images in a computer-generated visual scene, so that we can selectively control objects in a virtual world," Fineberg said. "This will allow us to merge the physical with the virtual. We cannot do this without quite a bit of front-end development in both the physical and virtual area, and that is what we are doing now."