17TH SLS ANNUAL MEETING AND ENDO EXPO 2008 GENERAL SESSIONS

OPENING CEREMONY
6:30pm Wednesday, September 17, 2008

SPECIAL PRESENTATION
Virtual World Environments and Their Potential Impact on Surgical Training and Care
James C. “Butch” Rosser, MD

As the sun sets on the real world, Butch Rosser, MD FACS, shines a light into the still-murky dawn of the virtual earth in which our progeny will henceforth live more and more of their lives. In his typical style of aggressively probing the “what if”, he introduces the hypothesis that surgery should leverage the assets of this new medium to enhance surgical care and training. This is not a plea for generations to come, but rather, it is an announcement that the future is ready to happen today

BEST OF LAPAROSCOPY UPDATES
7:30am Thursday, September 18, 2008

UPDATE FERTILOSCOPY/TRANSVAGINAL ENDOSCOPY COMMITTEE
The Current Status of Transvaginal HydroLaparoscopy
Duncan Turner, MD

Approximately seven years ago transvaginal hydrolaparoscopy was introduced to the United States. One particular technique utilized was that of fertiloscopy. This is a procedure involving a transvaginal evaluation of the pelvis, a dye test, and a hysteroscopy in one setting under general or local anesthesia. Although this has not been completely incorporated into the practice of the regular gynecologist, it remains a very interesting technique with some distinct advantages, both in terms of morbidity and financially to the patient. An international multi-center study is about to be embarked upon comparing a fertiloscopy with a hysterosalpingogram for prediction of abnormal pathology. 

UPDATE ROBOTIC SURGERY COMMITTEE
Robotic Surgery: Coming to a Hospital Near YOU Soon
James F. Carter, MD

Over the last 30 years the evolution of Endoscopy has developed to reduce surgical injuries, decrease hospital stays along with reducing postoperative pain. Though laparoscopy could allow better visualization, laparoscopy has continued to work on a 2 D scale that limited to a certain degree tactile feedback and many surgeons fail in their suturing skills. In the last 10 years there has been a plateau of Growth of Laparoscopy with less formalized training, except in residency programs and fear of litigation. Beginning with NASA and the military thinking outside of the box with attempting to work on remote procedures. After initial difficulties, telepresence improving with Cardiac surgeons and Urologists with improving efficacy and lowering mortality. Newer set ups bring surgeon closer to patient, allowing an ergonomic console with 3-D visualization and ultimately bringing together a fully integrated team to effectively dissect laparoscopically returning to the surgeon all six positions of the wrist and making a much easier transition to operative laparoscopy. The ultimate Robotic will allow an organized, validated program to upgrade the skills of the surgeon, cause less pain on even the more challenging patient by restoring the surgeons dexterity and expand the original concept of remote surgery. We will be limited only by our own imagination. What is next?

UPDATE ABDOMINAL/PELVIC PAIN/ADHESIONS COMMITTEE
Pelvic Pain and the Reduction of Adhesions
Dan Martin, MD

Adhesions are a major problem after surgery. Consequences for patients include small bowel obstruction, chronic pelvic pain, infertility and repeat operations. This presentation covers the use of adhesion prevention solutions at laparoscopy.

The results of a FDA approved efficacy study demonstrated that the use of Adept (4% icodextrin) or lactated Ringer's solution at a volume of 1,000 cc decreases reformation of adhesions compared with the literature at volumes of 300 cc and 660 cc. 660 cc of a buffered solution was superior to 300 cc. Adept is a 4% modification of a 7.5% buffered, peritoneal dialysis solution. Adept patients achieved greater clinical success than lactated Ringer's solution in patients with filmy adhesions. Adept and lactated Ringer's were equal in their 50% decreased reformation of dense adhesions.

These solutions are contrasted with normal saline. Normal saline contains sodium and chloride in equal concentration that do not reflect the ratio in human extra cellular fluid. A variety of metabolic and tissue effects are produced by this abnormal ratio. Normal saline may predispose to the formation of peritoneal adhesions and fibrosis of the peritoneum when left in the pelvis. Use of normal saline to wash the peritoneal cavity after chronic peritoneal dialysis appears more likely to produce adhesions than no irrigation at all.

