Prepping for Surgery
Company's Simulated Body Parts
Used to Teach New Procedures

Chris Toly, 37, sorts through the body parts strewn across his desk looking for a videotape of a gallbladder operation. One of his employees pops his head in the door.

"Can I get a knee?" he asks. Toly plucks a knee joint off a file cabinet and hands it over.

Toly is president and chief operating officer of Ballard-based Simulab Corporation, a company that makes models of soft-tissue body parts, organs and bones for surgical training.

The privately held company, which was founded in 1994, has been working closely with the University of Washington Medical School to develop simulators to train surgeons in the latest high-tech surgical procedures.

The UW, which has one of the leading centers for videoendoscopic surgery in the country, recognized the need for new training methods because the latest "minimally invasive" surgery techniques require very different skills than traditional "open surgery," said Dr. Mika Sinanan, who holds appointments in surgery and electrical engineering at the UW. Sinanan is also co-director of the UW's Center for Videoendoscopic Surgery.

Videoendoscopic surgery uses tiny, high-resolution video cameras to guide specialized instruments that are inserted into the body through small incisions. The instruments, which are attached to long handles, are manipulated from outside the body while the doctor views the surgery on a videoscreen. The whole operation resembles a high- tech video game.

Only, with real patients under the knife, it's not a game doctors can afford to lose.

"When you remove the 3-D image, and have to look at a two- dimensional image, the level of difficulty goes way up," Toly said. "It takes a whole new set of skills as opposed to those used in open surgery."

Sinanan has been working with Simulab to develop realistic models so students can master the new skills before working on patients.

The idea, borrowed from the use of simulators in the aerospace industry, is to give students the practice they need before putting lives on the line.

Historically, surgery has been taught through the "watch one, do one, teach one," method, Toly said. Residents observe surgeries on live patients, then as their confidence and experience increases, progress to doing it themselves.

But that's not as easy to do with videoendoscopic procedures, which require different hand-eye coordination and dexterity than traditional surgical techniques.

The need for such training has been increasing with the explosion in use of videoendoscopic techniques in the past five years. An increasing number of surgeries, ranging from gallbladder removal to hernia repair, can now be done using minimally invasive techniques.

Patient demand is also driving the increased use of these techniques, Sinanan said. Because the incisions, which may be only a few centimeters wide, are so much smaller than traditional incisions, healing is typically quicker and less painful.

"It's an expanding field," Sinanan said. About 30 percent to 40 percent of all operations are now either minimally invasive or use elements of minimally invasive techniques.

Simulab, which has 15 employees, has patented its videoendoscopic simulator, a device that lets students practice a variety of surgical techniques while viewing what they're doing as a two-dimensional image.

In addition, it has patented its fake body parts used for practicing the surgeries.

The company, which employs an assortment of artists and manufacturing engineers in its 6,000 square-foot facility, uses a variety of materials to create body parts that look and feel realistic so surgeons can get the appropriate "tactile feedback" and learn the exact pressure required to manipulate, cut and suture tissue.

The goal of simulation is to improve safety and at the same time reduce the time it takes to produce surgeons, Sinanan said.

"It takes five to eight years to train a surgeon," he said. "It's a very long, drawn-out process. With simulators, we hope to shorten the training process by bringing much of the training to the lab."

That should also bring down the cost of training surgeons, Toly said.

Endoscopic equipment costs about $60,000, whereas the simulators range in cost from $295 to $695.

Simulab envisions its simulators being used in medical offices, libraries and labs to give students the chance to perform as many procedures as necessary to become competent.

The company, which is one of the corporate sponsors that support the UW's Center for Videoendoscopic Surgery, was founded by software executive Chuck Stonecipher, attorney Mark Deife, and a third founder, who has since moved on. Toly is now the third owner.

Revenues of the private company, which are not disclosed, have been doubling every year since the company's inception, Toly said.

Simulab has sold its systems to medical device manufacturers and medical schools all over the world, he said. It is also working with UW researchers to develop data to show how use of simulation affects skill development in surgeons.

"This is a great cause," Toly said. "We have very high hopes."

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattle-pi.com

(Copyright 1999)

©1999 UMI Company; All Rights Reserved. Only fair use, as provided by the United States copyright law, is permitted. UMI Company makes no warranty regarding the accuracy, completeness or timelines of the Publications or the records they contain, or any warranty, express or implied, including any warranty of merchantability or fitness for a particular purpose, and shall not be liable for damages of any kind or lost profits or other claims related to them or their use.