A blade makes an incision into the patient, but looking down from the surgeon’s perspective, you realise it’s someone else’s hands making the cut. No, this isn’t the description of a horrifically realistic virtual-reality (VR) game, but the future of medical training.
It’s a concept that’s already been trialled: in mid-April, British surgeon Dr Shafi Ahmed allowed anyone with a VR headset to watch colon tumour surgery in near-real-time at the Royal London Hospital. Speaking ahead of the surgery, he told Alphr: “There will be sound and vision, so you’ll be immersed in the operating theatre. You’ll be able to see how the team works, observe the operation itself, or watch the anaesthetist specifically, for example.”
The idea, he said, is to improve the quality of medical training. VR will provide trainees with a more detailed, first-hand view of a procedure – something that can’t be achieved from simply reading a book or peering over a surgeon’s shoulder – and it will open it up to the rest of the world. “Anyone, anywhere will be able to pick up a smartphone and Google Cardboard [the cheap-and-cheerful VR system powered by an Android phone] and access training around the world, with the best people teaching them,” he said.
Medical Realities co-founder Steve Dann said this particular surgery would be the first of many videos the company aims to create in the future. “There will be a library of VR recordings that will form the core of our interactive VR training programme,” he said.
Streaming a surgical procedure
The procedure was filmed with the help of VR firm Amplified Robot. “We use a special multi-lens camera system that records from multiple angles and stitches the shots into a single, seamless 360-degree video,” said Matt Leatherbarrow, CTO at the company. “Unlike many 360-degree camera systems, ours stitches the footage in real-time – meaning the multiple camera angles are combined within the camera ready for streaming.”
Other than the cameras and a computer to process the stream, there’s no other technology in the operating theatre. “The operation is carried out as normal, so there’s no risk,” Dr Ahmed said.
“We use a special multi-lens camera system that records from multiple angles and stitches the shots into a single, seamless 360-degree video.”
To follow the op, viewers require the VRinOR app and a headset, such as Google Cardboard. Although they were unable to interact with Dr Ahmed during this particular surgery, in past live-stream procedures Dr Ahmed has answered questions mid-operation. In 2014, he took part in a similar live-stream event using Google Glass.
“They could view the surgery from my eyes,” he said. “Also, it allowed interaction. Students around the world could text in on the app and it would come up on my Glass, so I could communicate with people asking questions.”
Patient safety
This first live-stream VR operation was shown with a minute’s delay in case of unexpected complications – because who wants to watch a medical emergency in VR?
Dr Ahmed confirms that the 70-year-old patient was “supportive” of his surgery being streamed globally. (And, don’t worry, everything did run smoothly.)
“Whenever we try these things, we make sure that both the patient and their family are happy, because all of this is new,” Dr Ahmed said. “The whole thing works because we have such fantastic patients; patients who are supportive of doctors and surgeons who want to innovate. Without that support, we wouldn’t be able to do anything.”
VR and psychology
This isn’t the first use of VR in healthcare. For decades, it’s been used to treat post-traumatic stress disorder (PTSD), psychological training (such as helping people with autism train for job interviews), pain management and rehabilitation. Dr Skip Rizzo, director for medical virtual reality at the Institute for Creative Technologies, has helped patients with third-degree burns manage their extreme pain: “Put them in a headset and give them a game environment to play in, and the perception of pain drops by at least half. It’s a pure distraction approach.”
Dr Rizzo specialises in the use of VR to treat PTSD, drawing on an existing technique called prolonged exposure, where patients recount the incident that caused the trauma in order to help them process it. The headset can amplify that, “setting up a virtual environment around their trauma memory,” he said. It could mean showing a military vehicle, driving down a road in Afghanistan, hitting a road-side bomb, as the patient describes the event. “It’s hard medicine for a hard problem… but we know it works,” he said.
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