Operating room technology
cadavers, there’s nothing like treating a genuine patient. And if they’re certainly better prepared than earlier generations of surgeons, any mistake can still cause problems. Between 2007 and 2017, for instance, patients in California state were subjected to 142 serious surgical errors. And though specific statistics are scarce, one 2012 study found that inexperienced surgeons may be more prone to distractions while operating, hardly surprising given the pressures involved. Even so, the situation is far from hopeless. By exploiting sophisticated digital platforms, surgeons can increasingly hone their skills before slipping on their scrubs – a change with important consequences for medicine right across the world.
VR you serious?
Digital models have been a part of industrial training for generations. As far back as the 1960s, for instance, pilots were using computers to practise take-offs and landings. Speak to Professor Anderson Maciel, however, and it becomes clear this hasn’t generally been true of surgery. “The older paradigm was ‘see one, do one, teach one,’” explains Maciel, an expert in digital training at the Federal University of Rio Grande do Sul in Brazil. “Even though trainees didn’t start with real patients on the first day, there were levels of simulation, depending on the resources available.” Indeed, Maciel continues, trainee surgeons have typically depended on a range of analogue training methods, spanning everything from fake rubber organs to human corpses and animals. From there, young doctors tended to learn by observation – before finally graduating to directing the show themselves. That’s fine as far as it goes. But it equally makes sense that some insiders would get frustrated at the lack of hands-on experience presented by traditional medical training, something that ultimately goes beyond surgery specifically. For Dr Paul Kelly, an anaesthetist and digitalisation expert at Guy’s and St Thomas’ NHS Foundation Trust in London, these difficulties are obvious in a range of fields, from a lack of resources to an inability to insert sudden crises into training scenarios. Jag Dhanda has his own worries too. “It lacks valid scientific evaluation,“ argues Dhanda, an oral and maxillofacial consultant surgeon at London’s Queen Victoria Hospital, as well as a professor at Brighton and Sussex Medical School. “It’s also very expensive.” Certainly, this last point is reflected by the figures – one recent estimate suggests that the average American surgical education costs $80,000. To be fair, these challenges have seen some doctors move fitfully towards digital training. But as Maciel stresses, that has sometimes involved just looking at computer screens, rather than having students try anything more proactive. But as
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the Brazilian continues, newer technology is increasingly introducing more fundamental changes to the field. “Virtual simulators represent a tremendous asset in overcoming the challenges of traditional surgical training,” he says. “When they are available, they are used as a new level of simulation, besides physical models, cadavers and animals. This allows for the possibility to repeat the training several times by several trainees with minimal additional cost, while cadavers, animals and supplies for physical simulators are expensive and can be used only once.”
Research by doctors at UCLA discovered surgeons training in VR completed procedures 20% faster than those who underwent regular training.
“Virtual simulators help in overcoming the challenges of traditional surgical training and allow for the possibility to repeat training several times with minimal additional cost.” Professor Anderson Maciel, expert in digital training.
Get your head(set) in the game Travel to the Brighton and Sussex Medical School and you can witness something remarkable. There, Jag Dhanda by your side, you can experience a genuine operation, happening right there in front of you. You can see the flick of the scalpels, the drilling into bones, the shuffling of the patient on the bed. The catch, of course, is that you’re not really there at all. What Dhanda has done, instead, is to integrate live-streamed surgery onto VR headsets. Through a system he describes as “360° video”, the consultant brings genuine operations directly to surgical students, along the way creating an archive of content that can be used and reused.
Nor is the British doctor alone. On the contrary, systems like Dhanda’s, as well as more conventional
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