UPDATE INFERTILITY/FERTILITY COMMITTEE
Laparoscopic Update on Infertility/Fertility
Grace Janik, MD

MULTIDISCIPLINARY PLENARY SESSION
8:30am–10:00am, Thursday, September 18, 2008

MULTIDISCIPLINARY APPROACH TO ADHESIONS
Abdominal and Pelvic Adhesions, the GYN Perspective
Charles H. Koh, MD

Adhesions in the Abdomen, the General Surgeon's Dilemma
Phillip Shadduck, MD

Intraabdominal adhesions cause bowel obstruction, chronic abdominal pain, morbidity and mortality.
Approximately 70% of bowel obstructions are caused by adhesions. Adhesive small bowel obstruction alone results in nearly one million hospital days and more than 3 billion dollars of care in the US each year. Approximately 25% to 50% of patients suffering from bowel obstruction will require operative management. Discerning nonoperative from operative obstructions, accurately and timely, is difficult and carries risk. Operations for adhesiolysis can be tedious, difficult, and fraught with postoperative complications. Most adhesiolysis operations are performed open. The laparoscopic approach to adhesiolysis is feasible but requires careful patient selection, advanced laparoscopic skills, and sound surgical judgment, including a low threshold to convert to open when managing distended, thin-walled bowel. Postoperative complications are numerous, sometimes serious, and include prolonged ileus, fluid and electrolyte abnormalities, malnutrition, a variety of infections, enterocutaneous fistulae, recurrent early and late adhesions, and need for further surgery.

Adhesive abdominal pain can be chronic, severe, and frustrating for the patient, the family, and the health care team. Symptoms can be variable and nonspecific. Diagnostic algorithms are imperfect, and diagnostic studies are frequently nonspecific and unsatisfying. Surgery may be required for diagnosis and treatment.  Rates of pain recurrence, even after diagnostic surgery and adhesiolysis, are moderately high.

Safe, effective, cost-effective adhesion prevention is desirable yet seemingly elusive. Anti-adhesion barriers are better now than in decades past, though still with limited success. Opportunities for improved prevention and management of adhesion-induced morbidity and mortality remain.

New Strategies in Prevention and Management of Adhesions: The Research Perspective
Kathleen E. Rodgers, PhD

Adhesions are connections between normally unattached tissues created by surgical injury, infection or foreign body responses. Good surgical technique and minimally invasive surgery reduce the incidence and severity of adhesion formation, but they are not eliminated.

Intraperitoneal adhesion formation can have significant consequences, including small bowel obstruction, infertility, chronic pelvic pain and organ displacement/tethering. The latter can have severe consequences at the time of re-entry at re-operation. Medical devices to reduce adhesion formation have undergone preclinical and clinical development and are currently marketed in the United States, Europe and Japan. Marketed products include Interceed, a bioresorbable knit barrier of oxidized regenerated cellulose; Adept, a 4% solution of icodextrin that provides prolonged hydroflotation / tissue separation during healing; and Intercoat, a gel barrier of carboxymethyl cellulose complexed with polyethylene oxide. Additional therapeutic modalities are undergoing preclinical and clinical development. Pharmaceutical intervention to reduce adhesion formation has a promising future. Sites of intervention under investigation include (1) reduction of inflammation after surgery through prevention of the production of or neutralization of the activity of inflammatory mediators; (2) inhibition of deposition or enhancement of clearance of fibrin which is the scaffold for adhesion formation; and (3) modification of adhesion remodeling. The goal of these efforts is the development of a highly effective, easy to use and safe therapeutic for adhesion prevention.

Prosthetics, Synthetics and Biologicals: Notes from the Laboratory
Raymond J. Lanzafame, MD, MBA

Adhesion formation is part of the normal healing process and has been observed in 90-100% of all abdominal surgeries. Adhesions are a clinically relevant problem with the potential for significant morbidity for the patient. Postsurgical intraabdominal adhesions account for 79% of acute intestinal obstructions and are frequently responsible for chronic abdominal pain and infertility. Mechanical injury to the peritoneum, peritoneal ischemia, manipulation, exposure to foreign materials including powder, gloves and prosthetic materials; and inflammatory diseases and processes have been demonstrated to cause adhesions.

Modern herniorrhaphy techniques utilize mesh bioprostheses in a variety of types and configurations. The ideal material should be chemically inert and noncarcinogenic, should be capable of being fabricated in the form required and be sterilizable, should not be physically modified by tissue fluids, should not excite an inflammatory or foreign body reaction, and should not induce a state of hypersensitivity or allergy (Jenkins SD, et al.: Surgery 1983; 94(2):392-398). Bioincorporation of the mesh material is critical to the success of the repair. Mesh is typically secured with staples or sutures. Clinical use of fibrin glue, other tissue adhesives, and cyanoacrylates for mesh fixation has resulted in strong fibrous reactions and increased inflammatory response locally.

