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Virtual surgery Simulated surgery on "virtual patients" and wireless sensors are among developments being explored to improve medical training and patient care in Hawaii.
edges toward reality
Simulation software and
wireless sensors expand the
horizons of medicine and healthBy Helen Altonn
haltonn@starbulletin.com
UH-Manoa is collaborating with Stanford University Medical School to apply the innovative techniques as they are developed, said Dr. Lawrence Burgess, associate dean of clinical affairs and director of telemedicine and simulation at the UH medical school.
He hopes to have a surgical simulation program in the fall next year so medical students can practice virtual surgery before working on real patients.
The simulator operates something like a video game, Burgess said, "where you would program a cartoonlike character to resemble a live human, then you would practice procedures on that human.
"You can focus down on one specific area and do anatomical teaching or actually do surgical training."
Demonstrating the technologies recently at the John A. Burns School of Medicine was Kevin Montgomery, engineer with Stanford's National Biocomputation Center.
Montgomery developed a device to allow real-time interaction with a simulator from a distance. At UH he accessed a server at Stanford where a simulator is located to get views of a human body.
Using a joystick or haptic device to manipulate surgical tools, Dr. Stanley M. Saiki Jr., director of Pacific Telehealth and Technology Hui, pulled back skin from a virtual patient's abdomen, noting there was some resistance.
Force feedback occurs, which means "when you touch the liver or a structure, you feel it in the instrument," Burgess explained.
Still, a lot of research is needed, Montgomery said. "We're years away from simulating an actual patient, but we're going to get there."
UH-Manoa and Stanford plan to link their sites this summer with the Maui High Performance Computing Center for another demonstration.
With the supercomputer involved, Montgomery said, "A clinical department could just sign up for a service and buy the right equipment, and you're online."
Burgess said the medical school also "is using the high technology of the computer world to monitor patients better than humans would be able to do.
"You can't stick a human in front of a monitor full time, but the computer doesn't lose any sleep over it."
Burgess is working with Dr. Daniel C. Davis Jr., a software developer, on a proposed project to do physiological monitoring with sensors at a nursing home.
Wireless sensors could be used to detect and treat problems, such as high glucose readings for a diabetic, so the patient would not have to be hospitalized, Burgess said.
"A lot of things we're talking about have immediate application for patients," Davis said. "Automatic uploading of physiologic data into Web-based home health systems is a very powerful tool."
Burgess also is collaborating with Saiki on a Department of Defense and Department of Veterans Affairs project at Tripler Army Medical Center using sensors to monitor 40 to 50 patients after open-heart surgery. The patients have to call the hospital twice a day for any changes in their heart activity.
The doctors said they are getting good data, but the patients would prefer an automated device.
Stanford engineers expect in about two weeks to have an inexpensive wireless sensor that will transmit directly, Montgomery said.
On the day of the demonstration, Burgess wore a sensor and a small computer that transmitted his vital health information. "We could have a student at Stanford click on a monitor for his heartbeat," Montgomery said. "He could be anywhere transmitting."
NASA, the Department of Defense and National Institutes of Health are among agencies interested in wireless sensor technology, Montgomery said.
He said NASA is collaborating with Stanford to develop physiology and environmental sensors for astronauts in space. "On spacewalks there is no good way of determining how they're doing, if they can go another hour. They can't get a good EKG on astronauts."
The space environment also should be monitored to understand how conditions may affect astronauts, Montgomery said.
Burgess said a simulation center is part of Medical School Dean Ed Cadman's vision for the new medical center at Kakaako.
Bruce Wilcox, chairman of the new Division of Ecology and Health, plans to use sensors to monitor the ecosystem and water quality at pilot sites.
Wireless telemedicine also can be used to care for patients on airplanes, to monitor soldiers in the field and to detect bioterroristic events, he said.
The Defense Department is interested in a sensor combined with global positioning capability that would report the physiology, readiness to fight and location of soldiers, he said.
Both the Defense Department and the NIH are talking to Stanford about sensors to measure gas, hydrogen and cyanide, water quality and other environmental factors, he said.
The technology has "incredible applications," Montgomery added. "Most we won't realize for years to come."
University of Hawaii
