All you need is a headset and smartphone to enter a virtual world of gaming, movies, travel — and now surgery. Health care company Medical Realities is using virtual reality to transport people directly into an operating room to watch surgeons as they operate.
The first surgery of this kind took place last week at the Royal London Hospital, when Dr. Shafi Ahmed gave global access to his operating theater as he removed cancerous cells from a 70-year-old British man with colon cancer.
“People can see how the whole theater works,” said Ahmed, a consultant cancer surgeon at the Royal London Hospital and co-founder of Medical Realities. His company is stepping away from the usual realms of entertainment for VR and using it to develop training materials for medical students worldwide.
Nearly 55,000 people tuned in worldwide to watch the surgeon conduct the procedure, which lasted two hours and 40 minutes.
“Once you take away the wow factor, I see a teaching medium that can be used,” Ahmed said.
In 2014, Ahmed became the first doctor to use augmented reality during a live stream of his surgery. wearing Google Glass and communicating with the people viewing. He sees both forms of reality as means to educate people. “They have different ways to reach people,” said Ahmed.
VR is about full immersion, making direct communication more complicated, but Ahmed has set this as his next goal. “This scales up surgical training and education,” he said.
What you see
The idea of last week’s event was to make people feel like they were in the operating room, seeing and hearing as a nurse or clinician would on the team, with options to change their viewpoint and zoom in and out of what they would like to focus on.
“It gives direct access to operations,” said Kapellos.
One camera was placed directly above the operating table. “You have a bird’s eye view of the actual surgery,” he said.
By dragging the video, you can look around the room down onto the operating table. (Caution: some readers may find images of surgery graphic.)
“It gives direct access to operations,” said George Kapellos, head of marketing and partnerships at Mativision, the 360-degree video experts that streamed the surgery. Originally specialists in music and entertainment, Mativision has now seen the potential for the technology as an educational tool.
Ahmed decided to conduct a routine operation — that, as a colon cancer specialist, he does on a near-daily basis — to train people in something that can be performed anywhere in the world.
“It has to be one that’s possible for anybody to do, with simple equipment,” said Ahmed, whose primary goal for the technology is to enable access to high-quality training for medical students globally.
Who could watch?
While the live-stream targeted those in need of training, anyone keen for an insight into an operating room beyond the dramas of “Grey’s Anatomy” could tune in.
The operation took place on Thursday, April 14, on a 70-year old British man, and viewers could watch using the VRinOR app available on Android and iOS as well as the Medical Realities website.
Ahmed later received feedback from post-graduate trainees who had watched from hospitals in regions as remote as the West Bank and Gaza.
“They actually managed to stream it live and teach their students,” he said.
As well as students, the team was also keen to open the eyes of people whose loved ones have undergone treatment for cancer.
“Cancer has a lot of interest and is emotive,” said Ahmed, who hopes to put people at ease by showing them such routine procedures. “It takes away the myth of surgery.”
Numbers released by Mativision found that many of the people tuning in were the public in search of content, using gadgets such as Samsung Gear VR. “[This] had a huge impact on total numbers and is a strong indication of the appetite for VR content from the public.” said Kapellos.
While the majority of people that tuned in on mobile platforms were in the United States and United Kingdom, total numbers spread across the globe including people watching from Vietnam, Saudi Arabia, Chile, South Korea and Turkey. More than 50% of viewers watching on their desktops were in China, according to data provided exclusively to CNN.
“These numbers are unheard of for a nonentertainment live-stream project,” said Kapellos.
Piece of mind for families?
The wife and two sons of the British patient watched the surgery live along with the rest of the world, according to Ahmed, who believes tuning in this way could ease the worry and unnerving that comes when waiting for people to come out of surgery. “His wife said she watched the whole operation [and that] it helped her through it,” said Ahmed.
As for the patients being watched by people worldwide, privacy and permission is vital.
“In this case, the patient was willing and happy to share his experience with those who could learn from it. But patients should never be pressured or incentivized to go on camera,” said Skip Rizzo, director of the Medical Virtual Reality group at the University of Southern California’s Institute for Creative Technologies.
Rizzo’s team at USC designs and develops a range of VR systems targeting health care areas such as clinical training, treatment and rehabilitation. He is a proponent of using VR to aid surgical learning, as shown by the Medical Realities team, and believes that with improved viewing systems, this approach could become standard.
“This is a great effort, but it is just the start … it is one step in the learning chain that will amplify opportunities for doctors to improve their skills in ways unimaginable 30 years ago,” Rizzo said.
Truly virtual surgery
The team at Medical Realities is not stopping simply at immersion inside an operating theater. The next goal is to provide truly virtual surgery, where the viewer conducts the operation. The patient would also be virtual.
Rizzo’s team at USC has already begun work on something similar: The Virtual Patient is where human avatars are used to train future clinicians in patient interviews and diagnoses.
“It gives a new clinician a chance to mess up with a virtual patient (and learn from it) rather than messing up with a real patient,” Rizzo said. “I don’t believe we should try to ‘virtualize’ all treatment, but where it makes sense it could serve to amplify or extend the skills of a good clinician.”
Ahmed wants to extend this further and remain in the operating room by incorporating haptic feedback, where the sense of touch is added to provide greater information to and from users.
“My vision is that you have a virtual body, pick up a virtual scalpel, see virtual blood and create a completely virtual operation,” said Ahmed.
He hoped to have this running within two to five years, as part of the company’s overall mission to make training available to all populations.
“My hope is to reach parts of the world that are difficult to reach,” Ahmed said. “We want to show that the world is a small place.”