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Technology enhances department's efforts in education and care

A third-year medical student uses the Web to perform a mock patient examination for course credit. A surgeon removes a cancerous tumor with a tiny incision and robotic arms. A soon-to-be mother feels her baby kicking as she watches the little legs move on a computer screen.

Gynecologic oncologist and surgeon Peter Argenta, M.D., performs minimally invasive, robotic-assisted surgery using the da Vinci Surgical System.

The Department of Obstetrics‚ Gynecology‚ and Women’s Health has honed in on technology to improve the way it cares for patients and educates students and residents. As a part of the University’s Academic Health Center‚ the department and its faculty members have benefited from collaborations with colleagues in bioengineering‚ basic sciences‚ information technology‚ and many other disciplines.

“These rapid advances have significantly improved the clinical practice of obstetrics and gynecology and our teaching and research efforts‚” says department chair Linda Carson‚ M.D. “Faculty can continue to push the envelope and explore new applications of research‚ resulting in improved care for women in Minnesota and throughout the world.”

Interactive learning

Associate professor June LaValleur, M.D.,has been awarded a six-month Bush Foundation Medical Fellowship todevelop “Webcasts” —or Web-based lectures—and an interactive learning tool for the department’s medical students and residents.

The interactive learning tool will consist of 30 “must-see” patient scenarios that every medical student in obstetrics and gynecology will likely encounter as providers of women’s midlife health care. Students can access the password protected system from any computer‚ view a sample patient’s presenting complaint‚ ask the patient questions‚ perform a virtual exam‚ order tests‚ and devise a treatment or management plan based on the findings.

LaValleur plans to create an educational tool that will closely mesh with current medical students’ learning styles.

“Today’s medical students grew up on Sesame Street‚ and for most—if not all—of their lives‚ they have been entertained while they have been educated‚” says LaValleur‚ who is the course director for the third- and fourth-year rotations in obstetrics and gynecology. “To accommodate that learning style‚ we have to devise more interactive approaches.”

The technology will also serve the 35 to 45 medical students working in greater Minnesota through the Rural Physician Associate Program‚ thanks in part to a $30‚000 grant from the Association of Professors of Gynecology and Obstetrics.

The Bush Foundation grant also covers the development of a website for consumers of midlife women’s health care in Minnesota. LaValleur says the website will give women‚ especially those living in greater Minnesota‚ easy access to current information about health issues.

The da Vinci Surgical System in action.

Lending a robotic hand

For the past 18 months‚ assistant professor Peter Argenta, M.D., has been performing minimally invasive surgery for gynecologic cancers using the da Vinci Surgical System‚ a sophisticated setup that features a surgeon’s console and three interactive robotic arms with attached surgical instruments.

Minimally invasive surgery‚ which gained ground in the 1990s‚ has many advantages over traditional “open” procedures‚ Argenta says. It allows surgeons to work through tiny keyhole incisions‚ which cause less pain for patients and heal faster than the typical longer cuts.

Therobotic system offers advantages over even the most modern laparoscopic equipment. Perhaps the biggest advantage is its additional joint‚ which improves the surgeon’s dexterity. If you think of the robotic arm as a human arm‚ the additional joint allows the da Vinci arm not only to swing back and forth at the shoulder and wrist but also at the elbow. Because the surgeon’s moves are translated electronically to the robot from the console‚ the da Vinci system also eliminates the slight natural tremor of the human hand‚ allowing precise‚ steady surgical movements for delicate surgeries.

To illustrate the benefits of the da Vinci system‚ Argenta uses uterine cancer as an example. “Intraditional open surgery‚ the procedure would take 2 hours and require 2 to 4 days hospitalization with 4 to 6 weeks for full recovery‚” he says. “With the da Vinci system‚ the procedure takes an hour longer‚ but 85 to 95 percent of patients go home the following morning‚ and full recovery can be achieved in 2 weeks.”

Long- and short-term complications such as infection‚ bleeding‚ pain‚ and scarring are also reduced through minimally invasive procedures.

“We have been doing surgery for thousands of years‚ and to me the biggest advancement since the development of antibiotics has been this technology‚” says Argenta.

“As time passes‚ the da Vinci system will be available for more and more patients‚” he says.

Babies in 4-D

Associate professors Kirk Ramin, M.D., Phillip Rauk, M.D., Preston Williams, M.D., and assistant professor Tracy Prosen, M.D.,are using 4-D ultrasound as an innovative diagnostic imaging technique in maternal-fetal medicine. In 4-D ultrasound‚ a 3-dimensional image is continuously updated so that external anatomy can be viewed in real-time‚ producing images much like a CT scan with motion.

Both 3-D and 4-D ultrasound more clearly reveal fetal anomalies involving the face‚ spine‚ heart‚ and brain; 4-D ultrasound also allows physicians to observe fetal movement and behavior previously not seen by ultrasound techniques.

“Three-D and 4-D ultrasound are often used to show the patient the fetus in more detail‚ but we can now take advantage of the technology to more completely view fetal anatomy and identify anomalies‚” Rauk says. “The use of this new technology is expanding as the use of CT and MRI did decades ago.”

Additional research will continue to advance understanding of fetal health in the womb‚ he says.

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