Life-like mannequins the new face of surgical training
James Reynolds is one of life's battlers.
The 87-year-old has just spent the morning inside one of Waikato Hospital's operating theatres having a cancerous skin lesion the size of a poached egg removed from his neck.
As he begins to rouse, Kaylene Henderson, an anaesthetic technician, moves to his side and offers him words of comfort.
"It looks like your neck has stopped bleeding, so that's great," she tells him.
"We've rung your daughter, so she knows you're going to be coming out of theatre."
The procedure is a success, but Reynolds is not yet out of the woods.
Countless operations, challenges and changes lie ahead.
"In the future he might become a young man or even a young woman," Waikato DHB anaesthetist Jeff Hoskins explains.
Reynolds is a humanoid robot, the centrepiece of a world-leading simulation programme being rolled out in hospitals across the country, including Waikato.
The Multidisciplinary Operating Room Simulation programme, or MORSim for short, brings together surgeons, anaesthetists, nurses, anaesthetic technicians and orderlies for training in a real theatre environment.
Hoskins said it's the first time hospitals have had access to realistic manikins that are good enough for every theatre member to work on together.
"Often when we train with simulation training, we just train as a group of surgeons or just as a group of anaesthetists, and that's not very realistic to the way that we normally work.
"The unique thing about MORSim is that the surgeons and anaesthetists and the theatre nurses and anaesthetic technicians are all working together in the teams in which we normally work."
The MORSim programme was developed by Auckland University and is intended to enhance participants' teamwork and communication skills as well as promote patient safety.
Auckland-based company MEDICFX creates the augmentations that are then applied to a SimMan 3G - a wireless, computer-controlled patient simulator.
The manikin blinks, breathes, has a heartbeat and can even talk.
He's so realistic that those using him often feel compelled to stitch up his wounds once the exercise is finished.
Registered nurse Penny Johnstone works as a simulation technician, creating moulage to replicate specific conditions or injuries.
She makes blood clots, tumours, pus, urine, and faeces - the "extra little bits" which make the robot patient come to life.
"In one scenario, the robot has a dead gut, its bowel is perforated, and pus and the contents of the bowel have gone into the abdomen cavity. To replicate the smell, I went to a joke shop and got a bottle of smelly spray and put that on the wound."
Currently, Reynolds is an elderly man whose back story reveals he lives in a rest home and his daughter has power of attorney over his affairs.
In the future, the robot might be changed to resemble an obese patient, or a young woman.
"The special thing about the MORSim programme is that the robots are not only able to respond to an anaesthetic, but they also have extremely realistic surgical wounds that the surgeon needs to do something to," Hoskins said.
Auckland University professor of anaesthesia Jennifer Weller said using the realistic manikins made it easier for theatre members to buy into the scenarios.
The programme also allows participants to work together as a team in a crisis event.
"There's a huge amount of evidence that a lot of patient harm is due to a failure in communicating information about a patient and communicating the surgical plan between the teams," she said.
"James Reynolds' back story turns him into a real person and is part of the clinical information that the team needs in order to be able to treat him appropriately."