Finding surgical safety in a virtual space

Frustration with the complexity of studying surgery led Dr George Oosthuizen to develop virtual training. Picture / Martin Sykes

Off-duty surgeons who relax by fighting computer-generated monsters or leading virtual reality assault teams may soon find themselves playing doctor instead with new surgical training software.

VR Medical's software combines text, interactive 3D anatomical models, video demonstrations and a surgical simulator for practising procedures.

The first programmed procedure is a laparoscopic appendectomy: the removal of an appendix. The software can be used on a PC and uses a combination of gaming technology and movie animation.

When in simulator mode, two computer mice are used to select instruments and to click on the appropriate area for the next stage of the operation.

The control of instruments uses gaming technology, but once the trainee clicks in the appropriate area, the graphics are replaced by movie animation that plays the next few frames of the operation.

Players can be scored based on their selection of instruments, application to anatomy and the time taken to make decisions.

The software is the brainchild of VR Medical's executive chairman and medical director Dr George Oosthuizen, who became frustrated with the complexity of studying surgery in South Africa in 2001. One exam required Oosthuizen to study 67 different operations.

"I couldn't find a book that had all the information on each procedure that I wanted," he said. "So that's when I thought there's got to be a way that we can put all this data into a computer and stick it all into a single interface."

The company was formed in 2003 and an introduction to Craig Meek (co-founder of Virtual Spectator, the developer of real-time 3D graphics used in America's Cup coverage) led Oosthuizen to The Icehouse business incubator in Auckland.

That resulted in a meeting with Keith Pine, now VR Medical's chief executive, who had recently sold the Geddes Dental practice.

"Once we got into The Icehouse things just really took off", Oosthuizen said.

In February last year the shareholders, who now included Meek and Pine, put up $50,000, which was matched with a $50,000 grant from The Foundation for Research, Science and Technology.

The shareholders have since put in another $150,000 with a further $80,000 from the foundation. VR Medical has also received A$50,000 ($55,000) from the Royal Australasian College of Surgeons to test the software at hospitals in Melbourne, Sydney, Brisbane and Auckland.

Pine described the tool as a flight simulator for surgeons aimed at first and second-year doctors, and nurses in hospitals.

More procedures being developed: the company wants 20 to be ready for the launch of a commercial website by April.

Ian Stewart, training committee chairman for the New Zealand Association of General Surgeons, said the ability to study anatomy in 3D would help students.

"It [software] is not something that's part of our training programme ... but it's certainly something that we would see as a positive step in surgical training," he said.

The competition faced by VR Medical includes the publishers of text books and training videos, and the manufacturers of large hardware surgical simulators, which Pine says cost about $130,000 each.

VR Medical plans to sell its software for each procedure for about $100 a year, and to build a library of more than 100 procedures.

Building the software has not all been plain sailing. An attempt to build a version based solely on gaming graphics was shelved because of difficulty in creating realistic images.

However, greater use of gaming graphics in future versions could increase the software's functionality, Pine said. Users would be able to fully control incisions and feel varying levels of resistance via a games controller as they cut through tissue.

"The next step along the track is total immersion using gloves", Pine said, but added that it was more important now to get to market with a working product.

Pine has recently returned visits to hospitals in London and the United States.

He said people were astonished at the image quality and the prospects of surgical training in a virtual world. "It seems a hell of a lot safer to us if it is done in virtual space so if you make a mistake you can be forgiven."

VR MEDICAL
* Who: George Oosthuizen, executive chairman.
* Where: Icehouse business incubator, Auckland.
* What: Software for training surgeons.
* Why: "I know what it's like when you have to do practical procedures on people and you don't have the confidence to do it because you are too junior."