Simulation is especially important for training surgeons in the techniques of minimal access surgery, including laparoscopy and arthoscopy. This type of surgery differs from so-called “open surgery”. In open surgery, the surgeon has complete access to the surgical site, including the ability to view the tissues and also to directly apply tools and hands to the surgical site.
In contrast, minimal access surgery is done through a very small portal into the site of the surgery. All viewing of the surgery is done through a lighting and camera system that is inserted through a portal into the site. The camera is moved and controlled indirectly, and the images are viewed on a video monitor. The position and orientation of the camera are not directly observable by the surgeon, and must be determined through a combination of visual and positioning feedback.
Furthermore, all the surgical steps are performed through indirect means as well. In the case of laparoscopy, usually done in the abdomen, tools are inserted into the body cavity through trocars, portals which are attached to the body wall. These allow surgical tools to be inserted and moved within the body cavity, which is usually expanded using compressed air to provide better viewing and access to the internal organs. The trocars incorporate gaskets that fit around the tools, preventing the rapid escape of air, while allowing the tools to be respositioned and slipped in and out.
All surgical manipulations, including palpation, lifting, repositioning, incision, ablation, extraction, evacuation, rinsing, suturing, and other tasks are more difficult in minimal access surgery than in open surgery, and require additional skills and training inthe use of tools and techniques in addition to those of general surgery.