The document discusses ProMIS, a surgical simulation system that uses mixed reality with real instruments to provide realistic training for laparoscopic procedures. It offers various basic skills modules and procedures that have been validated in studies to be highly realistic and effective for training. ProMIS provides comprehensive metrics on trainees' performance and can be customized with new modules to integrate with surgical curriculums.

1. ProMIS: accelerating surgical performance through simulation SAGES Phoenix, AZ April 2009 www.haptica.com | +1 617 342 7270 | info@haptica.com

2. Accelerating performance through simulation More surgeons doing more procedures more proficiently – in less time, at lower cost and at lower risk ProMISSAGES09 © Haptica 2009 Page With simulation Without effective simulation solution Time Adoption; Patient Safety

3. The NEW ProMIS3 ™ surgical simulator : 100% of trainees felt that ProMIS "simulated reality effectively compared with only 38% in the VR group". ProMISSAGES09 © Haptica 2009 Page JSLS(2008)12:219-226

4. The NEW ProMIS3 ™ surgical simulator Real instruments interact with virtual and physical models, with comprehensive metrics on performance Outperforms pure VR for MIS training Metrics are “Excellent predictors” of scores in FLS; “predict readiness for FLS Certification”. Basic Laparoscopic Skills and procedures Meets ACS & ACGME RRC requirements for simulation Three surgical and technical innovation awards ProMISSAGES09 © Haptica 2009 Page Pure VR Task in ProMIS—using real instruments ‘ Mixed reality’ Task: real anatomical model; real instruments; 3D graphics

5. Why ProMIS 3 ? Highly realistic camera image Flexible positioning and zoom Multiple real instruments in realistic port positions Team training and non-technical skills training Multiple procedures Improved metrics reporting and functionality Build, adapt and integrate Modules and Tasks—including FLS and local curriculum ProMISSAGES09 © Haptica 2009 Page

6. Developing proficiency with ProMIS ProMISSAGES09 © Haptica 2009 Augmented reality, graphics, video & audio provide guidance and instruction 1. Show Physical and/or virtual anatomic model Tactile feedback Real instruments 2. Practice Valid metrics & proficiency Records errors User and group records 3. Measure Page

7. ProMIS Basic Laparoscopic Skills  Basic Laparoscopic Skills Laparoscope Orientation Instrument Handling Dissection  Suturing & Knot-tying  SAGES/ACS FLS Module ProMISSAGES09 © Haptica 2009 Page

8. ProMIS LapAppendectomy Full LapAppendectomy procedure: Investigation Diathermy Loop placement Cutting Mixed reality approach (virtual reality with real instruments and real appendix model) ProMISSAGES09 © Haptica 2009 Page

9. ProMIS Lap Colectomy ProMISSAGES09 © Haptica 2009 Full step-by-step procedure Mix of virtual and physical reality Uses real instruments Physical model enables realistic tactile feedback On-screen graphics, animations, video, audio, text Automatic metrics Page

10. ProMIS for Single Incision Surgery (SIS) ProMISSAGES09 © Haptica 2009 First simulator for Single Incision Surgery Will work for current ProMIS Modules Place any instruments (and any Task) in ProMIS and get proficiency metrics Ask now to participate in our trial to compare metrics on a FLS task when done pure lap vs SIS Page

11. ProMIS Metrics All tasks: measure Time Path length Economy of movement Hand dominance Play back track of instrument Play back video of performance ProMISSAGES09 © Haptica 2009 Page

12. Learning Management System Create users and Groups View records of individual and group performance Query by user, group, specific Module, etc. Set proficiency levels Export data to Excel Network for remote access ProMISSAGES09 © Haptica 2009 Page

13. Integrating ProMIS into the curriculum ProMISSAGES09 © Haptica 2009 Page Use ProMIS Modules Record Users Use with FLS Use Your Own Modules

14. Customising and Developing Modules ‘ Open Module’: Put any existing Task in ProMIS and get standard metrics (as has been validated with FLS Tasks). ProMISSAGES09 © Haptica 2009 Page

15. ContentCreationTool Design new measurable Tasks Record/insert instruction video Add audio cues and on-screen text Insert augmented reality, graphics for on-screen guidance Set proficiency levels Edit existing ProMIS Tasks ProMISSAGES09 © Haptica 2009 Page

16. Proven with FLS; Better than VR; Preferred by Users 100% of trainees felt that ProMIS "simulated reality effectively compared with only 38% in the VR group" 8 An “excellent predictor” of scores in FLS ; “predict readiness for FLS Certification” 1 2 3 Delivers performance data with robotic instrumentation 4 “ ProMIS scored significantly higher than SurgicalSIM; better than LapSim on all tested features” 5 6 ProMISSAGES09 © Haptica 2009 Page 1 SAGES 2006 S064 Ritter et al 2 SAGES 2006 P237 McCluney MD, et al 3 SAGES 2007 P279 McCluney et al 4 SAGES 2006 S065 Vuong et al 5 SAGES 2006 P224 Fellinger, et al 6 World J Surg. 2007 Apr. Botden et al 7 SAGES 2007 S077 Lin et al JSLS(2008)12:219-226

17. Why ProMIS wins in surgical simulation Best curriculum Basic skills, procedures, FLS Best instructional approach Real instruments, real haptics and VR; team training Best validation >25 studies validated Metrics; better than VR Best customization Edit and design new Tasks to integrate with curriculum ProMISSAGES09 © Haptica 2009 Page