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Simulation of Laparoscopic Surgery Lab

Phyllis Robitaille



Type of Entry:

  • lesson/class activity

Type of Activity:

  • hands-on
  • simulation
  • inquiry lab
  • group/cooperative learning
  • review/reinforcement

Target Audience:

  • Life Science
  • Biology
  • Advanced/AP Biology
  • Anatomy and Physiology


Abstract

The lab uses a cardboard box with cut out sides and a removable top lid. The box represents the body cavity. Holes are cut into each of the four sides, allowing additional light to enter. A piece of plastic, representing the serosa or membrane of the body cavity, is stapled to the open top of the box. Two holes are then made in the plastic for the insertion of the laparoscopic instruments. A sponge in the shape of a body organ is placed in the bottom of the box. The student, having learned how to manipulate the instruments, inserts the instruments into the "ports" of the plastic membrane, trying to clip, cut, staple the sponge organ according to the function of the instrument. Once the student has learned to manipulate the instruments under these circumstances, the student is ready for the next step.

A cover, representing the skin and muscle of the body cavity, is placed on top of the plastic membrane; then a video camera attached to a TV monitor is inserted into one of the open sides of the box. The student now manipulates the instruments while watching the TV monitor. The student learns to compensate going from a 3-D situation to a 2-D situation. The student learns the pros and cons of the procedure enabling the student to not only be knowledgeable about the procedure but also better equip them to ask the physician questions concerning the procedure for him/her self.


Background

The simulation of laparoscopic surgery enables students to practice and to learn the technique for the very first time. Students learn to manipulate a variety of instruments while watching a TV monitor, thereby learning to compensate while going from a 3-D situation to a 2-D situation. The students learn the pros and cons of the procedure enabling the students not only to be knowledgeable about the procedure but also better equip them to ask the physician questions concerning the procedure for him/her self.

The teacher should demonstrate and explain the working of the surgical instruments, especially emphasizing the safety features of each instrument.

The preparation time, once the boxes are prepared, is five to ten minutes for ten set ups.

The class time needed would be 50 to 60 minutes.


Project

Materials needed:

  • cardboard box with removable lid
  • clear sheets of plastic
  • laparoscopic instruments -
    (ETHICON , Inc. , Cincinnati, OH)
  • sponges
  • light bulbs
  • light sockets
  • video camera
  • TV monitor

Activity

  1. Students learn to manipulate laparoscopic instruments

    1. Procedure - use ALL safety requirements at ALL times.

      1. do not point laparoscopic instruments at anyone's face

      2. check the lap. instrument to be sure that safety switch is "on".

      3. use handles only - do not place fingers, body parts, etc. into working end of instrument

      4. do not place hands into sides of box

      5. do not touch light bulb

      6. follow directions PRECISELY - do not play with equipment

        --follow instructions for use of your specific laparoscopic instrument

      ENDOCLINCH:

      1. remove safety cover from tip

      2. rotate knob - note direction of clamp

      3. squeeze handle while rotating the knob

      THORACIC SCISSORS: with cautery and rotating shaft:

      1. remove protective covering from tip

      2. rotate knob at base of instrument - note position of scissors

      3. squeeze handle while rotating knob

      4. cover tips with protectors

      ENDOPATH CLAMP:

      1. remove tip protector

      2. push knob toward tip, then rotate

      3. release red button

      4. squeeze handle - note position of clamp

        e. secure safety and cover tip

      ENDOCLIP:

      1. rotate knob - note movement of instrument tip

      2. GENTLY - squeeze handle while looking at the tip

      3. note where clip is released

      4. once instrument is positioned on the sponge organ, press small button to release the clip

  2. Students simulate laparoscopic surgery

    1. Lab Procedure - Part I

      Each lab station contains a piece of plastic, covering the top of an open-ended box. The plastic, which represents the lining of the cavity, (represented by the box), has two holes, that is, "ports." The box contains a sponge cut into the shape of a body organ and a light bulb for better viewing.

      1. use only the top viewing plane of the box, as instruments are manipulated.

      2. place clamp instruments into the port to the right of the plastic surface of the box.

      3. manipulate instrument; clamp until the sponge organ is secured and held in place.

      4. take the second lap. instrument, place in the second port on the left of the plastic surface.

      5. manipulate instrument, performing function of the instrument. If using SCISSORS, manipulate to cut , but DO NOT cut sponge organ.

      6. when procedure is complete, remove each instrument, placing it on the table with pointed end covered with protection cap and directed away from bottom of the table.

    2. Lab Procedure - Part II

      In the final lab station, a cover has been added to the box with ports matching that of the plastic ports. The cover represents the skin and muscle of the cavity. A video camera connected to a TV monitor is placed in one of the open ends of the box, preferably, opposite end of the light. A student is selected to manipulate the video camera.

      1. student inserts one surgical instrument into the port while watching a TV monitor.

      2. student inserts second surgical instrument into the second port while watching a TV monitor.

      3. student clamps the sponge organ, while performing the function of the second surgical instrument. During each procedure student should be observing the various movements on the TV monitor.

      4. upon completion of the procedure the student, still grasping both instruments, should separately remove each from the ports and activate the safety mechanism.

      5. the next student should be ready to begin.


Method of Assessment/Evaluation

  1. Analysis - students are to answer the following questions according to their laboratory observations.

    1. What does the top viewing plane of the box represent?

    2. What do the "ports" represent?

    3. State several problems you incurred while manipulating the laparoscopic instruments while viewing the TV monitor?

    4. Why do these problems occur?

    5. How did you compensate for each problem?


Extension/Reinforcement/Additional Ideas

  1. Thought and Research questions

    1. What would be the differences between training a young physician versus an older physician in laparoscopic surgery?

    2. What types of surgeries are now being performed using the laparoscopic procedure?

    3. What are the pros and cons of new procedure versus the old?


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