New strategies for mesh fixation, adhesion prevention and tissue reinforcement are being developed from collagen and other biological substrates as well as a number of novel compounds. These novel technologies are demonstrating promising results in experimental models and will likely be made available for clinical use in the near future. This presentation will discuss some of the promising technologies incubating in the laboratory.

SPECIALTY BREAK-OUT CONCURRENT SESSION (GYN)
10:30am–11:30am, Thursday, September 18, 2008

HYSTERECTOMY DEBATE: WITH OR WITHOUT REMOVING THE CERVIX OR OVARIES
Oophorectomy at the Time of Hysterectomy: Pros & Cons
Farr Nezhat, MD

“Prophylactic oophorectomy in women undergoing hysterectomy at age 40 or older would prevent over 1,000 cases of ovarian cancer annually” (Sightler et al 1991). This risk of ovarian cancer must be weighed against the risk of coronary heart disease, hip fracture, and stroke to determine whether oophorectomy should be performed. Additionally, the patient's menopausal status must come under consideration. The current ACOG recommendation for ovarian preservation includes premenopausal status, desire for fertility, impact on sexual function, libido, quality of life, and osteopenia or other risk for osteoporosis. Factors that favor oophorectomy include genetic susceptibility for ovarian cancer, bilateral ovarian neoplasms, severe endometriosis, pelvic inflammatory disease, bilateral tuboovarian abscesses, and postmenopausal status. Among those patients with genetic susceptibility, BRCA and HNPCC mutations are most frequently addressed. This presentation will review the pros and cons of ovarian preservation in the general population as well as those with a genetic predisposition for ovarian cancer.
 
Why Total Hysterectomy and not Supracervical Hysterectomy?
Tommaso Falcone, MD

There is a recent trend towards retention of the cervix at hysterectomy due to the perception that several outcome parameters such as sexual function and pelvic support are better after a supracervical hysterectomy. However three prospective randomized clinical trials as summarized in a recent Cochrane review challenge this perception. These trials included 733 patients with follow up between one to two years. One study was double- blind (patient was not aware if the cervix was removed). There was no evidence to support the concept that leaving the cervix was associated with improved sexual function or lower rates of incontinence or constipation. All of these studies included hysterectomies that were performed by laparotomy. However there is no logical reason to believe that it would have been different by laparoscopy. Blood loss was reduced with supracervical hysterectomy but the transfusion rates were the same. Length of surgery was decreased in the supracervical group. This is the main reason why this approach has become popular with gynecologists. This decreased surgical time is especially the case for laparoscopic hysterectomy where the most difficult part of the surgery is the detachment of the cervix from the lateral ligaments and from the vagina. This is also where most ureteral injuries occur during laparoscopic hysterectomy. However this advantage should be balanced with the potential risk of ongoing cyclic bleeding from the cervix that has been reported to be between 5-20% from the randomized clinical trials and 19% from a prospective observational laparoscopic trial.

Why Supracervical Hysterectomy and not Total Hysterectomy?
Charlie Miller, MD

Prior to the introduction of the Papanicolaou smear in 1958, total hysterectomy was recommended to reduce deaths from cervical cancer. With the advent of “ThinPrep” and HPV testing, the ability to properly evaluate cervical pathology has further improved. Thus, the need to continue to extirpate the non-diseased cervix must be questioned.

In a study by Learman, et al., comparing supracervical hysterectomy and total abdominal hysterectomy, performance of either technique led to statistically significant reductions in most symptoms. Interestingly, although not significant, patients assigned to the supracervical hysterectomy group had more hospital readmissions. No significant differences were noted in the rate of complications, degree of symptom improvement or activity limitation.

