Computerized Intraoperative Surgical Atlas: An Exploratory Analysis of an Educational Tool
Drs. John W. Riggs, Melinda New, Robert Maier
University of Texas Health Sciences Center
Houston, Texas

Objective:   To study the acceptability of an electronic surgical atlas in the operating room to teach students and residents complex anatomical principles and surgical techniques.
Materials and Methods:   We designed a system that displays anatomical and surgical illustrations on a laptop computer and which can be navigated easily by physicians from within the sterile field.  After reviewing the copyright laws as presented by the parent institution, illustrations from available textbooks and published manuscripts of anatomy, and pelvic surgery were scanned to create image files on a Sony Vaio PCG-F290 laptop.  Control of the laptop was obtained from within the sterile field with the VersaPoint RemotePoint Plus cordless handheld pointing device placed within a sterile glove. This device was later replaced with a transparent plastic adhesive drape covering the keyboard.

The intraoperative atlas was used during surgical procedures based on the availability of the laptop and the suitability of the planned procedure for teaching.  The intraoperative atlas was assessed by residents and students using a 10 point Likert scale survey regarding their perception of the atlas’ impact on their learning and quality and duration of the procedure (10 = greatly helped; 1 = greatly hindered). They were also asked if they would want to use the atlas on future surgical cases.
Results:   Between the months of February and August 2001, the intraopertive surgical atlas was used to teach residents and students during procedures performed on 15 patients.  These patients underwent 3 anterior/posterior repairs, 4 vaginal hysterectomies, 3 abdominal hysterectomies, 1 Burch colposuspension, 1 sacro-spinous ligament fixation, 1 abdominal paravaginal repair, 2 laparoscopic tubal ligations and one diagnostic hysteroscopy.  Students and residents completed forty-six surveys.  The respondents rated very highly the impact of the atlas on the quality of the cases performed (7.93+1.4) and the educational value for learning the procedures (8.5+1.1) and the anatomy (8.89+0.9). They perceived that it slightly shortened the duration of the procedures (6.5+1.6) and one hundred percent of the respondents stated they want to use the atlas on future cases.
Conclusions:   Atlases are well-established learning tools in the anatomy lab.  An electronic teaching atlas can be used in the operating room. It may improve the learning of residents and students and their perception of the quality and duration of procedures.