What Clementines Can Teach Surgeons : Shots - Health News A piece of fruit can be a terrific stand-in for a patient during doctors' surgical training. And while there are high-tech simulators on the market, one researcher believes skills crucial to minimally invasive surgery might be better taught with something as simple as a clementine.

What Clementines Can Teach Surgeons

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Now, a story about a low-tech way of training doctors to do some high-tech surgeries. It involves fruit. Stick with us. We're talking about minimally invasive surgery, which is becoming the norm for many procedures. Things such as knee repairs and hysterectomies are often done through tiny incisions.

While at the University of Michigan, NPR's Andrea Hsu found a medical educator with a new idea for how to practice on produce.

ANDREA HSU, BYLINE: When Pamela Andreatta brought in medical residents to test a simulation she developed, she kept hearing this.

PAMELA ANDREATTA: Why are we doing this? Seriously.

HSU: She'd given them clementines, the tangerine-like fruit. She'd also provided a vinyl box with small holes in the top and basic laparoscopic instruments to go in those holes: a grasper, scissors and a scope or a camera. The task was to peel the clementine, separate the segments, remove the pith - that's the white stringy, spongy stuff - then put it back together and suture the peel closed.

ANDREATTA: So that the clementine looks like it did before you've opened it, except with some sutures.

DR. ADRIANNE GASPERUT: It's a lot harder than it actually sounds.

HSU: Adrianne Gasperut(ph) is a third year resident in obstetrics and gynecology. She managed to get her clementine peeled and sectioned but ended up having to open the box and sew it close by hand. Though frustrated by the exercise, Gasperut admits practicing on fruit could be valuable.

GASPERUT: It's a lot less threatening, I think, than starting in the operating room where obviously it's of critical importance that you're safe.

HSU: And that's Pamela Andreatta's point too. She's not a physician. Her doctorate is in educational psychology. But she spends a lot of time talking to doctors and nurses. One day, a colleague in gynecologic oncology asked, could she come up with a simulation for stripping nodal tissue, something they do to try to minimize the spread of cancer? Andreatta thought for a moment about the pelvic anatomy.

ANDREATTA: You have relatively substantial tissue, but then you've got that fine, delicate tissue, like ureters and vessels.

HSU: A clementine, she reasoned, likewise has a somewhat sturdy outer peel as well as the more fragile inner pith.

DR. DAVID MARZANO: It felt actually surprisingly similar. And I have to say, initially, I was somewhat skeptical.

HSU: David Marzano is an OB-GYN at the University of Michigan. A dozen years ago, when he was a resident, they practiced laparoscopy on live pigs. Today, he believes many of the same skills can be honed through simulations that are far less costly, yet still highly representative of the task at hand.

MARZANO: If you squeeze too hard on the orange pieces, all of a sudden you've got juice all over the place, which is similar to, if you squeeze too hard on an ovary that has a cyst on it, you're going to break the cyst.

HSU: Pamela Andreatta has logged many hours in operating rooms, observing. She's seen residents struggle as they drive the camera for the first time. She's watched as attending physicians have had to coach young doctors on how to hold the graspers, all of which prolongs the patient's surgery.

ANDREATTA: I look at that, and I think: We can do better.

HSU: It's not that Andreatta doesn't value the operating room experience. She knows there's a lot of critical learning that goes on there. It's just that she thinks residents should master some basic skills before they get to the patients.

ANDREATTA: Just the use of the instruments alone, it's tricky. It's challenging to use those instruments.

HSU: And beyond skillful instrument handling, she says, the clementine teaches planning and judgment. When do you decide that the removal of more pith is going to cause too much damage to the underlying structure? How long will you go before you decide it's safer to open the patient - in this case, the box - and finish the operation by hand?

The clementine is just one of many training models Andreatta has developed. She's also experimented with Meyer lemons and globe grapes, and she's been brainstorming about another piece of fruit she thinks may be a useful simulation for the removal of ovaries.

ANDREATTA: I'm still kind of on the fence about an apricot for an oovectomy. I'm thinking an apricot might work.

HSU: Residents, stay tuned. Andrea Hsu, NPR News.

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