In a prospective randomized study comparing surgical complications and clinical outcomes after supracervical versus total laparoscopic hysterectomy for the control of abnormal uterine bleeding or symptomatic uterine fibroids, Morelli, et al. found similar results. Again, significant pain reduction and improvement in stress urinary incontinence were noted in each group. Hospital admissions were again higher in the laparoscopic supracervical hysterectomy group. Once again, no statistical significance was reached in regards to complications, degree of symptom improvement or activity limitation. Though the above does not show a distinct advantage for laparoscopic supracervical hysterectomy, other studies indicate that SLH should be the procedure of choice when the cervix testing is benign and there is no indication of rectovaginal endometriosis. These advantages include the following:

•    Less hospitalization required
•    Faster immediate recovery, including time to intercourse
•    Faster long term recovery

SPECIALTY BREAK-OUT CONCURRENT SESSION (URO)
10:30am–11:30am, Thursday, September 18, 2008

TREATMENT STRATEGIES FOR THE SMALL RENAL MASS
Lap Partial Nephrectomy
Arieh L. Shalhav, MD

Laparoscopic nephron sparing surgery (NSS) is rapidly adopted by urologists that are experienced in urologic laparoscopy. Current laparoscopic NSS ranges from complex, challenging procedures such as laparoscopic partial nephrectomy (LPN) with intracorporeal suturing and the related need for warm ischemia (WI) to simpler laparoscopic needle ablating techniques which do not require WI such as Radiofrequency Ablation (RF) and Cryoablation (Cryo). Though more technically challenging LPN is related to better long term cancer control, however a slight increase in complications compared to RF or Cryo ablation. In experienced hands LPN is currently a standard of care for tumors ≤ 4cm that are not centrally located. Complex LPN defined as tumors >4cm, centrally located or in patients with a single kidney or compromised renal function, should only be performed by surgeons with a vast experience as part of the development curve of the procedure.

The limiting factor for the widespread use of LPN by multiple urologists is the related WI. With the introduction of robotic assisted LPN including 3D vision, increased degrees of instrument freedom and ease of suturing, WI even in less skilled hands will diminish and LPN will be disseminate to urologists with less laparoscopic experience. Initially performing robot assisted LPN for small exophytic tumors and then progress to larger and more centrally located tumors. I believe that as robotic assisted LPN will evolve the relative use of needle ablative procedures for renal tumors will decrease.

Radiofrequency Ablation
J. Kyle Anderson, MD

This presentation will focus on the treatment of renal masses using ablation technologies such as radiofrequency ablation and cryoablation. Success rates, patient selection criteria, and areas for future advances will be discussed.

Active Surveillance of the Small Renal Mass
David Chen, MD

Incidental small renal masses (SRMs) have become a diagnostic dilemma. While the evidence suggests that intervention by excision or ablation are highly effective, the impact these treatments have on the natural history of the disease may be overstated. Data from multiple institutions demonstrate that up to 30% of localized renal tumors under active surveillance demonstrate zero net growth when followed [1],  and that those which do grow show small incremental size increase averaging 3-4 mm per year over a median follow-up period of 34 months [2]. Moreover, active surveillance with delayed management does not appear to raise the risk for stage progression or impact the choice of subsequent minimally-invasive or nephron-sparing treatment options [3]. A recent review and meta-analysis of the data on over 6000 patients undergoing excision, ablation or observation of localized SRMs demonstrates significant limitations in current reports regarding treatment strategies for localized RCC [4]. In a full review of the literature, of 470 reported cases of localized kidney cancer under surveillance just 1.5% developed metastasis and only after a mean interval of 65.4 months [5]. Taken together, these data suggest that the benefit of SRM treatment may be overstated and that active surveillance of these lesions, particularly in the elderly and infirm, may be an appropriate option. This lecture will review the available data on the topic of active surveillance of the SRM.

1. Kunkle DA, Crispen PL, Chen DYT, Greenberg RE, Uzzo RG.: Enhancing renal masses with zero net growth during active surveillance. J Urol., 2007 Mar;177(3):849-53
2. Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DYT, Uzzo RG:. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol., 2006 Feb;175(2):425-31
3. Crispen PL, Viterbo R, Fox EB, Greenberg RE, Chen DYT, Uzzo RG: Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer, 2008 Mar 1;112(5):1051-7.
4. Kunkle DA, Egleston B, Uzzo RG: Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol., 2008 Apr;179(4):1227-33
5. Kunkle DA, Chen DYT, Greenberg RE, Viterbo R, Uzzo RG: Metastatic progression of enhancing renal masses under active surveillance is associated with rapid interval growth of the primary tumor. J Urol., 179 (4):375

Development of a VR Training Module for Lap Renal Skills
Robert M. Sweet, MD

Background: Surgical Simulation is finally coming of age. The focus has shifted from a demonstration of technology to a robust educational tool. Combining state-of-the art technologies with proper educational design begs for industry/society/academia collaboration. Until now that type of collaboration has been elusive. The project we describe, the development of the Laparoscopic Transperitoneal Nephrectomy (LTN) Learning Module is a major milestone on that path. It began with a defined need within the AUA to train and assess residents as well as practicing urologists in the performance of LTN.

