BLOG: Using virtual reality for surgical training

Surgeons are specialised physicians that operate on patients to improve their health. There are limitations to the current way that they train, however. In order to potentially save millions of lives, we must overcome these limitations. One way to do this is to incorporate new, revolutionary technology advancements in surgical medical education.

When training, surgeons observe their mentors performing operations before carrying out procedures themselves.[1] “You can read it in a book if you want but it’s not the same as watching it live,” says Dr. Nadine Hachach-Haram,[2] an NHS registrar. “However,” she says, “it’s physically difficult to get many medical students in the operating room at any time.” This means that only a small group at a time can learn this way and, due to time restrictions, these experiences are limited. Surgeons also work on human cadavers (corpses) to acquire certain skills and familiarise themselves with anatomy. According to Professor Paul McMenamin[3], however, “Many medical schools report either a shortage of cadavers, or find that handling and storage costs are too expensive.” Hence, trainees can only practice with cadavers for limited number of times before they handle actual patients. Ultimately, trainees’ current experiential learning is restricted.

One potential solution to overcome these costs and restrictions is to use 3D printing to produce training aids that can replace cadavers. For example, physicians at the University of Rochester Medical Center[4] have used 3D printing to produce artificial organs. These aids will not deteriorate, and can be reprinted numerous times. They are, however, costly to produce in terms of both time and money, and have unsatisfactory mechanical properties and accuracy.[5]

An alternative method to observing mentors is to use mobile applications, such as Touch Surgery,[6] that allow trainees to familiarise themselves with the steps of procedures. When the user does a gesture on the screen, tools appear and carry out the action with semi-realistic animations and graphics. Although trainees can access this learning material anytime and anywhere, they would not be able to see how a surgeon interacts and communicates with other people in the room, or how they deal with unexpected situations.

A proposed solution to the limitations imposed by such a mobile application is the use of virtual reality (VR). VR immerses a user into a convincing environment that can be computer-generated or recreated from real life.[7] The user typically wears a headset and, as Dr. Brian Jackson describes,[8] “the position of the user’s eyes are located within the simulated environment. If the user’s head turns, the graphics react accordingly.” One way to use VR is to create virtual operation rooms in which “the user will be able to look and move around in their environment with the headset and hold and manipulate tools to use on a virtual body by using hand-held controllers,” as explained by Dr. Justin Barad.[9] Virtual bodies can then potentially replace the use of cadavers.

Trainees can also become immersed in another surgeon’s operation by watching recorded operations using a VR headset. This approach also allows any number of trainees to observe their mentors anytime, anywhere. In April 2016, Shafi Ahmed, a general and colorectal surgeon, performed a successful operation on a cancer patient that was live-streamed around the world in 360-degree video using VR technology. It was shot using specialist cameras that were placed above the operating table and viewers could watch using a VR headset.[10] This allowed medical students and trainee surgeons from around the world to watch the operation as if they were in the operating theatre themselves.[11] Unfortunately, when watching a procedure using VR, user have expressed discontent that while the 360-degree video enables the user to look around, they’re not capable of changing positions in order to get a better view.[11]

Users have also complained that using VR for surgical simulations doesn’t incorporate the feeling of holding the tools and interacting with the body realistically enough. This is because most common controllers only provide feelings of soft taps and vibrations. However, it is possible to further improve the use of VR for surgical simulations by using it in conjunction with current research around haptic technology, which simulates the sense of touch.[12] For example, “light, flexible gloves that allow users to feel tactile feedback when they interact with virtual reality environments” are being developed by engineers at UC San Diego.[13] It’s therefore reasonable to assume that VR simulations will be made even more realistic, in terms of both visual and tactile feedback, in the future.

We’ve seen that while experiential learning is extremely important, it is becoming infrequent at medical schools. Although 3D printing and mobile applications are possible solutions, they don’t provide the same level of detail and knowledge as current methods. VR can therefore become a new platform for training, as it will provide similar experiences to current training methods but make them more widely accessible, easier to access and less costly. Although VR also has its own limitations, these can be overcome as technology advances. While it may not completely replace current methods, VR can still supplement traditional teaching. Indeed, advances in technology may provide many more ways of training without necessarily replacing current methods. Learning from a variety of effective training tools will make training more efficient and yield better improvements in the trainee surgeon’s skills.

References

  1. Mark Hinksman, Career Route to Becoming a Surgeon, 28 March 2012. Accessed 19 November 2017.
  2. Alice Bonasio, The Unreal, Bleeding-Edge Tech That’s Helping Doctors Make The Cut, 20 June 2017. Accessed 19 November 2017.
  3. Monash University, 3D printed anatomy for medical training, 16 July 2014. Accessed 19 November 2017.
  4. University of Rochester Medical Center, Creating the Model Human to Practice Surgery, 17 November 2016 Accessed 19 November 2017.
  5. Li C, Cheung TF, Fan VC, Sin KM, Wong CW, Leung GK, Applications of Three-Dimensional Printing in Surgery, 29 December 2016. Accessed 19 November 2017.
  6. Oliver Wainwright, Touch Surgery: the iPad app that teaches surgeons how to operate, 27 February 2013. Accessed 19 November 2017.
  7. Augment, Virtual Reality vs. Augmented Reality, 6 October 2015. Accessed 19 November 2017.
  8. Brian Jackson, What is Virtual Reality? [Definition and Examples], 3 June 2016. Accessed 19 November 2017.
  9. Scott Jung, Beyond Gaming: How Osso VR is Already Transforming Surgical Training, 21 September 2017. Accessed 19 November 2017.
  10. Ben Quinn, UK cancer surgery to be live-streamed via virtual reality technology, 25 March 2016. Accessed 19 November 2017.
  11. Nicola Davis, Cutting-edge theatre: world’s first virtual reality operation goes live, 14 April 2016. Accessed 19 November 2017.
  12. Virtual Reality Society, Getting to Grips with Haptic Technology, Accessed 19 November 2017.
  13. Jack Loughran, Robotic gloves allow users to ‘feel’ objects in VR environments, 31 May 2017. Accessed 19 November 2017.

About the Author

I am a third-year student at UCL, pursuing a BSc Computer Science degree.

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