SURGERY
FundamentalVR, provided an insight into how surgeons can accelerate the safe adoption of medical devices and procedures using the technology – helping to improve competency and hence patient outcomes. “VR allows you to connect with anyone, anywhere, to work through patient cases. The ability to connect people has really taken off in the past year-and-a-half. You can put on a headset and join colleagues anywhere in the world, enabling you to run a training session either on a one-on-one basis or in a large group,” Scattergood commented. He discussed how the development of immersive technologies are providing exciting new capabilities. Teaching hospitals and institutions are increasingly incorporating VR haptic solutions into their training programmes with flight simulator type machines.
Scattergood explained that haptics has an important role to play by allowing trainees to ‘feel’ the difference between hard and soft tissue. It is also possible to use VR to evaluate a trainee’s knowledge and understand who may need extra help and/or extra time in the OR to practice their skills. VR is especially useful in the evaluation of competency with robotics, for example. “Why bring people into a hospital for training when you can do it at home?” he commented. Remote multi-user capabilities mean that you can access training sessions with anyone in the world, from your kitchen, by simply donning a £300-400 headset, he explained. The technology offers the ability to put a patient case up, to annotate it, run a didactic session, then allow trainees to go into ‘break out’ rooms to practice on their own. The VR technology allows users to ‘pass surgical tools’ across geographies; to discuss patient anatomy, to experience working in the OR, to develop situational awareness and to hone their techniques.
Over 80% of radical prostatectomies are performed robotically, and one third of cystectomies are performed using a robot. We cannot reach a situation where we are performing this number of procedures robotically and expect good outcomes with
trainees who are not trained in this. Lolade Giwa-Brown, president of the Association of Surgeons in Training.
“It’s going to be a real game-changer,” commented Scattergood.
He believes that training will become fully digital and cadaver-free, in the next 10 years. However, haptics development will be key. Most VR technologies currently offer cutaneous haptics (much like the rumble sensation felt in gaming). This lets the user know that they have made contact with bone, for example. This is important in training as it helps build confidence and enables trainees to understand the steps of a procedure. However, Scattergood said that kinesthetic haptics can enable real skills transfer and skills analysis. “We now have data that shows a 35% increase in accuracy3
when using haptics
compared to standard VR,” he commented. “You can establish that someone has gone in at 40 degrees or 38 degrees, or whether they have gone in 2mm or 2.5mm,” he explained. “Users can feel the sensation of going into the skin layers and what it feels like to be in different muscles. This experience is really important.” In eye surgery, for example, the technology has advanced to such an extent that trainees can now feel the sensation of touching the retina. Kinesthetic haptics also make
it possible to simulate ‘sensory feedback’ when reaming an acetabulum in orthopaedic surgery. By donning a ‘haptic glove’, the trainee can even ‘feel’ the acetabulum to establish if the osteophytes have been worn down. “This kind of skill transfer is particularly exciting for the future,” commented Scattergood. “It is coming to a specialty near you…”
Surgical Simulation Theatre The Association for British HealthTech Industries (ABHI) Surgical Simulation Theatre of the Future also drew crowds of delegates wanting to gain an insight into the latest pioneering surgical techniques. This included the demonstration of a novel non- fusion surgical technique that aims to create a straight spine in children diagnosed with adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a promising new procedure currently being trialled in the UK for the first time. A simulation of the technically challenging technique was performed by consultant orthopaedic surgeon, Julian Leong, from the world-leading Royal National Orthopaedic Hospital and leading consultant neurosurgeon, David Baxter. The ground-breaking technique was developed in the US, where it has recently become widely practised to correct scoliosis while still preserving spinal flexibility. Rather than treating scoliosis by fracturing the spine and fusing it together – as per a traditional spinal fusion, during VBT, the individual bones of the spine are tethered together using
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WWW.CLINICALSERVICESJOURNAL.COM JANUARY 2022
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