Methods: The team assembled to deliver the final Learning Module represents a professional society, (the AUA), the University of Minnesota as the academic partner responsible for building the models, and METI as the industry partner and integrator. The AUA has established the learning objectives, is developing the corresponding metrics and is creating the didactic content required and will do the validation studies on the final module. The University of Minnesota is using novel advanced modeling techniques to deliver models that look and behave like real tissue required tissue properties, and METI has the responsibility to develop the architecture, provide all simulated scenarios, integrate all aspects of the curriculum into the Learning Module and bring the product to market.

Results: This collaboration is successfully delivering a VR simulator founded on user-directed educational design, state-of-the-art tissue appearance and behavior, and a strong pathway towards successful commercialization.

MULTIDISCIPLINARY PLENARY SESSION
7:30am–8:30am, Friday, September 19, 2008

PAY FOR PERFORMANCE (P4P)
Safety, Quality and Improving Operating Room Performance
Gustavo Stringel, MD

Patient safety has always been a priority in medicine. Over the past few years there has been a special focus through transparency and accountability in defining the role of the physician and other health workers in measuring, monitoring, developing and managing health care delivery in order to improve safety and quality of care to ensure desired outcomes. The landmark reports by the Institute of Medicine have raised awareness of the negative impact of medical errors on safety and quality delivery of care that have prompted the creation of new systems to try to prevent harm to the patients and to improve outcomes.

The Institute of Medicine has defined that high quality care should be safe, effective, timely, efficient, evidence based, and equitable. It is the surgeon's responsibility to deliver good quality care and to ensure the safety of the surgical patient. The surgeon is often confronted with hurdles and barriers that interfere with efficiency and performance. One of the main problems is financial constraints; the surgical services of health organizations have been forced to increase patient volume in order to ensure financial viability. The development and acquisition of new technology has significantly increased the cost and complexity of health care. The surgeon needs to learn to function under these new rules and strive to improve safety, quality and performance to improve outcomes.

Improving operating room and overall surgical services performance is essential to cope with the current high volume and technologically advanced modern surgical care. The ultimate measure of quality and performance for surgeons and surgical services is to evaluate and compare outcomes for similar surgical conditions.

Pay for Performance and Transparency
Alex Gandsas, MD

Financial Aspects of Surgical Care. Past, Present and Future
Raymond J. Lanzafame, MD, MBA

Medicine and healthcare are changing rapidly. Aging Baby Boomers and new technology are impacting our ability to provide appropriate care at a reasonable cost. Quality, safety and performance are an integral part of the new healthcare culture. It is incumbent upon the surgeon to acquire a thorough understanding of the financial aspects of surgical care from the perspective of the stakeholders, and the hospital in addition to the view of the provider.

There is a trend on the part of the federal government to mandate more transparency relative to CMS payments to hospitals, ambulatory care centers and providers as a way of providing consumers with cost information in an effort to encourage them to choose the least expensive alternative. It is unclear how the public will respond to this information, or to what degree an individual patient will make decisions based on the cheapest price, particularly since economic responsibility for healthcare is limited at best for most patients. Consumers and other stakeholders are demanding more information and more accountability from providers. Consumers base their decisions on service and satisfaction since they cannot evaluate technical skills. They use word of mouth or service and customer satisfaction attributes when making their healthcare choices, since they cannot evaluate expertise or quality effectively. Patients are willing to trade convenience and speed of access for more comprehensive or ongoing care.

Most healthcare costs are fixed and sunk over any reasonable time horizon. Fixed costs do not vary with the level of patient activity and once sunk they cannot be easily reversed. Once dollars have been invested to acquire a technology, the more frequently it is used, the less expensive its per case cost will be. The variable costs for any disposable items used with the machine would be the same per case. This creates a strong argument for encouraging the use of a technology once it has been acquired.

Many of the least expensive, quickest, and highest return reforms in health care are process rather than technology related. A quality initiative in the State of Kentucky, found that there was no single clinical situation in which safer practices were intrinsically more expensive than those that were less safe in six years of study. Similarly, they found no instances where practices that are more expensive were associated with better outcomes.

