The VRSS immerses surgical trainees in a virtual reality experience that facilitates the development of the psychomotor skills, sensory acuity, and cognitive planning that are required to perform complex surgical tasks. When combined with clinical training, virtual reality technology has the potential to significantly reduce the time and cost of achieving surgical proficiency in resource-constrained settings.
Cervical cancer is one of the most common cancer-related causes of death in the developing world. Surgery is essential to treat the disease, but traditional mentor-apprentice methods of surgical training have failed to provide developing regions with an adequate number of trained surgeons, largely due to the training time required. As a result, cervical cancer patients in these regions typically spend excessively long periods on surgical waiting lists, during which time their cancers may progress or they fail to return for follow-up.
Furthermore, as countries in the developing world implement and scale-up cervical cancer-screening programs, increasing numbers of women are diagnosed with advanced stages of cervical cancer that are only curable with surgical intervention. This relatively recent recognition of the alarming number of women in need has created an urgency to the task of developing ways to more effectively and efficiently train surgeons to treat cervical-cancer patients and prevent missed opportunities for cure.
Virtual Reality as a Low Cost, Scalable Solution
The Virtual Reality Surgery Simulator (VRSS) project utilizes inexpensive, off-the-shelf virtual reality (VR) equipment designed for use with video games, resulting in a total cost of less than $2,000 USD per unit. The low cost of this technology makes it feasible to install surgery simulators in medical training facilities that could not previously afford them, thereby reducing the per-surgeon cost of surgical training and increasing the availability of trained surgeons in low-resource settings.
VR surgery training aspires to create “pre-trained novices” who have mastered the psycho-motor skills, sensory acuity, and – to a lesser extent – cognitive planning of surgical tasks. Studies have shown that VR training can reduce training time needed for a novice to reach the skill level of an intermediately skilled surgeon by half. Similarly, studies have shown that VR-trained surgeons are much less likely to make errors than those who have completed standard training only.
The Virtual Reality Surgery Simulator is a computer-based, interactive virtual reality program that runs on commercially available Oculus hardware. The simulator was built using standard VR development tools and applications that are commonly used by video game development studios and taught in top video game development education programs like SMU Guildhall.
A VRSS trainees wears an Oculus Rift headset and holds an Oculus Touch wireless hand controller in each hand. The simulation starts in a virtual training room with guidance to help the trainee become comfortable working in a virtual environment. The trainee is represented by an avatar, whose hands, only, are visible. Once the trainee is comfortable, the simulation transitions to a basic operating room environment, featuring an operating table with a tray of instruments and a virtual patient prepared for surgery.
The simulation begins at the point in the surgery where the key procedures for the training begin. Visual instructions are provided on a virtual monitor, and audio feedback is provided to reinforce procedural knowledge by guiding users through the steps. The headset view of each VR training session is recorded for review and reflection.
As of September 2018, the VRSS project is being evaluated in a randomized clinical trial with surgical trainees at the University of Zambia. Surgical trainees in the trial have been randomly assigned to one of two training conditions: VR-enhanced surgical training or traditional surgical training. The goal of this trial is to assess the feasibility of the technology and compare the effectiveness and cost of VR-enhanced training with that of traditional surgical training. The next phase of VRSS testing will focus on the adaptation and evaluation of tele-mentoring protocols to maintain or enhance surgical skills.
As VR technologies advance, new systems that are completely portable and even more cost-efficient are expected to be released. As these systems become available, the VRSS team plans to utilize them to further reduce the cost of VR surgical training.
This project is funded with support from the Medical Research Council, UK