Extolling the Virtues of Surgical Simulation

Gaining surgical competence for a new technique has a drastic learning curve. When surgeons are trained to perform a new procedure, however, the curriculum appears remarkably straightforward. Typically, the surgeon will attend a one- or two-day course with a couple of hours to train with a cadaver, then must wait about four to six months before the procedure is actually performed on a patient.

This model requires an enormous amount of confidence on the trainee surgeon’s part, and isn’t reassuring to patients. The issue compounds when learning surgical techniques involving complex medical technologies. New surgical instruments and implanted devices are being created in order to follow the clinical trends of increasingly minimally invasive procedures and robotic assistance, making the learning curve exponentially steeper. And if surgeons can’t adapt to using these new technologies, none of them will gain traction in the market.

The simple solution would be to train surgeons more, but that brings up the cost problem. Training with a cadaver isn’t cheap, and proprietary surgical simulation systems involve a heavy capital investment and may not always be available for use in a busy hospital. Every surgeon should have the opportunity to practice and test themselves in a controllable space that mimics a true surgical procedure as closely as possible.

A company called Fundamental VR demonstrated a surgical simulation system fitting these criteria at the Global Education and Skills Conference in Dubai, United Arab Emirates, during St. Patrick’s Day weekend. With offices in both London and New York City, the company’s flagship SaaS service was deemed a “flight simulator for surgery.” Fundamental VR’s software platform uses off-the-shelf virtual reality (VR) hardware and software—specifically an Acer Windows Mixed Reality VR headset and Touch haptic device made by 3D Systems, a global 3D solutions company.

The result was a training scenario that reproduced both the visuals of the operating room setup as well as the physical sensations accompanying an operation. With this setup, trainee surgeons are granted the tools to feel everything as they proceed, and can start over if they struggle.

“If there’s a part of the operation you have difficulty with, you can repeat that step again and again and again,” Fundamental CEO and co-founder Richard Vincent said in an interview with Digital Trends. “It means you could practice an operation 500 times if you wanted. There’s just no other way to do that. A person will typically make consultant based on 40 procedures.”

Readers may be aware of a September 2017 video covering the world’s first 360-degree VR brain surgery at The Royal London Hospital. Viewers were able to experience the surgery from the perspective of both the patient and the surgeon via 360-degree HD cameras and head-mounted GoPros. The film began from the patient point of view, as if the viewer were being wheeled into the OR for surgery. The view then switches to the medical team, looking through the eyes of the surgeon. Details of the procedure were shown on a virtual screen in the OR, and it was possible to look around the entire room. A consultant neurosurgeon also narrated each stage of the procedure.

“For us, recording the entire procedure in VR enables us to start the process of recreating the surgery in a VR simulation, one where trainee surgeons can practice the key stages of the procedure in a safe virtual operating room, and actually feel in their hands the textures of all of the different tissue types using our FeelReal VR solution,” Chris Scattergood, co-founder of Fundamental VR, who produced the video, said in a Mashable interview.

Instead of a complete surgical simulation system, the company’s Fundamental Surgery software can be run on available hardware with an estimated investment of $4,000 to $10,000, as well as a licensing fee. Users will need to obtain a powerful PC with Nvidia GTX1080 (or similar) graphics card, a Microsoft, Oculus or Vive VR headset, and two Geomagic haptic devices to run the Fundamental Surgery software. The system launches with orthopedic-focused simulations, but will quickly transition to areas including laparoscopic, general surgery, cardiovascular, and otolaryngology.

According to Vincent, the technology is being targeted toward both industry and training hospitals. It has already garnered interest from areas such as the Mayo Clinic, Duke University, and Stanford University in the United States, as well as Guy’s Hospital and King’s College Hospital in the United Kingdom.

Fundamental VR also worked closely with Microsoft’s HoloLens team to develop holographic training and simulation, which the company calls the Multi MR HoloLens system. (HoloLens is a self-contained, holographic computer enabling engagement with digital content and interaction with holograms in the world around the user.) The company is a graduate of Microsoft HoloLens’ Agency Readiness Program, and was chosen as a partner for HoloLens development.

The system plunges users into a mixed reality environment, where holographic images of the surgical procedure (along with actionable buttons to zoom in or out and rotate the images) are superimposed on reality. This application is particularly useful because other users can be “brought in” to the mixed reality surgical environment for collaborative training purposes—a consulting surgeon could potentially train dozens of students at a time with this method.