Most of todays medical schools still use 19th Century training methods. Surgical students continue to practice on cadavers and animals to gain expertise. But with such limitations, the medical community is looking for innovative ways to improve training and perhaps even reduce surgical errors.
As reported in the July issue of "Spectrum," the member magazine of The Institute of Electrical and Electronic Engineers, some high-tech firms have now partnered with medical schools in an attempt to revolutionize surgery training with virtual reality technology.
How does virtual surgery work?
Virtual surgery simulators use haptic, or touch, devices that interact with a state-of-the-art computer to mimic the sensations a surgeon feels when wielding a scalpel on a live patient. One system, by HT Medical Systems , uses computer modeling, medical imaging, high-power graphics and tactile feedback to make the experience as real as possible.
"The haptic devices, or force feedback devices, that we use are very accurate and true to touch," says Col. Christoph Kaufmann of the Uniformed Services University of the Health Sciences (USU), the Department of Defenses medical school. "The sense of touch and resistance is enhanced because generally in the operating room the forces that we use are very subtle." Kaufmann heads USUâ€™s Medical Simulator Center, which is pioneering the use of virtual reality surgical simulators to train surgeons
As a student uses the computer scalpel, the haptic devices sense the force used and sends the data to the computer. The computer adjusts the resistance to match the tissues a medical student will encounter in a real patient, while showing the surgeryâ€™s progress on a display screen. The display allows the student to ‘seeâ€™ his or her work in progress, and alarms alert students to possible missteps.
"These devices will allow us to have students fail at operating procedures," says Kaufmann. "Clearly today, if an operative procedure is being preformed, the teaching surgeon has to be ready at any point in time to stop the procedure to protect the patient. Using these types of simulators, we can go ahead and let a resident fail and have a complication in the operating room, which we canâ€™t allow to happen today with real patients."
The simulators will also allow medical schools to follow a set teaching curriculum rather than relying on "training by opportunity," as Kaufmann puts it. "If someone comes in today with appendicitis, [the students] will learn about appendicitis," he says of the current method. "If someone comes in with gall bladder disease tomorrow, we learn about gall bladder disease tomorrow."
Lastly, virtual surgery will give surgical students experience on a wide range of procedures with many anatomical variations. "Using virtual reality anatomic training devices, we will be able to ensure that over the course of a residency, that particular resident has seen all of the, for instance, bile duct variations and therefore he or she will not be surprised when they first encounter those variations in the operating room," notes Kaufmann.
Flight simulators inspire firms
It was the success of flight simulators used by the aviation industry that inspired some high-tech firms like HT Medical Systems and Lockheed Martin to develop similar trainers for surgical students.
"Through the use of flight simulators, [the aviation industry] has decreased the flight risk by about 50 fold over the last 50 years, perhaps even more than that," says Kaufmann. And just like flight simulators are integral in preventing errors made by new pilots, it is hoped that virtual surgery might play a role in decreasing the number of surgical errors.
A 1999 report released by the Institute of Medicine stated that anywhere from 44,000 to 98,000 people die from medical errors in the United States each year, with many occuring during surgery. While the report is controversial and was recently challenged by others in the medical community, if true it would mean that such errors, even at the low estimate, kill more people than AIDS, auto accidents and breast cancer combined.
"Weâ€™re hopeful that with medical simulation we will improve the quality of medical care and decrease the adverse events that occur today," says Kaufman.
But Kaufmann stresses that virtual surgery is still in the "Wright Brothers" stage of development. "We are only at the beginning right now. Today we can do simple surgical tasks like suturing. We could start an IV, we can do flexible endoscopy-type procedures such as bronchoscopy or sigmoidoscopy, the very basic procedures and simple techniques."
However, with more advances in technology, Kaufmann foresees the day when virtual surgery will become a vital component in surgical training -- but he hopes it doesnâ€™t take too long. "I would hope that it doesnâ€™t take us 50 years, as it has the aviation industry, to achieve what they have achieved," he says.
Elsewhere on the web:
"Virtual Surgeon" - IEEE Spectrum
"Virtual environment surgery simulators for endoscopic training: a helicopter view"
Resources in Virtual Reality
Virtual Reality in Surgery