By Jeff Kelley

F

For a physician training to become a surgeon, surgical simulation is critical to building skills that will transfer to a real-life operating room.

At Virginia Commonwealth University, the School of Medicine and the Level I trauma center at VCU Medical Center have worked together for years to bring more realism to their simulations.

But surgical trainees and educators noted the artificial blood used in surgical training simulations didn't pulse or have variable flow like that of a living person.

Michel B. Aboutanos, M.D., professor and chair of the Division of Acute Care Surgical Services in the Department of Surgery, medical director of the trauma center and Trauma System Network and director of the VCU Injury and Violence Prevention Program, brought the challenge to VCU's simulation team. He tasked them with improving surgical simulation and incorporating more realistic blood flow that could help train future surgeons as well as military medical professionals via VCU Health's Military Civilian Partnership.

"Traumatic injuries are not identical. Our surgeons need to be prepared not only to repair an injury but to manage and control the variability of pulsing, flowing blood," said Susan Haynes, M.Ed., surgical simulation administrator in the Department of Surgery. "So we started thinking that we could really elevate the fidelity of the simulation practice if we had pulsatile flow - the way that blood actually flows through the body."

Inventing a multidisciplinary solution

The surgery team presented the idea to Peter Pidcoe, Ph.D., a physical therapist and biomedical engineer with appointments in VCU's College of Health Professions, College of Engineering and School of Medicine.

Since development began in 2019, Pidcoe has worked with VCU surgeons and has built several prototypes of a pump that delivers pulsatile and responsive circulation. The pumps have been lab-tested and evaluated by multiple trauma and military surgeons.

Pidcoe's recent invention disclosure, filed with the VCU Office of the Vice President for Research and Innovation's TechTransfer and Ventures team, marks a significant point of progress. It describes a "reciprocating diaphragm pump" that generates pressures, flow rates and stroke volumes that closely replicate human physiology.

The disclosure is the first step toward receiving a provisional patent on the road to using the pump in training scenarios.

"Peter has helped us bring surgical practice closer to the reality of the operating room," Haynes said.

Wide-ranging use with precision

The device can also mimic the blood flow for physicians performing complex procedures or managing acute trauma scenarios, such as gunshot wounds and blast injuries.

The "closed loop" device also uses software and sensors that allow it to act and react similar to the human autonomic nervous system, which regulates involuntary processes including heart rate, blood pressure, respiration, digestion and arousal.

"We can set a blood pressure level and have it maintain that pressure, but if the simulation requires the patient to bleed out due to a large wound, the pressure will drop and the device will compensate by increasing heart rate and stroke volume - just like the body would," Pidcoe said.

Once the training procedure is complete, surgeons and educators can review the data produced by the artificial heart pump.

"This elevates our ability to provide optimal simulation experience and improve response to real-life traumatic injuries that we see daily in our trauma center, and that our military surgeons, medics and corpsmen are seeing routinely in the field and down range," Aboutanos said. "It also expands our ability to deliver the best surgical education, training and simulation regionally and nationally to any training program seeking high-fidelity simulation and close to real-life emergent and surgical experience."

Meeting global demand with an adaptable device

The global surgical simulation market is estimated at around $500 million in annual revenue, said Thomasine Isler, innovation and industry engagement manager at VCU TechTransfer and Ventures. The growing market is led by demand for remote platforms and virtual/extended reality simulations that allow for anytime, anywhere training.

A high-fidelity, physiologically realistic pump simulator may appeal to other academic medical centers, trauma training programs and in military medicine, said Isler, an Army veteran.

The pump's inventor said that while similar ones exist for surgical training, this device's adaptability is its highlight.

"What makes this unique is the ability to control all the facets - heart rate, stroke volume, blood pressure - so the simulation responds like a patient," Pidcoe said. "To my knowledge, there's nothing like it out there."

The next step is taking the device from prototype to a more formed, designed product. Pidcoe imagines the final design will be about half the size of a briefcase.

"We are about 80 percent of the way to having a finalized design," he said. "The next steps are to condense, consolidate and put this in a position where it can be involved in a training course."

The real winners: patients

For Haynes and the VCU Health surgical trauma team, the impact isn't just a better-trained surgeon - it's better outcomes for patients, too.

"I love being able to pull together brilliant minds, and very skillful surgeons and engineers, so that we can offer the highest quality of care for patients with life- threatening injuries," Haynes said. "The kind of realism that we have been able to create is invaluable."

Isler added that the collaboration between the surgery team and Pidcoe has the potential to change how surgical training is performed.

"VCU TechTransfer and Ventures helps faculty translate great ideas into real-world impact. This collaboration is a perfect example," she said. "By connecting a clinical need with engineering expertise, they are creating a technology that has the potential to transform surgical training and ultimately improve patient care."