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Virtual Reality (VR) Simulation in Surgery Training

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12 min read

Insufficient opportunities to gain hands-on operating experience and limited access to operating room space and training equipment are among the top issues threatening the effectiveness of traditional surgical training.

A report by the Royal College of Surgeons of England found that 56% of surgical trainees have faced major challenges when it came to getting access to operating rooms. Some 52% of respondents also expressed concerns about a lack of sufficient time for training.

Thanks to its immersive nature, Virtual Reality can help overcome these challenges. The technology offers trainees realistic practice opportunities that more closely recreate real operating room situations compared to traditional training techniques. 

Let’s explore in more detail the ways in which VR technology is improving surgical training. 

Table of contents:

How Virtual Reality is Changing the Healthcare Sector

Benefits of Using VR in Surgical Training

Potential Risks of Using Virtual Reality in Surgical Training

Types of Surgical VR Training Methods and Simulators

VR’s Technology Stack and Devices

How to Сreate a Surgical Training VR App

Success Stories of VR in Surgery Training

Key Takeaways

How Virtual Reality is Changing the Healthcare Sector

Virtual Reality is a powerful tool that offers innovative solutions for medical training, patient care, and therapeutic interventions. As this technology continues to advance, it’s transforming many aspects of the healthcare sector, including:

  • Medical education. By interacting with realistic 3D models of the human body from various angles, trainees can learn anatomy, practice surgeries, and explore how diseases progress. VR-based training modules enable repetitive practice, provide automated assessments, and allow learners to experience rare or high-stakes scenarios. For example, by interacting with 3D anatomical models using a VR app instead of exploring static pictures and physical models, students achieved a 63% knowledge retention rate. 
  • Surgical planning. Experienced surgeons can use VR to plan and practice  upcoming procedures by visualizing a patient’s anatomy and medical condition details in 3D. This helps specialists identify potential challenges and ways to overcome them before the actual procedure. 
  • Patient care. VR can offer a non-pharmacological approach to manage pain, mental disorders, and anxiety related to chronic conditions. Additionally, VR helps ensure that patients receive adequate care. For example, VR traing on caring for people with dementia enables users to gain skills related to delivering proper support for people suffering from this disease.
  • Diagnostics and medical visualization. VR offers an intuitive way to visualize intricate medical data in 3D, such as MRI or CT scans. Using this approach, users can practice interpreting medical images, enhancing their understanding of how diseases can appear in the human body. One example is our educational tool Bodyscope, which allows for accurate scan visualization and collaborative learning. 

The market for this emerging application of VR within healthcare for surgical training is projected to expand at a CAGR of over 30% from 2021 to 2026

So, let’s explore how VR simulation is enhancing training for surgeons and the benefits it offers.

Frame 29 min - Virtual Reality (VR) Simulation in Surgery Training

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Benefits of Using VR in Surgical Training

By fully immersing students in realistic simulations, VR offers numerous educational advantages for surgical training:

  • improved hands-on surgical practice;
  • faster muscle memory and shorter learning time;
  • 24/7 access to rare and complex cases; and
  • a safe environment

Improved hands-on surgical practice

VR simulation provides a highly realistic surgical representation, replicating the operating room and providing the ability to practice sequential procedures from start to finish. 

Surgical trainees can be immersed in a controlled 3D environment featuring precise anatomical models and haptic feedback that closely match real experience. In this virtual environment, students can assess the medical condition of virtual patients, examine diagnostic images, plan operations, and then perform the complete cycle of various procedures.

An evaluation of the efficacy of VR solutions determined that this training approach helps learners reduce errors during actual surgery performance by 50%.

VR operating room - Virtual Reality (VR) Simulation in Surgery Training
VR operating room

Faster muscle memory and shorter learning time

VR allows for repetition that helps engrain techniques into a surgeon’s “muscle memory,” reducing the time required for surgery. By conducting virtual surgeries as many times as needed, surgical trainees reinforce the neural pathways associated with precise hand movements, instrument handling, and overall procedural proficiency. 

A later study conducted by Imperial College London found that 83% of surgeons who practiced using a VR training program were able to competently perform the actual surgery with only minimal assistance. In contrast, surgeons who didn’t receive the Virtual Reality training primarily required guidance when carrying out the real procedure. 

Moreover, VR simulations combine motor and visual brain pathways, ensuring alignment between visual perception and hand movements. This is crucial for navigating complex anatomical structures and performing delicate maneuvers, improving patient safety. 