Managed care organizations focus on the variable cost of health care delivery and largely neglect capacity decisions. There is little disincentive for the hospital with excess capacity to do additional cases and at reduced capacity there are incentives to increase throughput to increase volume because resource consumption in healthcare is front-loaded. Most of the expenses are incurred on the first day of a patient's stay. Reducing length of stay is important in cases of high capacity utilization, since it frees up capacity and creates opportunities for more admissions. There is very little incentive to reduce length of stay at the extreme condition of low utilization of capacity.

Surgeons have a significant effect on the cost of care. Individual surgeons have statistically and clinically significant differences in their costs and volatility of costs when holding patient factors and procedural complexity constant. Surgeons with similar case mixes can have very different ranges of cost as they treat their patients. There is a dichotomy between what payers pay in professional fees to doctors and what they pay to the hospital. The interaction between the amount of OR time used, the RVUs per case and the number of cases performed per year determine the contribution to the hospital margin by any particular surgeon or surgical service.  The choice of technologies used and the use of disposables rather than reusable instruments can adversely affect the hospital's margin and transform a modestly profitable or break even procedure into an economic loser for the hospital. However, the surgeon is still reimbursed at the usual and customary fee for the procedure.

Previously lucrative surgical services are facing financial challenges as the costs of materials and services continue to rise, while reimbursement remains flat or is decreasing in many cases. Institutions that are positioned to survive these challenges must develop strategies to improve processes, increase efficiency, and lower the costs of care delivery. The surgeon is a key player in the evolving healthcare revolution. Fiscally responsible care is as important as technical skill and excellent outcomes.

FUTURE TECHNOLOGY SESSION
8:00am, Saturday, September 20, 2008

Brace yourself for a vision of the future. Directed by Richard Satava, MD, and featuring an exciting keynote speaker, this session promises to inspire all interested in the future of the medicine.

Richard M. Satava, MD, Director
Leigh R. Hochberg, MD, PhD, Keynote Speaker presents Brain-Computer Interfaces: Frontiers in Restorative Neurotechnology
Orlando Portale, MS, presents Simulated Reality: Exploring the Virtual Hospital of the Future
Kit Parker presents Intracellular Surgery - The Next Surgical Frontier?

BEYOND HUMAN CONTROL
Keynote Address: Brain-Computer Interfaces: Frontiers in Restorative Neurotechnology
Leigh R. Hochberg, MD, PhD

For people with cervical spinal cord injury, brainstem stroke, amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) and other neurologic illnesses, currently available assistive and rehabilitation technologies are inadequate. In severe brainstem stroke and advanced ALS, both the ability to speak and the ability to move are lost, creating a “locked-in” state of being awake and alert but unable to communicate. Neural interfaces, however, are poised to revolutionize our ability to restore lost function to people with neurologic disease or injury. Over the past decade, technologies to record the individual and simultaneous activities of dozens to hundreds cortical neurons have yielded new understandings of cortical function in movement, vision, cognition, and memory. This preclinical research, generally performed with healthy, neurologically intact non-human primate subjects, has demonstrated that direct neural control of virtual and physical devices can be achieved. Recently, this exciting research has been translated into initial pilot clinical trials (IDE) of an intracortically-based neural interface system, seeking to determine the feasibility of persons with tetraplegia controlling a computer cursor simply by imagining movement of their own hand.  A variety of methods for recording and decoding brain signals are now being tested, with the hope of not only restoring communication, but also providing a control signal for the reanimation of paralyzed limbs.

Simulated Reality: Exploring the Virtual Hospital of the Future
Orlando Portale, MS

Metaverse, Second Life, Machinima, Avatar....what do these terms mean, and how do they relate to healthcare? Find out, as we explore first hand, what the future of high-tech healthcare will look like with an architectural and conceptual simulation of the hospital of the future. Built within Second Life, the on line virtual world with millions of users, the simulation offers a preview of medical, architectural and technical advancements, as visitors are guided along a personalized path to recovery. The virtual hospital simulation includes such as innovations as 3D multi-modality medical imaging, RFID, remote telepresense, acuity adaptable patient rooms and robotic surgery suites. These are just some of the innovations that are being incorporated into the real world $900M hospital that is scheduled to open in 2011. But there is no need to wait, you can experience it all today in the virtual world.

Intracellular Surgery - The Next Surgical Frontier?
Kit Parker