Lifelike Surgical Training Model

Join us as we explore Medical Frontiers！ It rotates on a spindle.
Once this is on, it's ready.

Japanese specialists have developed cutting-edge humanoid models.

They were created to help surgeons acquire the advanced skills needed to perform complex operations.

High-quality surgical training requires both precise and also realistic surgical simulators.

But it is extremely difficult to produce a model that accurately recreates the texture and the structure of the human body.

And this one has managed to do just that.

Doctors and engineers worked together to come up with this innovation, which is changing the way medicine is practiced.

The surgical training model is the product of a government project involving the cooperation of the business and academic communities.

It's so lovely to meet you. Thank you so much for your time today.

Thank you for coming!

Kanako Harada led the project.

The biomedical engineering specialist teamed up with medical doctors in the development effort.

What actually is this?

It's a bionic humanoid for eye surgery.

Bionic humanoid.

You can see the back of the eye.
Take a look inside.

Gosh! That's incredible!

We replicated the membrane at the back of the eye.

A bionic humanoid contains certain artificial tissues with lifelike textures.

It also replicates complex structures within the body.

In this model, a part of a membrane at the back of the eye has been recreated.

The team also developed a model that can be used to train for brain tumor surgery, and another to practice inserting a catheter into a blood vessel.

The project was launched in 2015.

It involved 20 research teams including surgeons and engineers from universities and companies.

It took them three years to create the bionic humanoid.

How and why then did you get involved with this bionic model and what motivated you to get involved?

What if a doctor told you you're their first patient?
Would you feel honored or scared?

Terrified.

Every doctor has their first patient.

It's impossible to know how experienced
or skillful a particular doctor is.

We focus on procedures that surgeons
have no other way of training for.

We would like doctors to have the chance to
practice thoroughly before an actual surgery.

Demand for sophisticated surgical models has been high among eye doctors.

Ophthalmologist Makoto Aihara was involved in development.

He says it's not easy to train novice doctors during an actual eye surgery.

Learning by observing has always been the norm.
In eye surgery, patients are given local anesthesia.

We drape them so they can't see,
but they can hear everything.

They hear and picture what's going on around them.
We can't say things that could cause them stress.

Therefore, we're reluctant to give advice
to novice doctors during surgery.

Aihara has high hopes for bionic humanoids, because they allow doctors to practice surgery as if operating on an actual patient.

There are different types of bionic eyes.

One is made especially for glaucoma surgery training.

But we'll focus on another that has been developed for macular hole surgery.

Macular holes are not common among young people.

To see why that is, let's look at the structure of a healthy eye.

When light enters the eyeball, it gets focused on the retina, a layer covering the back of the eye, and forms an image.

At the center of the retina is an area called the macula, where the optic nerves are concentrated.

It provides sharp focus and detailed vision.

This is a cross section of the retina.

It consists of multiple layers with a gentle depression.

The central part is the macula, a spot with a width of about 2 millimeters.

When a hole forms in the macula, the eye cannot receive sufficient light.

The field of vision is partially lost or distorted.

Normally, the space between the lens and the retina is filled with gelatinous tissue called the vitreous body.

But as people age, the vitreous body loses some of its moisture and shrinks, pulling on the retina.

Experts say this can cause a hole in the macula.

The key to successful surgery is the retina's innermost layer called the "Internal Limiting Membrane," or "ILM."

It's only 3 micrometers thick.

The ILM has a strong pull,
so as it shrinks, the hole widens.

If this membrane is removed, the retina will return
to its original place and the hole will close.

If the ILM is torn, it pulls on the soft retina underneath it, widening the hole.

The effective way to treat the condition is to remove just the ILM.

After the ILM has been peeled away, the eyeball is filled with non-toxic gas.

This allows the retina to eventually seal the hole.

The procedure is done by inserting a piece of equipment into the back of the eye.

Surgeons then gently remove the extremely thin ILM while looking into a microscope.

This is footage from an actual surgery.

When peeling away the ILM, applying too much strength or pulling excessively can damage the retina.

Advanced skills are required.

Human hands normally have a slight tremor
of several hundred micrometers.

It's very hard to hold and peel away a membrane
that's only a few micrometers thick.

Without proper training, doctors can't be nurtured.

Japan's population is aging rapidly.

People suffering from macular holes are likely to increase.

Aihara introduced a bionic humanoid on a trial basis to train novice doctors.

The ILM's texture has been replicated accurately in the model.

You're touching the retina.

It's hard to peel away the membrane.

That's OK. You're new to this.
You're in training.

But now you know how it feels
and how to move your hands, right?

Yes, I know how deep I need to go.

This will help you learn
how to use both of your hands.

You've peeled away quite a bit.
That's good.

