by Raimundo Sierra, Ph.D., Co-Founder, VirtaMed
As the world continues to advance technologically, medical education must follow suit. The educational potential of medical simulation is evolving rapidly and offers surgeons the unique ability to hone their skills using software and hardware that effectively simulates the operating room experience.
While studying electrical engineering at the Swiss Federal Institute of Technology, I took a medical image analysis lecture that highlighted the intersection of technology, healthcare and software. The idea of bridging these worlds inspired me to complete my master’s thesis in medical imaging and get my Ph.D. in surgical training simulation. After several years as a consultant, I returned to the medical simulation sphere and VirtaMed, a company I had co-founded. VirtaMed is now a global leader in surgical simulation technology, with the goal of changing the way surgical skills are taught.
As the CEO of a surgical simulation company, I have seen the exponential increase in the ability and diversity of simulation technology. Here is some of the larger trends and specific innovations I believe will inform the direction of the industry in the years to come.
And even deeper collaboration between technology experts and surgeons to improve patient outcomes
The trend of combining cutting-edge technology with surgical training is not new, but the ability to create simulation technology that accurately mimics real medical practice has finally begun to reach its full potential.
The feedback loop between physicians and simulation researchers has allowed the industry to develop effective products that address many areas of medical device training including orthopedics, gynecology, urology, laparoscopy and more. This approach has proven vital in training and educating current and future surgeons in the necessary psychomotor skills required to perform surgery successfully and safely.
I believe that in the future researchers and physicians will work even more closely together to create simulation technology that reflects the complex techniques necessary to be successful in today’s operating room. Collaboration will occur more quickly and sooner on in the process of simulation development, getting technology into the hands of surgeons faster. Collaboration will also expand to cover more disciplines and geographies as technology moves further into healthcare training across disciplines and geographies.
The digital patient
When I started my research in surgical simulation and surgical planning, we were on the cusp of accurately replicating areas of the human anatomy in 3D computer models. We now have this technology refined to the point where surgeons can train on highly accurate representations of the human body that respond to interaction just as a real human body would.
For surgical training using simulation, one of the major innovations has been the move toward digital patients. I am specifically referring to two types of digital patients, a generalizable patient for training and a highly-specific ‘twin’ patient for rehearsal.
For general learning, we need patient models with sufficient differentiation to capture the main anatomical variations that a surgeon will encounter in the operating room (e.g. size, position, and number of pathologies present in the body). These patients would form the standardized simulated anatomies that provide trainee surgeons with a broad range of scenarios from which to learn. There are many independent validation studies that show VirtaMed simulators capture and process sufficient data points to distinguish between different competency levels of surgeons and can therefore be used for both training and assessment of surgical skills.
The other type of digital patient would be the digital ‘twin’ of a real patient. This digital twin is based upon a patient-specific anatomy that allows surgeons to rehearse a procedure with that one patient in mind, usually a patient with a complex or rare pathology. We can think of this as the interpolation of computed tomography (CT) scans of real patients to computer-generated imaging (CGI) for surgical simulation.
Learning and practicing surgery on digital patients provides surgeons with the opportunity to gain confidence in the operating room, reduce operating time, and can lead to improved health outcomes for patients.
Just as pilots perfect flying skills through flight simulation software, surgeons today can hone their abilities through simulation and better prepare themselves for the operating room experience.
The digital surgeon
Whereas a digital twin patient is a virtual representation of a physical body, a digital twin surgeon is a virtual representation of a surgeon’s knowledge and skills. A digital surgeon can take many roles in surgical training (e.g. a mentor guiding a trainee through a virtual surgery or a skills assessor), all the way to the primary surgeon in a real operating room. Much like digital patients, they can also be based upon a collection of generalized surgical skills or be the ‘twin’ of a specific surgeon doing a specific procedure.
Currently, VirtaMed uses digital surgeons in our training simulators to mentor trainees. Mentoring includes instrument guidance, real-time feedback, error identification, and progress reports. In the future, we hope to capture specific surgical techniques by using high-precision sensors embedded in the instruments that surgeons hold to convert their manual movements into digital data streams. We then have the potential to digitize these manual actions and combine them with our 3D digital twin patient models.
Recent research has centered around the potential of algorithms to learn the mapping of surgery — for instance, programming a laparoscopic camera to follow the path of the physician. This approach could allow surgical teams and instructors to analyze and coach surgeons on techniques.
We are now moving toward a more proactive role for digital surgeons. For instance, by training machine learning algorithms with surgical technique data collected from experts, we can simulate how an experienced surgeon would typically perform a procedure.
Of course, we are looking at a very precise part of the surgery, the interaction between surgeons, surgical instruments and patients, and we are very conscious this is only one part of optimal patient care. Yet the goal is clear: by modelling the best surgical techniques, we can democratize access to this knowledge as less-experienced surgeons can rapidly gain skill from the most experienced surgeons available.
The future of digital surgery
The scenarios outlined above are based on techniques currently used in operating theaters. Another path to the best surgical techniques follows that of pure artificial intelligence, where the digital surgeon is an agent in and of itself. For instance, an AI could be programmed to learn how to perform surgery by itself on a simulated patient. This has the potential to revolutionize how new surgical skills are taught and new medical devices tested.
At some point that we will likely see new medical devices and procedures being trialed and tested on completely digital patients by digital surgeons. Much like how self-driving cars must first prove themselves safe by successful navigating a virtual city, such AI surgeons would be able to learn from their virtual environment and apply their newly-acquired skills on virtual patients. These interactions could then be used to determine the best practices for new procedures or medical devices in the real world. Being able to do this would support a rapid advancement of the medical field by making medical device development and testing faster and much less risky.
Advancing simulation for the benefit of all has become a highly collaborative effort. Through partnerships with global medical thought leaders, technologists, universities and practicing professionals, medical simulation is expanding the boundaries of digital surgery and revolutionizing the best possible training and guidance for a surgeon to be supported with in the operating theater.
