A rule of thumb when training surgeons is that they should do about 60 operations before considering themselves ready for prime time. For cataract surgery, the ideal practice count is over 100. But most schools have surgeons practice on 10 to 20 cadavers and then work under the guidance of a skilled surgeon in a real OR.

Even practicing on cadavers has drawbacks. Long exposures to the radiation from fluoroscopes could be hazardous to a surgeon's health.

Engineers at Simulution, Burnsville, Minn. (simulution.com) think they have a better way in a device that lets surgeons practice spinal operations, letting them develop expertise on a specific spinal implant in a realistic computer-based environment and with zero patient risk. The simulator lets surgeons acquire the skills using computer imagery and ‘artificial touch’ in a realistic environment.

The user interface for the orthopedic simulator is based on the Melerit TraumaVision platform, an interface for a widely used fluoroscope. During a simulation, a user steps on pedals to activate “radiation” and generate a fluoroscopic image on a screen as it would appear in an OR. The simulator uses haptic (simulates touch) devices and a software toolkit from SensAble Technologies Inc, Woburn, Mass., (sensable.com).

Surgeons in training hold a SensAble Phantom haptic device in place of surgical instruments, such as the canulation tool and screwdriver to tighten pedicle screws. As the surgeon tightens a screw, the Phantom resists the torque applied by surgeon, so they “feel” each step of a procedure, such as palpating a bone while looking at an X-ray view, inserting a needle into the bone, inserting a guide wire into the needle, and tightening a screw. After the simulated operation, the surgeon's performance is tallied and scored. Progress can be measured over several simulations.