The inside view of the eye is realistic, and so is
the way the retina curves when it's touched.

The peeling sensation feels real, too.

With the model, it takes less time to
learn how to do the surgery.

I can also make the procedure
less invasive for the patient.

He's obviously dexterous and capable.
I can trust his skills.

Seeing his performance during training
assures me that he can do the surgery.

However, replicating the ILM's texture was extremely difficult.

Only surgeons who have operated on the ILM know what its texture is like.

Reproducing it was an unprecedented challenge for Harada, an engineer.

Doctors said this surgery is like
tearing plastic wrap that's on a piece of tofu.

I thought, "Tofu? Wrap?"
We can't touch or measure a real eye.

What we replicate based on their words
may not be what they're looking for.

It's not easy for us to describe the ILM's texture.

In some cases, it's sticky and hard to peel away.
It can also tear easily. But that's about it.

People don't usually touch or hold something
so thin, so it's hard to say what it resembles.

Engineers want to replicate the ILM, so they ask us
what it feels like. But it's hard for us to describe it.

I'm a project manager, but I'm like a translator.

We try to comprehend what doctors say
and rephrase it so that engineers can understand.

To do that, we must have knowledge of both fields.
We also need to respect both sides.

Mechanical engineering specialist Fumihito Arai took on the difficult challenge of replicating the ILM's texture - - something only eye surgeons are familiar with.

The ILM's mechanical characteristics and
physical properties weren't well known.

At first, we tried to replicate it after watching
surgery videos and imagining what it was like.

But the result wasn't very accurate.

There were no detailed studies on the ILM's strength or hardness.

Arai first created a machine that could measure the strength of a membrane that's just 3 micrometers thick.

Then he enlisted Aihara's help and studied the ILM in detail.

He discovered that the ILM is 100 to 150 times as hard as the outer layers of the retina.

His research eventually led him to a gel-like substance made of a synthetic resin called polyvinyl alcohol, or PVA, which is used to produce glue.

He made about 150 samples with different ingredients and moisture content.

And as a result, he finally succeeded in creating an artificial membrane with a texture resembling that of the ILM.

The model's physical properties are important.

It's best to use materials that are easy to
handle and process. Cost is most important.

In the human body, the ILM is naturally maintained.
But with the simulator, long-term storage is important.

It needs to be free of decay or germs,
and preserved in a clean state.

Those factors often take priority too.

Arai also attempted to quantify the surgical skills of experienced doctors.

He created a sensor that determines the subtle force applied by a doctor.

The ultra-sensitive sensor is 1 millimeter wide and 8 millimeters long.

It can measure as little as 22 milligrams of force.

If it's installed in a bionic humanoid, it can show how much force the retina is being subjected to.

The level of force is depicted in a waveform.

Doctors can see it in real time.

The pushing force that's exerted on the retina when the ILM is held is shown as a rising wave.

The pulling force caused by the peeling of the ILM produces a dip.

A smaller range of waves indicates a safer surgery.

The doctor's skill levels, techniques and
accuracy during training can be shown numerically.

There's a model that has accurately replicated not only the texture of tissues, but also the structure of the body.

This bionic humanoid has been developed for practice in brain tumor surgery.

Brain tumors often develop around the base of the skull.

Tumors in or around the pituitary gland are especially difficult to reach in surgery.

The model is used to train doctors for such procedures.

To reduce the risk of brain damage, it's becoming more common for surgeons to remove brain tumors through the nostrils.

But each nostril is only about 1 centimeter wide.

Removing a brain tumor through them requires advanced techniques.

One of the members of the development team for this bionic humanoid was Akio Morita, a neurosurgeon with vast experience in transnasal operations.

In transnasal surgery, you can only move each hand
within a range of 1.5 to 2 cm from side to side.

But within the skull, you have a depth of about 5 cm
if the bones have been shaved down properly.

You need skill to move the device around deep
in the skull with limited sideways hand movement.

If you can do this, it's not hard to apply
the skill to other parts of the brain.

Based on MRI images and anatomical charts, the development team created the world's most sophisticated computer graphics that show the structure of the brain and the bones and the networks of nerves and blood vessels.

It used that data to recreate the structure and area around the base of the brain with a 3D printer.

Using this model, Morita is conducting training on a trial basis to remove a tumor from the pituitary gland through the nostrils.

The bone in front of the pituitary gland has also been replicated.

Doctors can practice shaving down this bone as well.

The surgery requires utmost attention to the optic nerves that spread out around the pituitary gland.

This is footage from an actual surgery.

The tumor is covering the pituitary gland and adhering to an optic nerve.

When removing a tumor from the pituitary gland, it's critical not to damage the optic nerves in the process.

