Virtual surgery: Training without pain (SXSW 2011)

Surgery is one of the most difficult and dangerous professions to train for on the planet. Before you’re skilled at operating you can kill someone, but you can only really learn those skills by operating. Virtual surgery has long held the promise of allowing apprentice surgeons to learn from mistakes without killing patients, but until recent advances in technology, it hasn’t had much success. Now two different groups of researches are redefining the technology.

Speaking on a panel at this year’s South By SouthWest interactive festival, Professor Gregory Wiet of Ohio State University, as well as Frank Sculli and John Qualter of BioDigital Systems revealed some of their latest innovations in this fascinating field.

Professor Wiet introduced the topic, sprinkling it with historical tidbits, such as the fact that the world’s first simulators were for training airplane pilots, and existed as far back as the 1930s thanks to the pioneering genius of Edwin Link. Wiet pointed out that, apart from training, surgical simulators are also useful for things like planning complex surgeries in advance and objective assessment of a surgeon’s technical skills.

But it’s when he revealed the (somewhat toe-curling) details of his own specialisation, Otologic (ear) surgery that things got really interesting. Since all the working parts of the ear are encased in the solid temporal bone, otologists must carefully drill away at the bone, looking for “landmarks” along the way that help them avoid delicate structures. One false move can render someone permanently deaf or even paralysing the whole side of their face.

Luckily for all of those suffering from ear problems, Professor Wiet’s team have developed a simulator using 3D reconstructions to allow virtual dissections of the temporal bone. And it’s not just some pixels on a screen either – the system has haptic elements (force feedback) as well as realistic sound effects and even a virtual tutor. The technology has also been developed in an open source framework.

Now that the technology is in place, Wiet and his team are conducting randomised studies to test its efficacy. By comparing traditional methods (and their outcomes) to virtual students, they are hoping to prove that the system produces surgeons with the appropriate skills, at a lower risk. “We need to be careful to avoid negative transference,” warned Wiet, “Surgeons may end up learning harmful things unless we test properly.”

Frank Sculli and John Qualter demonstrated some equally fascinating technologies. Using data collected during the Digital Human Project, they have created a 3D model of the entire human body called the BioDigital Human. But what’s really extraordinary is that they have done this using WebGL – so that it is available online.

They are also working on physics based simulators which are not just animations, but mathematical models of how tissue behaves when it’s cut and manipulated. Like Professor Wiet’s simulator, the BioDigital Human includes haptic feedback and stereo sound. The ultimate goal, though, is patient specific simulators which would allow surgeons to test the affects of different surgical approaches – something that is currently impossible.

Perhaps the most surprising insight of all came from Professor Wiet. The people driving the enablement technology are not doctors or academics, but the gaming industry. As Wiet says, “NVidia can’t sell five million video cards to surgeons, but they can to gamers. We are really a very small voice in this market.”

When asked how long it would take for the technology to be accepted, all three panelists pointed out that the “apprenticeship model” of surgical training has been essentially unchanged for over a century. “We don’t change very easily as physicians – unless we see hard proof” said Wiet, hence the reason for extensive trials.

We can only hope these go well, because the benefits of a universally accepted system would be immense, including the growing possibility of remote surgery. Wiet said during questions that this was already possible, and that the only thing holding it back was the latency of internet connectivity. Once that hurdle is overcome, we may soon find heart surgeons in California operating on children in Indonesia.

Who said video games were a waste of time?