Research at MITIE
Along with education and training, research is a fundamental part of MITIE's commitment to excellence in medicine.
MITIE serves as a core facility for state-of-the-art work in less invasive and more accurate surgical procedures.
Since its inception, researchers from The Methodist Hospital System, The Texas Medical Center, The University of Houston and Rice University have used the sophisticated surgical and simulation environments in MITIE to foster their work. While impossible to list every project, examples are provided within three key areas:
1. Measuring Technical Expertise
In an ideal world, when a surgeon comes to MITIE to learn a new procedure he or she would leave with a valid measure of competence that would reassure patients and credentialing bodies of readiness to perform real cases. Yet, the current methods of measuring competence take years to develop for each individual operation and require teams of researchers to validate. Dr. Barbara Bass, chair of Methodist’s Department of Surgery, and Dr. Ioannis Pavlidis, a computer scientist from the University of Houston, have teamed up to create a better method of measuring procedural competence using thermal imaging. a special camera is focused on a surgeon’s face while performing a surgical procedure and quantitatively measures the surgeon’s level of stress. The scientists have proved that stress correlates with performance; less skilled surgeons exhibit more stress than experts. By measuring a surgeon’s reaction to performing a procedure rather than measuring the procedure itself, Dr. Bass and Dr. Pavlidis have discovered a new method of measuring procedural competence that can be rapidly adapted to any procedure. This novel work was published in the Journal Scientific Reports, a primary research publication from the publishers of Nature.?
2. Supporting Surgeons During Their First Procedures
Even with advanced training, most surgeons welcome expert guidance when first performing a new procedure on a patient. Ideally, an expert would guide a novice surgeon during his first cases in the OR at his own hospital -- an arrangement that, today, is difficult to support. A lack of mentorship while learning a new procedure is a significant barrier to successful adoption into practice. To address this, MITIE researchers have developed technology that allows practicing surgeons to communicate wirelessly with MITIE experts. After a surgeon completes training, he or she returns to a home hospital with a suitcase-sized telementoring platform. Inside the suitcase is a computer, backpack and headset with a microphone and high-definition camera. During a procedure, the surgeon switches on the computer and wears the backpack and headset. At MITIE, an expert surgeon working on a laptop computer communicates with the novice surgeon over the Internet, sees what the surgeon sees, and guides him or her through the new surgical procedure. Dr. Brian Dunkin has been awarded a grant from the Department of Defense to support the development of this “wearable” telementoring technology. Working in MITIE, Dr. Dunkin has developed the mobile platform and tested it on multiple surgeons proving that he can effectively help them safely adopt a new surgical procedure, with expert guidance over distance.
A sophisticated research environment allows MITIE scientists to develop and rehearse new procedures on simulators rather than real patients. Once perfected, the procedure then can be performed safely on patients.
For example, Dr. Gerald Lawrie, a Methodist cardiovascular surgeon, sought to perform robotically assisted mitral valve repair surgery for his patients. He had traveled the world and watched the handful of surgeons performing the procedure and had ideas on improving it. Dr. Lawrie and his operating room team came to MITIE and perfected his approach using the same robot he has in the operating room and a simulated open-heart surgery model. He and his team practiced the technique, measuring simulated pump times -- the time required for the patient to be on a heart-lung machine to complete the valve repair -- comparing them to his usual open procedures. When the team reached a proficiency level that resulted in pump times close to open valve repair times, they performed their first human case. Within months, Dr. Lawrie successfully performed over 35 robotically assisted mitral valve repairs.
Work is currently underway to develop new procedures in other areas of cardiovascular medicine as well as gastrointestinal, transplant, and hernia surgery.