An Immersive Model Simulating Massive Surgical Haemorrhage

Oral Presentation 2
Prof Tim Brown, Mr Stephen O'Neill, Prof Frank Lyons

An Immersive Model Simulating Massive Surgical Haemorrhage.

Introduction Non technical skills in the operating theatre (surgical human factors) relate to human and individual characteristics in the operating theatre which influence behaviours that affect patient safety and surgical outcomes. An important element of human factors to overcome is “startle effect” or “amygdala hijack”. Startle effect is induced by the experience of a sudden, catastrophic event which induces a stress response. The psychological outcome of this phenomenon is characterised by loss of situational awareness, tachypsychia and difficulty in making decisions. When this happens to an operating surgeon in cases of unexpected, massive haemorrhage, there is a threat to patient safety. A surgeon in “startle” must act to arrest haemorrhage whilst in a psychological state that is complicated by a difficulty in developing rational thought processes. Poor decision making whilst in “startle” may lead to inappropriate surgical manoeuvres that can attenuate the harm of the bleeding patient. The airline industry has recognised the concept of startle and trains pilots in a simulated environment to help them recognise the signs of startle in themselves but also has developed checklist strategies to overcome the human errors which are evident in decision making whilst pilots are in startle.

Aims: To develop an immersive simulated environment of massive, unexpected surgical haemorrhage in a patient undergoing elective laparoscopic nephrectomy. Virtual reality immersive simulation was used to limit unnecessary use of live animal models.

Methods: Ethical approval was obtained from the UK Home Office. A single porcine model was anaesthetised and prepared for laparoscopic surgery. The renal vessels of each kidney were dissected out. Both renal arteries were sequentially and deliberately transected with laparoscopic shears causing massive and catastrophic haemorrhage. 360-degree camera and sound recording was obtained which recorded the human factors at play within the theatre environment and the actions of the surgical team. The right renal arterial injury was managed inappropriately to simulate a surgical team suffering from “startle effect” and represents a simulation of “what not to do”. The left renal arterial injury was managed according to best practice and represents a “successful management” strategy to deal with “startle effect”. The image and sound capture were collated and edited and developed for presentation via a Virtual Reality headset.

Conclusion: A successful and realistic immersive virtual reality model of surgical haemorrhage has been developed and has multiple potential applications in the field of training to ameliorate and overcome surgical “startle effect”.