The model brain's optic nerves contain sensors that trigger a warning sound when unnecessary force is applied to them.

The suction tube is heavy and slightly large.

Insert it smoothly so that
it doesn't hit surrounding areas.

The surgeon uses a suction tube, a device to remove the tumor, and an endoscope.

It is not easy to handle all of them through the nostrils.

The novice doctor takes out the piece that represents the tumor.

It is adhesive and can be reattached to the model and reused again and again for tumor-removal practice.

Next is a demonstration by Morita.

Don't pull. Move it sideways.

By rolling it to the side, you can avoid
pulling on the nerve excessively.

Hold onto the part where it's sticking,
and try to pull it sideways.

And hone your sense of location.

You should be able to bring the
tips together with your eyes closed.

That way, you'll have a
three-dimensional grasp of where things are.

During the tumor removal process, the load applied to the optic nerves is shown on a graph.

Morita's waveform doesn't swing much.

The graphs show the skill levels as concrete data, so the novice doctors don't have to rely only on touch and their senses.

My expectations of this surgery were
quite different from what Dr. Morita showed me.

I'm glad this model helped me
to understand that today.

The procedure requires that we
rely on our sense of touch.

The model alerts us when we aren't doing it right.

It helps us to learn how to gently remove
a tumor before actually operating on a patient.

It's a very valuable experience.

Everything, including the optical nerves and
blood vessels, is replicated in the bionic humanoid.

It even has sensors, so it's very useful.

But the cost of the model is important.
It should be cost-effective.

That way, doctors can practice more
and acquire skills at a low cost.

Every time the bones in the brain model are shaved down, internal parts that cost thousands of dollars need to be replaced.

Project manager Harada wants to utilize bionic humanoids in the development of surgical robots and medical devices.

She points out that a wider application of the humanoid models would reduce their cost, while decreasing the time needed to develop surgical robots and medical devices.

Various surgical robots and medical devices
are being developed worldwide.

When developing cutting-edge models, it's always
difficult to evaluate their functions and safety.

Using the models will allow us to assess
the new devices before they're taken to doctors.

I want people to know bionic humanoids can help
with the development of medical devices.

This will increase their value.

I'm so excited to see what you're going to be doing next and thank you so much for your time today.

Thank you.

Our guest today is personal trainer Kiyo.

This is the second session of his "Shindo" exercises, based on the traditional Japanese martial art of kendo.

Last time, he showed us some basic movements.

In this session, he will introduce more active, advanced exercises.

There's footwork in Kendo called "ashi-sabaki."
I've combined some of the different steps.

They will help you burn more calories.
It's going to be more difficult this time.

Harder than last time?

You'll be short of breath. They're aimed at
improving the functions of your heart and lungs.

Please be gentle and kind with me.

Sure.

Try to follow along for the next four minutes.

Take 2 steps forward with your right foot,
then 2 steps back.

In the first exercise, keep your left heel slightly raised while stepping back and forth.

Next, we'll add a move called "men."

Bring your arms up high over your head.

Make sure your upper body and lower body move rhythmically in sync.

One more set!

Lower your arms to the basic position.

Rest a little while moving your body up and down.

Now, onto the second exercise.

Take two steps to each side.

Let's add the arm movement.

Bring your arms down in sync with your steps.

Keep your body straight.

This is much more aerobics than functional exercise.

Stretch your arms out when you lower them.

This will strengthen your core and upper arms.

Next, jump sideways.

Add the arm movement as well.

The third exercise is a jump that's also done in kendo practice.

It boosts your heart and lung functions and trains your calf muscles.

Let's go to the fourth exercise!

Take steps like this.

Don't hunch your shoulders.

Straighten your back and chest.

Add the arm movement.

Thrust your arms down diagonally as if slashing with a sword.

Keep the axis of your body still as you twist your lower back.

This can tighten your waistline.

This is very different from the first part of the exercise.

Bring your arms as low as possible.

Are you running out of breath?

Just one more move left!

Jump up and down, while
opening and closing your legs.

When you open your legs,
lower your hips as if you're doing a squat.

Add the arm movement.
Move them up and down.

Bring your arms down as you open your legs.

Make dynamic movements to train the muscles in your thighs and around your buttocks.

Your arms shouldn't go too low. Stop them here.

Let's do 4 more reps.

4, 3, 2, 1. That's it!

Wow! That is quite hard working out!!!

I'm so up my breath, it's so different sorts of exercises which are very much functional movements and exercises.

Martial arts require you to maintain a good posture.

If your body's core isn't firm, your backside
may stick out and ruin your posture.

By improving your posture,
you can also strengthen your core.

But it's really fun!

Let's bow to each other.

Thank you.