MedCity Influencers, Health Tech

May the force be with you

Haptics technology is a vital surgical training alternative because it lets surgeons interact with virtual environments by adding the sense of touch to the overall simulation. 

The global health crisis has accelerated the use of haptics in allowing surgeons to continue their training under strict Covid restrictions. As with all emerging technologies, however, I’ve noticed there is a hype circle. Hopefully, I can clear up some of these misconceptions and explain the technology’s actual value in surgical training.

The term ‘haptics’ has become diluted and manipulated to suit some vendors’ marketing requirements. Out of the five known senses, touch is undoubtedly the most proficient. It is the only one that can provide simultaneous input and output. Haptics, which has been in development for some time, enables tactile feedback to be integrated into computer simulations, providing tactile and proprioceptive feedback.

Surgery is a multisensory skill. Touch is pivotal in enabling the surgeon to learn and carry out procedures.  Tactile exploration provides the surgeon with information over and above visual cues, allowing adjustments to movements during surgery. Pressure and contour provide information on the form of the object. The sense of touch is critical in guiding the surgeon’s actions during procedures where line of sight is restricted or non-existent. In ophthalmology, where cataract procedures necessitate precise accuracy, for example.  Blood vessels are incredibly fragile and can accommodate much smaller force compared to ligaments.

Surgical education is one of life-long learning and requires extensive practice on patients with close faculty supervision. This can become cost-ineffective for teaching and is impossible in a pandemic. The ability to carry out cadaver labs and face-to-face sessions with students and sales teams has been impossible.

As a result, surgical training is carried out on cadavers or animals. There are, however, ethical and technical disadvantages. Cadavers, for example, have short shelf lives. Embalmed Cadavers lack the texture and tactile feedback needed to practice procedures such as nerve blockers. While training on real patients is imperative, it involves risks for living patients. In addition, cadaver labs are costly.

Opening up a feeling, virtual world

This is where haptics come in as a vital training alternative because it lets surgeons interact with virtual environments by adding the sense of touch to the overall simulation.  Therefore, it is little surprise that the global haptic technology market is expected to hit $4.5 billion by 2026, partly fueled by its growth in the medical industry, according to analysts.

The issue, however, is that the term ‘haptics’ has become diluted as it gains increasing market traction.  In its broadest sense, haptics can be a system that incorporates tactile feedback and vibrates through a sense of touch.

Haptics is the deployment of vibration and/or physical resistance to engage your sense of touch when using technology. The most simplified example is your smartphone vibrating in your pocket when you have a call.  But, it is essential to note that not all haptics are created equally.

Haptic interactions are understood as the bidirectional transmission of cutaneous and kinesthetic sensations. Cutaneous sensations refer to pressure, break off and jams due to structural strains and vibrations applied to the skin. Kinesthetic sensations encompass forces and motion sensed by the muscles, tendons, and joints. In cutaneous active haptics, the user explores the touchable surface, typically with fingertips. In kinesthetic haptics, the user consciously applies forces and motion to the haptic device to collect information.

For example, during a knee replacement, the surgeon uses a surgical saw to resect bone. Haptic feedback enables the surgeon to actually ‘feel’ changes in resistance between harder and softer bone to prevent injury to blood vessels, nerves, and so forth. These layers of bone cannot be seen, they must be circumvented via feeling.

Flight simulator-style haptic technologies for surgery have been around for some time. But they are fixed room systems and ultra-expensive, and approximately 0.5% of surgeons have access to them. There are now highly affordable, portable systems out there that have shown their value during the pandemic.

There are companies offering low-cost, scalable software as a service platform that provides simulation experience for life sciences companies, educational institutions, and qualified surgeons. Solutions are made up of immersive, kinesthetic haptic technology and off-the-shelf hardware. These solutions incorporate an intelligence engine that is programed to mimic the real-life sensation of a number of medical tools and tissue, muscle, and bone variants. When surgeons use it, they get the feeling of an actual surgical procedure within a submillimeter of accuracy and resistance.

One size does not fit all

When we finally return to a ‘new normal,’ and COVID-19 restrictions are relaxed, there will be a massive backlog of examinations and elective procedures that will further reduce training opportunities for both students and experienced surgeons looking to advance their skills.

Haptic technology will become invaluable here. Haptics has the potential to democratize surgical training by providing every surgical student, surgeon, educational institution, and life science company with access to affordable, authentic simulations in a safe environment.

Haptic technology has the ability as we advance to improve surgeon’s cognitive and psychomotor performance and ultimately improve patient outcomes.  But, it is first essential that we clear up the confusion and frustration about exactly what haptics is and what it can achieve.

Haptics isn’t a silver bullet, and neither is it a one size fits all solution. Traditional ways of training are still essential. But, fully immersive haptics have much to bring to the profession in reducing surgical errors and improving patient safety. As well as getting innovative, new surgical procedures mainstream faster.

Haptics that are fit for purpose

Moving forward, the goal is for vendors must be a multimodal platform that can provide all modalities to support various learning and training levels, depending on what stage of knowledge acquisition the user is at.

However, it is imperative decision makers in the medical profession can strip around the myths that have grown up around haptics. The objective is artificial 3-D scenarios that provide the same sensual experiences like those found in real-world surgical environments. Without true haptics capabilities, any great intentions will fail.

A respected thought leader and pioneering healthcare and education futurist, Dr. Grossmann is dedicated to integrating technology into medical care and driving innovations to improve the overall healthcare system. He is a full-time practicing surgeon in Maine, specializing in general, trauma,
advanced laparoscopic, single incision, and robotic-assisted surgeries. In 2013, he was the first doctor ever to use Google Glass during live surgery and is a passionate advocate of technology's transformative potential to improve patient care. A global speaker at events including TEDx, Exponential Medicine, and MedicineX, Dr. Grossmann often lectures on innovations in healthcare and how the growth in mobile and wearable platforms will improve connectivity, communication, and data management to help make medicine more efficient, intuitive, and less expensive.

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