Surgical technology has developed rapidly in recent years, improving patient outcomes but arming doctors with a dizzying array of tools and techniques that many struggle to get to grips with before wielding them in the operating theatre. Research suggests that when graduating from general surgery residency, about 30 percent of trainees were still unable to operate independently.
Dr Naeem Soomro understands this problem all too well. The director of robotic surgery at Newcastle Hospital has been rigorously exploring how to leverage technology to improve training since he was appointed in 2012. His investigations led him to Osso VR, a virtual reality training platform used to prepare surgeons for difficult procedures.
Osso VR allows his department to run countless simulations of operations and programme any procedural changes into the system. Multiple doctors spread across different physical locations can train together in one VR space, and supervisors can use the analytics tool to assess their individual skills.
"We bought their system to train our orthopaedic trainees to be able to do minor procedures in knee surgery," Dr Soomro tells Computerworld UK. "What we hope is that once they are able to do that, they can move on to doing operations on cadavers and in real life much more quickly."
Virtual benefits
Newcastle University boasts the widest adoption of robotic and minimally invasive surgery in the UK, and holds over 300 surgical training courses each year, but the tuition remains expensive and time-consuming.
Dr Soomro believes that VR training could help dramatically expand access to minimally invasive surgery and save the NHS millions of pounds.
"Currently, what happens in the UK is it takes 15 years to train a surgeon, and that's a huge amount of time," he says. "But I think there's a possibility we can train surgeons in the future much more quickly, because they will train in those environments."
The facilities where they use simulators and cadavers are expensive and there aren't many in the UK. "But if we develop VR or AR then people will be able to use it in their own time and at their own pace," says Soomro.
The system uses haptic devices to replicate the use of medical instruments. Image credit: Osso VR
Osso VR can also provide objective measures of surgical skills through the data analytics feature that tests a doctor's knowledge of the procedure, level of precision and overall efficiency. The results can be used to assess each doctor and identify areas where they can improve.
Soomro says that this information can be used to predict someone's performance and flag up areas they're having difficulty with. “In future, by using all these instruments, we will be able to analyse outcomes and progression, which we haven't previously been able to do in surgeons, and be able to define what a good surgeon looks like digitally.
"I think all of these metrics will help us get a bigger picture so we are also undertaking research to be able to define those metrics and use AI and machine learning to be able to see whether we can actually identify those areas."
Choosing Osso VR
In the US, Osso VR is already being used in a range of orthopedic residency programmes, including at the Vanderbilt University School of Medicine, Columbia University, and Harvard Medical School, but Newcastle Hospital is the first European facility to adopt the system.
Newcastle chose Osso VR due to its reputation and encouraging results of early trials. "There is evidence of effectiveness and efficacy from these training systems in America," says Dr Soomro. "That was the thing that we recognised with OssoVR."
In a company-run study of first-year medical students, those trained on the system performed procedures twice as well as those who underwent traditional training methods, as measured by the Global Rating Scale, a scoring system for surgery.
However, the department remains open-minded to working with other companies too. This could include incorporating haptic feedback developed by FundamentalVR, and expanding the use cases from orthopaedics to other surgical specialties.
Dr Soomro believes that the future digitisation of surgical practice will not only transform treatment outcomes but also help society to cope with changing healthcare needs. He compares the issues in surgical practice to ones observed by Thomas Robert Malthus in the 18th century, an English cleric and economist who feared that the global food supply could not keep pace with human population growth.
"He said people would starve...but that didn't happen, because we were able to use technology to produce more and to deliver more grain," says Dr Soomro. "In the same way, I think there's a common perception that we don't have enough resources to spend on our health, which is a real concern, and the only way we can overcome that is to use technology to overcome our cost pressures in the same way.
"You have to have a bigger picture. How would you cope with pressures on delivery of care? You can't keep on being more productive with the same methodology. You have to use a different methodology - robotics, artificial intelligence, optics and everything else. Technology will be the thing which is going to take us out of this current problem."