The advances in surgery over the past 100 years are remarkable, and many procedures these days barely resemble those of the past. The rapid evolution in surgical methods has led to surgeons developing individual approaches to many critical procedures. While a high percentage of operating room (OR) events deliver excellent success rates, many patients remain at risk of having a procedure performed by a practitioner less familiar with the particular modality. FundamentalVR’s use of virtual reality (VR) in surgical training offers a solution to this issue, with potentially far-reaching consequences for healthcare.
Challenges Facing Surgical Training
More than 5 billion people worldwide lack access to safe surgery due to a shortage of trained surgeons. Despite significant advancements in science and medical technology in recent years, the way we train surgeons has remained unchanged for the past 150 years. Traditional training still consists of classroom-based theory, theater-style viewing of cadaver-based teaching, and OR observation far removed from the actual procedure. Getting suitable cases to practice on or exposure to enough scenarios to have realistic rehearsal opportunities is challenging.
Hands-on cadaver practice, closely monitored live patient involvement, and specialized textbooks are all expensive options compared to VR, leading to limited usage and complex logistics. Using traditional methods to equip surgeons for specialized surgical procedures is time-consuming and expensive, and reaching proficiency as fast as possible is vital. VR training enables healthcare institutions to accelerate and flatten surgeons’ learning curve dramatically.
The Promise of VR Technology
Since 2015, FundamentalVR has focused on developing technology for the medical sector, and VR simulators now offer a viable SaaS-based option for surgical training. This method gives users full situational awareness and immersion, which are combined with haptics to deliver a sense of touch, resistance, and force feedback. Machine learning is overlaid onto the foundation to enable understanding, interpretation, and to predict user behavior. This combination delivers virtual surgical training that results in specific skills transfer, increased precision, and VR simulation of real-life experiences.
In an OR procedure, various surgical objectives exist, such as needing to open the patient in a certain way, perform specific actions during the procedure, and close the wound in a particular fashion. Within each objective, the system can make an informed assessment of a surgeon’s capability and provide feedback to the user on their performance. Assessments include determining how the surgeon interacted with the patient’s tissue, how confident their movements were, whether they were distracted during the process and achieved the surgical outcome.
For example, during a virtual facetectomy, the system can precisely assess the percentage of the joint removed, how much remains, the location of the remnant, and its potential impact. In another instance, if a surgeon is resecting a knee, they might approach it at an incorrect angle. The system can trigger an alert immediately to avoid a possible adverse outcome.
Healthcare has traditionally been slow to adopt new technologies, mainly because it typically increases costs. Some VR simulators require specialized, immobile equipment that costs more than $100,000. Because of the steep costs of these simulators and the immobility of the equipment, less than 0.5% of the world’s surgeons have access to this training option. However, at the other end of the scale, budget simulators provide a game-like experience with no sense of touch.
Fundamental Surgery’s immersive VR training solution solves this issue and democratizes surgical simulations and training by enabling hi-fidelity, haptically enabled simulations to be easily accessible to any surgeon worldwide. It allows them to experience the same visuals, sounds, and feeling that they would during a real surgical procedure—anytime and anywhere.
A Bevy of Benefits
VR training in surgical applications offers valuable benefits for customers, users, and patients. The main attraction is the ability to shorten and accelerate the learning curve. Patients don’t want surgeons “learning” on them. Surgeons and their teams don’t want to enter an OR unprepared.The Fundamental Surgery platform delivers on all these fronts, while offering these additional benefits.
● Better Outcomes
VR for surgical training has generated high validation in the market. Between 12 and 14 validation studies conducted by different US and global institutions all indicate this method helps to improve skill acquisition compared with traditional training methodologies. For example, a US study showed an assessment of employees trained using non-haptic VR were 233% better at the task than those taught using traditional techniques. With an additional 44% improvement when using haptics. This shows haptic feedback plays a crucial role in training and furthermore bettering patient outcomes.
● Time and Cost Savings
The time and cost savings generated by VR training are phenomenal. Users no longer incur travel and accommodation costs to reach a training location. Companies can avoid the expense of using wet labs and other venues, and expensive materials and supplies. By investing in doing the training in a virtual space, institutions can accelerate training time, increase repetition, gain increased surgical precision, and facilitate better patient outcomes. Moreover, users can rehearse as often as needed, whether to improve their abilities, focus on conquering particularly challenging aspects of a procedure, or simply refresh their skills after a period of time passes between a training session and a live patient event.
● Refined Surgical Capabilities
By utilizing VR surgical training options, surgeons can develop the skills they need to perform flawlessly. The system can identify the user’s level of skill at the outset, and can then deliver variable presentations they may not have access to in a live situation. These allow them to see the breadth of contexts that could occur and practice their technique in each scenario.
An actual surgical procedure might be hours long, but it probably contains a few moments that encompass the really tricky bits, and those are where the surgeon wants to spend time rehearsing. VR training offers the opportunity to fast-track to those sections and hone the skills where, based on simulation feedback or based on their own assessment, the surgeon might want to refine their capability. These factors make the technology an excellent complement to existing modalities.
● Hardware Agnostic Requirements
The system is completely hardware-agnostic, meaning any VR headset, haptic gloves and other haptic devices are compatible. SaaS-based systems can be updated offsite and over the air as necessary, ensuring users have access to the most up-to-date tools at all times.
● Deep Data Insights
The VR system records telemetry data, movement data, patient interaction data, and other data types. Through the application of machine learning technologies, this data enables users to predict outcomes and understand optimum performance. The system feeds insights back to surgeons in real time while they’re in the virtual OR, and provides them with a complete medical record for learning going forward.
