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The Future: Virtual Reality in Surgical Training

First we were trained using organic and cadaveric simulation. Next came inorganic, model based simulation. Is high fidelity, virtual reality simulation on the horizon? We look to explore the possible role of VR in the future of surgical simulation and training.


Changes to surgical training


It is no news, that practice is key for developing operative skills as a surgeon. However, in the age of the new junior doctor contract, increasing pressures on the NHS and potential unknown changes to the European Working Time Directive in the wake of BREXIT, current and future surgical trainees face new modern challenges to surgical training. Increasing needs for service provision; higher rates of rota gaps and cancellations of theatre lists due to winter pressure, all contribute to fewer opportunities to practice core surgical skills. As trainees, we must therefore seek alternative opportunities to develop our skills


Simulation as part of training is a proven and validated beneficial adjunct to training to prepare surgeons for actual practice without compromising patient safety. Previously simulation of full operative procedures has been difficult, with medical schools and post-graduate deaneries having limited access to dissection on cadavers. However in the modern era, the opportunity of virtual and augmented reality can provide a fully immersive simulated surgical experience. This concept however is not new, the aviation industry has been using simulation and virtual reality for decades, however we in the medical sector are only starting to follow suit.


What is virtual reality?


Virtual reality is a three-dimensional computer-generated environment, which is accessed using a virtual reality headset, smartphone or tablet and enables the user to be immersed in the pre-designed virtual world. Augmented reality uses technology that superimposes a computer-generated image over images from the real world, such as from a live camera feed on a headset, providing a composite view.


Virtual reality headset

What may virtual reality be used for?


Both can generate opportunities for training and practice of surgical procedures and ultimately have a positive impact on patient safety. Virtual reality has been shown to reduce training times and in addition, can have benefits of monitoring performance. For example, it is possible to collect objective measurable metrics on performance indicators, such as speed, trajectory and accuracy, which can help guide performance. Studies have shown that the use of virtual training can help decrease errors intraoperatively. For example a study looking at surgical residents at Yale University found that virtual reality trained residents were 6 times less likely to cause errors and 5 times less likely to cause injury the gallbladder. In addition those trained using virtual reality were 29% quicker at performing gallbladder dissection compared to the non-virtual reality trained residents and 9 times less likely to fail to make progress.


Work is being done in the UK to discuss the merit of virtual reality in the demonstration of basic surgical skills. In the future we may see virtual reality videos being commonplace on courses such as Basic Surgical Training and Advanced Trauma Life Support. These courses are key for future surgeons to attend during Foundation Training or Core Surgical Training.





Of course, the quality of the training also depends on the technology itself. With equipment still expensive and developing content challenging, it may be some time before virtual and augmented reality is readily available and provide a significant impact on the training of surgeons. That being said, simulation is a useful supplementary training environment to real life operative experience. However it is important to remember that using simulation, may not fully be able to replicate the fine nuances in theatre particularly the socialisation skills that are required to function within the surgical environment. Nevertheless, virtual reality in surgery provides an exciting opportunity to use technological advances to help optimise surgical training. Perhaps as technology improves and also becomes cheaper, we can have our own operating room at home to practice!


References


  1. EWTD for surgical trainees (ASIT document)

  2. 360° virtual reality video for the acquisition of knot tying skills: A randomised controlled trial.

  3. Virtual Reality Training Improves Operating Room Performance - Results of a Randomized, Double-Blinded Study

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