Navigation to the cubic millimetre in Medical Delta

Many surgical interventions are already possible using MIS. But this technique calls for completely different skills on the part of the surgeon. 'Trainee surgeons first ought to train in a ‘skills lab’, something like a flight simulator,' Frank Jansen will suggest on Monday 11 January at his inaugural lecture.

Inaugural lecture Monday 11 January, 16.00 hrs in the Academy Building
Professor F.W. Jansen, gynaecologist
Faculty: Medicine
Specialist field: Clinical evaluation of minimally invasive surgical instruments

Professor Frank Jansen: ‘The chair is spread over four research groups, two in Delft and two in the LUMC. This research and teaching remit could not wish for a better foundation, and it also benefits from the cross-fertilisation of ideas.'

MIS

MIS stands for ‘Minimally Invasive Surgery’. This form of surgery has been made possible by the advances in technology. The technque has been proven to have many medical and scientific advantages for the patient, but at the same time it demands completely different skills on the part of the surgeon than  conventional approaches. 'This issue requires serious attention if we are to guarantee patient safety,' Jansen warns. 'It's the same as in aviation, where the safety of patients and crew is paramount.' 

Skills lab

The new technology is complex enough in itself, and if it is not properly managed at the different levels in the organisation, it can be harmful for patients. 'This is the reason why, in parallel with the safety procedures in operating theatres, trainee surgeons should first practise in a skills lab. Once they have passed the relevant exam, they can then apply the technique to patients, under the supervision of a mentor. The Netherlands Health Care Inspectorate has been advocating this approach since 2007 and the professional bodies have taken the message on board.' 

Medical Delta

Jansen is Professor of the Clinical Evaluation of Minimally Invasive Surgical Instruments both in Leiden and in Delft.  His dual appointment emphasises the collaboration between Leiden, Delft and Rotterdam Universities and the LUMC and the Erasmus MC in Medical Delta. Medical Delta is a partnership based on the California model: it is comparable with the larger university consortia that have been common in the US for some time. Such a consortium creates accessibility and excellence; bundling scientific knowledge leads to a greater spin-off than when each institute works separately. 

New innovations

But there is still reason for concer, with the introduction of new techniques such as robotic surgery (NOTES) and single incision laparoscopic surgery (SILS). These techniques hold the promise of improvements in the approach to surgery, but according to Jansen: Such techniques are often introduced without any critical evaluation of the new technology.' This is also because the technology is primarily approached from a technical or commercial viewpoint. 'And the demand from patients for treatment using the new technology should not be underestimated.'

End result

‘Close co-operation between clinicians and technical experts makes it possible to reach a balance.' And that is exactly what Jansen wants to do with his project, under the umbrella of Medical Data. ‘By learning one another's language and stressing the clinical approach, the result should be a more critical and therefore a safer introduction of highly advanced technology in surgery. Just as with the introduction of new medicines, criteria have to be formulated for new instruments and new technology before they are accepted into clinical use. The recommendation is also that advanced MIS interventions in the Netherlands should be centralised and accredited to avoid a situation where 'little is done by a lot, and a lot is done by few.' The key issue is the end result for the patient.'



(5 January 2010)