24/7 access to rare and complex cases

VR simulations can recreate rare and complex surgical cases that trainees may have limited exposure to during traditional training, which mostly focuses on common kinds of medical cases. This wide range of scenarios helps better prepare surgeons for challenging situations they may encounter in their careers. 

Additionally, VR platforms allow for collaborative training, where multiple trainees and experts can interact within the same virtual surgical environment. Thus, trainees can  learn from experienced surgeons’ techniques and receive guidance while performing procedures themselves, which facilitates knowledge sharing. 

Safe environment

In a virtual setting, learners practice surgical procedures without any risks to real patients. which gives them the confidence they especially need in the early training stages. Learners are free to make mistakes and receive immediate feedback for improving their actions. 

The risk-free nature of VR simulation empowers trainees to experiment, solve problems, and develop critical skills until they have sufficient mastery to apply their knowledge in real life. This is invaluable for building surgeons’ confidence and competency before working with live patients.

With all the capabilities described above, VR enables trainees to refine their techniques until they become second nature. Despite its obvious potential, this approach is not without some risks.

Potential Risks of Using Virtual Reality in Surgical Training

While VR simulations strive to replicate real-life surgical scenarios, there are still many factors to consider to ensure accuracy. If not developed properly, VR surgical training may carry certain risks:

Simulation accuracy. Variations in haptic feedback, tissue properties, and anatomical variations may exist, potentially leading to a discrepancy between VR experiences and actual surgical procedures. 

To ensure trainees develop correct and adaptable skills that can be applied in diverse surgical settings, immersive scenarios must be constantly refined by the experts. Continuous integration of surgeon feedback into simulation development will help bridge the gap between virtual representations and surgical reality.

For example, when developing our internal educational tool Bodyscope, our team invited an experienced radiologist to ensure that 3D scan visualization correctly replicates the conditions on actual MRI/CT scans. 

Individual discomfort. Extended sessions in VR environments can lead to user discomfort. Therefore, it’s important for trainees to take regular breaks and adjust VR settings to 10- to 20-minute lessons to minimize potential side effects, such as motion sickness, headaches, etc. Selecting more modern VR equipment can also decrease discomfort, as manufacturers now use advanced techniques to improve headset usability and eliminate side effects. 

Technical challenges. Factors such as screen resolution and field of view limitations can restrict realistic viewing of the virtual operating field. In particular, constraints in motion-tracking fidelity can hamper accurate 1:1 reproduction of hand and tool positions, movements, and scales needed for microsurgery. To ensure seamless training experiences, you need regular maintenance, updates, and technical support.

Having explored the potential risks, let’s now delve into the various types of surgical VR training methods.

Types of Surgical VR Training Methods and Simulators

Each type of VR training simulator offers unique features designed for different training objectives and skill levels. The selection of the appropriate simulator depends on the specific training needs and desired level of immersion. Here are three main examples of VR surgical training simulators available on the market.

Procedure-focus simulators

These types of simulators allow trainees to hone their skills for particular surgeries. Through an immersive virtual environment, trainees can drill down on the individual components of an operation, such as practicing laparoscopic maneuvers, orthopedic techniques, or neurosurgical skill sets. 

By iteratively rehearsing each micro-step under simulated conditions, trainees can boost their technical proficiency and memorize proper sequencing before handling live cases. 

PrecisionOS is an advanced virtual reality surgical training platform developed specifically for orthopedic procedures. Surgical trainees can feel the resistance and interactions as they operate on 3D virtual bone models using virtual surgical tools. A wide range of routine and complex orthopedic procedures are simulated, such as total hip and knee replacements, fracture fixations, and spinal surgeries.

Team-based simulators

Team-based VR simulators target the development of effective multidisciplinary surgical teams. By simulating the collaborative environment of the operating room, they provide an opportunity for trainees assuming different medical roles to practice coordination, communication, and other interpersonal skills required among surgeons, nurses, anesthesiologists, and other staff. 

Within realistic virtual simulations of surgical cases and emergent situations, professionals can practice team-based decision making, task allocation, and management of intraoperative challenges in a low-risk setting. 

An example could be an Immersive-touch VR platform. It allows multiple trainees to jointly explore patients’ medical details to plan further procedures, fostering collaborative work. 

Patient-tailored simulators

Patient-specific VR simulators leverage medical imaging technologies such as CT and MRI images to digitally reconstruct personalized anatomical models. By importing scan data of individual patients, these simulators enable surgeons to carefully examine virtual representations of each person’s unique condition prior to performing a procedure. 

