Robots at Work

Nicholson Center Offers Latest in HIGH-TECH SURGICAL TRAINING AND RESEARCH

By Diane Sears

With straps around each middle finger and thumb, he peers into the visor at a screen where red, blue and yellow star-shaped jacks are scattered across a table. Each move he makes with his hands operates the arms on the screen as a computer tracks how quickly and accurately he can place the items into matching color petri dishes. Getting them there involves dexterity and strategy — and a bit of just pure faith that the machine will follow his commands.

It seems like a children’s game, but it’s serious business. Doctors use the dV-Trainer machine to get the feel for its more complicated cousin, the da Vinci Surgical System. Produced by California-based company Intuitive, the da Vinci is used in abdominal surgery that is less invasive for the patient and more ergonomically fit for doctors.

It’s one of three types of robotic surgery systems in the training labs at the AdventHealth Nicholson Center in Celebration. Since opening in 2001, the center has trained more than 50,000 professionals, ranging from surgeons to medical students to administrators, from all over the world.

Named after Orlando philanthropists Tony and Sonja Nicholson, who donated $5 million to create the center, the robotic surgery training facility has come a long way since it was formed in borrowed space in what was then Florida Hospital Celebration. The Nicholson Center moved in 2011 to its current location, a 54,000-square-foot building that includes auditorium, meeting, event and classroom space as well as surgery training bays with adjacent conference rooms for observation.

“When we moved in, we were rattling around here because we’d never had so much space,” said Roger Smith, the Nicholson Center’s chief technology officer. “So for the first couple of years, we were operating one or two events at a time, just like we always had, and then it gradually, like a snowball going downhill, got bigger and bigger and bigger until we were operating six or seven or eight events at the same time. We went from being a modest production to something that is literally world-class.”

Better Medicine

Doctors have been training at the Nicholson Center since 2001 because of the promise it offers in the future of robotic surgery. Today its capabilities are growing, and the facility has the capacity to continue adding different kinds of robotic training to meet the increasing interest of surgeons, Smith said.

“A surgeon is like a carpenter with hand tools,” he said. “Doctors are contorting for hours in a hunched position. They have worked under terrible ergonomic conditions, and that has just been considered normal. We’re just starting to give them smart power tools. All of the stresses are on the machine instead of the human body.” - Roger Smith

The robots have changed everything. Video screens offer magnification so the surgeons can see better. Connective devices inside the patient give surgeons the ability to perform microscopic procedures without invasive incisions. Robotic arms operated by the surgeon’s hands and feet even give doctors something everyone has wished for at one time or another: a third hand. The da Vinci allows surgeons to hold back a flap of tissue, for instance, while the other two robotic hands perform the operation.

Surgeons are increasingly interested in how robots can help them increase not only their productivity but also their effectiveness. Traditionally, they have been limited by the amount of stress their bodies can endure as they bend over the operating table for sometimes hours at a time peering into the body of a patient.

“They experience the hardship on their own body firsthand,” Smith said, “so when someone demonstrates a robot to them that takes away all of those stress injuries they’re having, or the repetitive injuries like carpal tunnel, they get very interested. They start thinking about the longevity of their career and how long they’ll be able to operate with these nagging pains that keep getting worse every year.”

Additionally, doctors are interested in anything that can improve the success rate of their surgeries. Robotics allow them to perform intricate functions that are difficult to do with human hands.

“They’re aware of their own limitations when they’re doing surgery — where they’re successful and where they’re not,” Smith said. “When they can see an advanced tool that helps them be more successful more often, they’re very eager to do that.”

High Technology

One thing visitors notice right away at the Nicholson Center is the number of televisions and video cameras throughout the three-story lobby, the seminar sections, the conference rooms and the surgery bays. The Nicholson Center’s technology team developed a device that allows for two-way audiovisual interaction: the B Hive Mobile Broadcast Solution, which is housed in a wheeled cabinet about the size of a microwave cart.

“When we use the remote connection, that’s the kind of training that’s mostly knowledge-based,” Smith said. “You can’t learn how to do surgery on the internet. But we offer systems where a course can be conducted here and then all of the content — whether it’s a video on a surgery, a video on a cadaver, or a lecture — whatever is happening here as part of the physical course can be beamed out to other people and they can get the intellectual part of that remotely.

“Conversely, the technology that lets that happen works both ways. You can have a doctor doing a surgery in New York and have that broadcast to an event here.”

Past, Present, Future

Smith joined the Nicholson Center in 2010 just as it was branching into research in addition to training. As a computer scientist, he had worked for decades in the modeling, simulation and training industry, serving most recently as the chief scientist for all U.S. Army simulation operations in the country.

Since then, the center has continued to evolve and remain unique in the medical world. With its location in Celebration giving it easy proximity to Walt Disney World, the Nicholson Center has relied on its famous neighbor for advice.

“In the early days, we were patterning ourselves after Disney,” Smith said. “We had the Disney Institute come in and we asked, ‘How do you appeal to clients? How do you create a destination event for them? What does ‘front of house’ and ‘back of house’ mean, and how do you apply that here?’ We had a lot of inspiration and guidance from Disney when we first started.”

The facility started with the da Vinci robots and has added two more to its training capabilities. Mazor systems manufactured by Mazor Robotics in Israel, now owned by Medtronic Inc. in Minneapolis, assist with spinal surgery, and Mako systems, invented in Fort Lauderdale and now owned by Stryker Corp. in Michigan, work with hip and knee replacements.

About 18 months ago, Smith said, other robotic companies emerged on the scene with the express intent of ramping up the competition.

“As they came out, there were aware of how Intuitive, which creates the da Vinci robot, trains their surgeons and the part we’ve played in that,” he said. “All of them came to us and said, ‘We want the same quality of training that you’ve been doing for Intuitive. We want that for our clients as we come to market.’ That’s what’s most exciting to me. I get to see the robots before anyone outside of the companies.

“Each year you will see the Nicholson Center offering courses and research about a robotic device no one else is in a position to offer that material from. Eventually it’ll be open enough that other places will have their hands on it as well, but we’ll be the first. Then it’s our job to sustain that advantage.”