The 360-degree view that Medical Realities live-streamed of a cancer surgery in U.K. in April
In April, Dr. Shafi Ahmed, a U.K surgeon and cancer specialist, entered the operating room to remove a tumor on the colon of a man in his 70s. About a half-dozen surgical team members stood by assisting with the procedure, watching it live in person. But worldwide, almost 55,000 people in 142 countries also watched the surgery in real-time online, thanks to footage recorded in 360 degrees and live-streamed by a small London startup, Medical Realities.
From phones, computers, and even virtual reality headsets, video of that surgery remains available — and it represents a market that Medical Realities and other companies, small and large, are targeting when it comes to training the next generation of surgeons.
“Two-thirds of the world’s population don’t have access to safer, affordable surgery, but surgical training is not scalable,” said Steve Dann, who, along with Dr. Ahmed, cofounded Medical Realities about three years ago. “We started experimenting using virtual reality, and it seemed to be the perfect tool.”
By contrast, most surgeons today are still trained in an apprenticeship model: Under the tutelage of an experienced surgeon, they learn how to perform simple to complex surgeries. By performing surgeries over and over (and then some ), medical students become proficient, until they perform their first surgery solo. Still, gaps in training remain, especially since the end of the last decade when limits were passed on how many hours a week surgical trainees could work. Whereas students in the past were guaranteed to do one surgery a day, now they are lucky if they do as few as three surgeries a week, according to one doctor writing in the New York Times.
Given the decrease in volume, people are wondering if surgical simulations can replace direct OR experience to train future surgeons.
The answer seems to be yes.
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Two studies published this month in The Annals of Thoracic Surgery show that heart surgery residents who logged time in simulations came out better prepared. Plastic models, real tissue, and even pig hearts were used for immersive simulated training in a variety of surgeries and scenarios. Trainees were also grilled on what to do during mid-surgery “catastrophes.”
Surgical simulation is one thing, but Medical Realities appears to be taking education and training to a different level by harnessing the immersive experience of VR. In a way, it is democratizing medical education by stripping away issues of infrastructure and access needed to gain an inside view of how surgery is done.
Using a proprietary training regimen called the Virtual Surgeon and virtual reality headsets like the Oculus Rift, the London startup gives surgical trainees a 360-degree view of surgical procedures. Right now it’s installing training stations, composed of VR headsets tethered to high-speed computers, inside several hospitals and universities in London. Students with access can pull up a library of operations from hospitals around the world at those stations to learn the steps and decisions involved in those surgeries.
“We’re looking for the best specialists in each procedure to showcase what they do,” said Dann, whose background is in augmented reality, film, and special effects, in a phone interview.
Right now Medical Realities is bootstrapped, and has only just begun building up its library of surgeries available to trainees. Starting in September, it will have filming access to 10 surgeries a month, Dann said.
While Medical Realities has opted for the VR route, another startup is using an app approach. Touch Surgery, with offices in London and New York City, has developed a “mobile cognitive simulator,” said Andre Chow, its co-founder.
Sounds fancy but it’s actually an app loaded up with about 100 different surgeries, including cardiac bypass and hand transplant surgery. From their mobile phones, surgical trainees are taken step by step through each procedure. While operating room apprenticeship tends to teach students how to cut, Touch Surgery is trying to teach students “when to cut and what to cut” during surgery, Chow explained.
“Everyone knows a surgeon needs good hands, but a surgeon also needs to train his brain,” Chow said.
Backed by venture capital and a 40-person team that Chow said includes people from the likes of places like Pixar and the video game industry, Touch Surgery just signed a partnership with Ethicon, part of the Johnson and Johnson Medical Devices Companies. This will enable the startup to train surgeons in appropriate techniques and the use of J&J’s surgical equipment.
Despite the advances, there is still some debate over how effective surgical simulation is compared with real-world, inside-the-operating-room experience. A study in The Annals of Surgery from 2013, while conceding that the current apprenticeship model left surgical trainees ill-prepared, still maintained that real experience trumped simulated scenarios.
But the studies noted in The Annals of Thoracic Surgery above indicate that simulations had a positive effect on students.
“This type of learning allows surgery residents to develop their knowledge, skills, and confidence, before going into the operating room, thus protecting patients from unnecessary risks,” said Dr. Richard Feins in a press release. Dr. Feins, from the University of North Carolina at Chapel Hill, led one of the studies.
Chow, once a medical student en route to becoming a surgeon, said he wished tools like what Medical Realities and his own startup are developing were around when he was still a surgical trainee.
“The first time I learned to take an appendix out was literally by taking an appendix out,” he said.
In the future, a pair of Oculus Rift goggles could instead offer surgical trainees a realistic operating room experience before they ever set foot inside it.
Photo Credit: Medical Realities
