Surgical Simulation Center

Our newly renovated center provides a safe environment for hands-on technical training for mastering fundamentals in:

• Laparoscopic surgery
• Robotic surgery
• Endoscopy
• Bronchoscopy
• Suturing and surgical knot tying

Surgical simulation is an essential training component for residents and fellows in:

• General Surgery
• Urology
• Vascular Surgery
• Obstetrics and Gynecology
• Cardiothoracic Surgery
• Pulmonology and Critical Care Medicine

2 high-fidelity laparoscopic simulators with tactile feedback (LapSim®).

• Modules and courses with configurable difficulty specifically tailored for trainees of all levels in General Surgery, Urology, Obstetrics and Gynecology.

Training instruments for gaining proficiency in essential laparoscopic devices, including:

• GIA™, EndoGIA™, TA™, EEA™ staplers
• LigaSure™ sealing device
• Endo Stitch™ suturing device

• The Simulation center features the gold standard in endoscopy and bronchoscopy simulation (GI-Bronch Mentor ™) with a comprehensive library of modules and training exercises.
• Allows trainees to safely and quickly gain clinical competency, while training on the same simulator used in the SAGES Fundamentals of Endoscopic Surgery (FES) exam.

• 4 daVinci Xi training consoles across 3 campuses (York Street, St. Raphael, West Haven VA).
  • Integrated library of modules (SimNow) allows trainees to master fundamentals and gain experience with complex surgeries in a safe setting.
    • Simulations include:
    • Hernia repair and mesh placement
    • Colectomy
    • Cholecystectomy
    • Lobectomy
    • Prostatectomy
• 1 daVinci SI tower for robotic wet labs (York Street).

• 3 laparoscopic training stations with ergonomic height adjustable tables designed to simulate conditions on the actual Fundamentals of Laparoscopic Surgery (FLS) exam.
• Fully equipped for practicing all 5 tasks on the FLS practical exam.

Simulation for PGY1 residents will focus on learning fundamentals essential for navigating the operating theater, including preparing patients for surgery, as well as knowledge of commonly used instruments and equipment. Technical training will emphasize on fundamental skills, including basics in suturing, knot tying, and laparoscopy.

• Fundamentals of the OR (ACS/APDS Module 1, J&J SuturED modules)
  • Consenting and preparing patients for surgery
  • OR etiquette
  • Instrument names
  • Suture materials and needles
  • Tissue adhesives
• Fundamentals of knot tying (ACS/APDS Module 2)
  • Slip knot
  • Square knot
  • Two handed
  • One handed
  • Instrument tying
• Fundamentals of suturing (ACS/APDS Module 3)
  • Needle driver form, loading needles, protecting needles
  • Interrupted stitch
  • Running/Subcuticular stitch
  • Figure of 8 stitch
  • Horizontal mattress stitch
  • Vertical mattress stitch
  • Drain/tube stitch
• Basic laparoscopy knowledge
  • Instrument names
  • Techniques for establishing pneumoperitoneum (Hasson, Veress, OptiView)
  • Stapling devices
  • Energy sealing devices
• Beginner laparoscopy simulation and training (LapSim modules, on low difficulty)
  • Camera Navigation
  • Instrument Navigation
  • Coordination
  • Grasping
  • Cutting
  • Catheter Insertion
  • Clip Applying
  • Lifting & Grasping
  • Handling Intestines
  • Fine Dissection
  • Seal & Cut
  • Suturing
  • Precision & Speed
  • Peg Transfer
  • Pattern Cutting
  • Ligating Loop

Simulation for PGY2 will focus on refining laparoscopy skills, with an emphasis on skills training required to pass the FLS exam. Residents will also learn the basics of robotic surgery by completing the Intuitive Robotic Surgery curriculum, as well as learn the basics of endoscopy in preparation for taking their FES exam. Technical training will also include fundamentals in vascular anastomoses.

1. Advanced laparoscopy simulation and training (FLS, ACS/APDS Module 13)
   • LapSim modules on advanced difficulty
     • Gastrointestinal
     • Needle Passing
     • Interrupted Stitching
     • Running Stitching
     • Square Knot
     • Surgeons Knot
     • Stitch & Square Knot
     • Stitch & Surgeons Knot
     • Interrupted Suturing
     • Running Suturing
     • Side-to-Side Anastomosis
     • Cholecystectomy Complete
   • FLS modules
     • Peg transfer
     • Circle cutting
     • EndoLoop
     • Extracoporeal knot tying
     • Intracoporeal knot tying
   • Laparoscopic instrument training
     • EndoStitch training
     • Suture passer training
   • Introduction to Robotic surgery
     • daVinci YaleSimNow modules
   • Introduction to Endoscopy (FES Modules)
     • Endoscopic navigation
     • Mucosal evaluation
     • Targetting
     • Retroflexion
     • Loop reduction
   • Introduction to vascular surgery (ACS/APDS Module 16)

Although the priority in Professional Development years is research productivity and career development, residents will have the opportunity to hone their operative knowledge in a safe setting, while learning to become more effective teachers and surgical leaders by working closely with medical students in their cadaver labs. Residents will lead medical students through common operative procedures, allowing them to prepare for teaching cases on their return to full time clinicals. Residents will also pass their FES and FLS exams.

Cadaver lab (Teaching cases with medical students). Residents will perform core General Surgery operations with medical students as their surgical assistants as part of the Yale School of Medicine Anatomy Program. Areas of simulation will include:

1. General abdomen
   • Cholecystectomy
   • Appendectomy
   • Hemicolectomy
   • Antrectomy/distal gastrectomy
   • Supraceliac control
2. Retroperitoneum
   • Adrenalectomy
   • Nephrectomy
   • Distal pancreatectomy
   • Splenectomy
3. Neck and chest
   • Central line placement
   • Thyroid lobectomy
   • Tracheostomy
   • Chest tube insertion
   • ED thoracotomy
   • Lung lobectomy

PGY3 residents returning to full-time clinical responsibilities will begin the year with training in advanced robotic surgery skills in a web lab setting to prepare them to operate safely on the robotic console. Simulation will also focus on mastery of advanced vascular techniques to prepare them for technically challenging anastomoses in their Vascular Surgery and Transplant Surgery rotations.

1. Advanced Robotic surgery skills wet lab
2. Advanced vascular anastomosis lab

PGY4 residents will have the opportunity to train with the SpyGlass Direct Visualization System to develop proficiency in cholangioscopy. Residents will also have the option of participating in advanced robotics wet lab courses, as well as in Vascular anastomoses labs.