● Full Institutional Accreditation
The Fundamental Surgery platform is fully accredited by entities such as the Royal College of Surgeons in England and the American Academy of Orthopedic Surgeons. The company is currently working to achieve accreditation by additional global medical institutions.
Types of VR Surgical Training
Haptics is a form of touch technology that allows people to experience the sensations they can expect in the real-world sensation in a virtual environment. In the context of surgical training, users get to feel the textures and resistance of human bone, muscle, and soft tissue, and how these interact with their surgical tools and medical devices. The Fundamental Surgery platform has three types of virtual surgical training, each offering has different capabilities.
StandaloneVR is a compact virtual training solution that works with any VR headset in any environment. Users can access the training at home, in their office, or in a hospital setting, using high-quality visual and auible content that enables them to learn a procedure. At the same time, the platform tracks, evaluates, and provides feedback on each step. The method is ideal for familiarizing surgeons with the steps of a procedure, the 3D anatomy, and the tools involved. The system can be integrated into proprietary, back-end systems, so institutions don’t have to reinvent everything. Large or multinational medical device or pharmaceutical organizations can simply plug the system into what they already have.
HapticVR, which enables surgeons to use physical cues to practice their skills with a full sense of touch. This model replicates the operating room and the tools they would use in the procedure, and gives them the chance to determine how it feels to perform the procedure—both correctly and incorrectly! The platform also provides insight into the operator’s competency during the procedure and skill development progress, taking users from the standalone experience where they learn the procedure to a full haptic experience where they can learn and rehearse the skills to perform it.
CollaborationVR is a collaborative tool developed for organizations needing to train surgical personnel at scale. This offers virtual classroom capabilities, where multiple users can interact with each other. They can collaborate, practice using particular products or performing procedures, and interact with simulated medical instruments and devices. They can receive instant feedback from advisors and peers via the system.
A Compendium of Use Cases
So far, these virtual training tools have been proven helpful in a wide range of use cases, and the possibilities for use in healthcare appear unlimited. The platform has been deployed across probably eight or nine different disciplines, from small-movement, finite procedures like gene therapy and ophthalmology, through to the big gross movement such as orthopedics.
The platform is also helpful for training soft skills like nursing, because students can access specific scenarios for each use case. This benefits real-life applications significantly.
Real-Life Examples
Novartis expanded their training program by using Fundamental Surgery’s novel method of medical education. This new way of training and accelerating skills transfer, for their hard to administer ocular gene therapy drug, was integrated into their medical education program for treating patients with inherited retinal dystrophies. Social distancing and pandemic-related issues had added further complications and put face-to-face training programs at risk.
The Fundamental Surgery platform was configured in conjunction with Novartis’ key opinion leaders. The resulting dual-user VR system employed our latest HapticVR™ technology, creating the precise sense of touch required for this intricate sub-retinal procedure. This allowed consultant level ophthalmic surgeons to acquire the necessary skills transfer.
Staying in the ophthalmology realm, Orbis International, an eye charity organization specializing in fighting avoidable blindness in the third world, uses the VR training system to teach cataract removal procedures in around 17 countries. Cataract surgery is the most commonly performed surgical procedure, compared with any other surgery in medicine.1
In endovascular care, the platform helps surgeons learn how to place heart pump systems into patients, which often occurs in emergency scenarios out in the field, rather than in a fully equipped OR. In these instances, the system creates digital twins that surgeons can work through.
Robotics is affecting every surgical discipline these days, and the space offers yet more opportunities for VR training. For example, robotics company CMR Surgical is deploying the platform to accelerate acquiring the technical skills needed to use its robot in the OR. This scenario requires a team training exercise involving multiple people, and VR training accelerates that process.
Beyond the Training Aspect
In addition to the technology, the successful deployment of the VR training platform depends on high-fidelity visual content, haptic fidelity or both. We work closely with our customers to incorporate their expertise on the correct way to perform a procedure, their instructions for use, and their authorization.
FundamentalVR has an extensive team of working surgeons who consult with key opinion leaders and leading medical staff to integrate their scenarios into the platform. This process involves deconstructing every step of a procedure to extract the information,to then turn it into code. It’s also possible to create different pathologies, clinical presentations, and adverse events. These enable users to run scenarios they could never run in the real world and provide insights they wouldn’t see if they were learning in a traditional way.
A Bright Future for Surgical Training
Future possibilities for the use of VR training in the medical sector include the opportunity to create standardized procedures. This could develop out of deconstructing the procedures practiced by top surgeons for the purpose of VR training, and using the data to train future surgeons in the same method.
VR training such as Fundamental Surgery’s platform enables doctors to learn through deliberate failures and repetitive training, without bad outcomes happening in the real world. Deliberate failure is an excellent way to increase understanding and facilitate scenarios surgeons may never face until they occur and they’re operating against the clock. The opportunity to rehearse those scenarios beforehand is invaluable.
As medical professionals get to grips with virtual and augmented reality, applying these technologies to healthcare is likely to spawn many exciting opportunities. For now, VR is spearheading a radical new way to train surgeons in complex and intricate procedures.
Author’s Biography
Richard Vincent has 20+ years’ experience in building international businesses and has throughout his career sought opportunities for positive market disruption through technological application. It was this desire that led him to co-found FundamentalVR to help address an age-old problem for the medical market; how to create safe, realistic, measurable spaces to learn, train and develop skills. In his role as CEO Richard is responsible for building a world-class team of medical, learning, and technologists who together can realize the company’s ambition of creating the world’s first global, haptically enabled, low cost platform.
1 Behrens, A. (2021) Cataract surgery, Cataract Surgery | Johns Hopkins Medicine. Available at:https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cataract-surgery#:~:text=Cataract%20surgery%20is%20the%20most,with%20a%20new%20artificial%20lens (Accessed: March 7, 2023).