Students and real surgeons can simulate preoperative planning, develop surgical strategies, study surgical access routes, and repeatedly practice anticipated workflows. 

For example, using HoloSurg, surgeons can view CT/MRI scans and other medical documents during pre-operative planning and actual medical procedures. 

Patient tailored simulators - Virtual Reality (VR) Simulation in Surgery Training
HoloSurg by Microsoft Hololenz

To ensure effective surgical training of such complexity, it is essential to employ efficient solutions capable of handling numerous intricate details. This requires utilizing a robust and sophisticated technology stack. Here is an overview of the typical components commonly used in such scenarios.

VR’s Technology Stack and Devices

VR combines specialized hardware, displays, interaction methods and software to fully immerse users. Here are the key components of VR’s technology stack and common devices used.

Languages

JavaScript, Node.js, PHP, Java, Go, Python, Vue js, Angular, React, C++, C#, HTML, .NET 

Cloud technologies

Google Cloud, Microsoft Azure, Amazon Web Services

Hardware

HTC Vive, Oculus Rift, Samsung Gear VR, Google Cardboard/Daydream, treadmills, haptic gloves

Development frameworks / SDK

Unreal Engine, Unity, Oculus SDK, SteamVR SDK,WebVR, React VR, iOS/Android SDK, Google VR

After examining the core components of the VR technology stack and the common devices used, we can now turn our focus to the process of developing a VR surgical app.

How to Сreate a Surgical Training VR App

To create a surgical training VR app, these are six basic steps.

Step 1. Detailed analysis

The first step is to analyze existing training materials and then gather requirements for the future training program. You’ll need to specify surgical procedures to be simulated, the essential skills and tasks involved in each procedure, and the learning objectives for trainees at different competency levels.

Step 2. Creating a training scenario 

The second major step is to develop specific training scenarios within the VR environment. This involves creating a relevant medical history, imaging findings and pre-operative considerations as well as various complications that may arise. 

Educational designers usually use storyboards to outline the key steps the training should include to align with the learning objectives. To enhance the immersive experience, educational specialists plan 3D models and environments to be incorporated, providing trainees with a lifelike representation of the surgical setting. 

At HQSoftware, we have a dedicated educational designer who can create VR training scenarios from scratch or enhance the existing ones. By working closely with medical professionals, we design accurate and realistic VR medical training solutions, catering to different skill levels. This way, trainees will be able to gradually advance their proficiency and tackle increasingly complex procedures. 

Step 3. Design and architecture

Through the third phase, developers define the technical architecture, including the VR platform, interaction models, database, and authentication, outlining the app’s structure and data flow. Afterward, designers create wireframes and prototypes for the first review. This includes creating an environment, 3D models, interactions, and navigation. 

 Step 4. VR app development

Development begins with setting up the VR environment with 3D medical assets and dynamic interactions. The development team utilizes specialized tools, such as Real Engine or Unity, to build the virtual environment and surgical simulations, and then integrate necessary functionalities. For example, hand tracking and haptic feedback.

Considering the complexity of creating a VR surgical training app, it’s worth seeking the assistance  of an experienced software development company. With our key specialization in AR/VR development services, HQSoftware’s developers offer full-cycle VR development, including analysis, design, development, integration, and testing. 

Step 5. Third-party software integration

To enhance  surgical training functionality, you may need to integrate medical imaging data, patient records, or other relevant medical software. If you need to keep records of users’ performance and analyze their progress in real-time, integration with Learning Management System (LMS) can be your go-to option.  

 Step 6. Testing

Testing involves identifying and fixing any bugs or issues, as well as conducting user acceptance testing to gather feedback and make necessary improvements. Testing is a critical step to guarantee the VR application performs as intended and provides the desired user experience before full deployment. 

Our head of Quality Assurance utilizes several testing methods, combining both manual and automated techniques. By finding the optimal blend of approaches and calculating the ROI of automated testing to define its feasibility, the head of QA allocates your resources wisely, ensuring thorough testing.

​​By following the step-by-step approach outlined above, our development teams can effectively plan and build customized VR solutions for surgical training. 

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book template 1 - Virtual Reality (VR) Simulation in Surgery Training

Success Stories of VR in Surgery Training

Now let’s explore some uses of VR in surgery training that have proved successful, including VR systems used in medical schools, hospitals, and surgical simulations. 

VR training system for orthopedic surgery

The Johnson & Johnson institute has launched a Virtual Reality training program for practicing the anterior approach in hip surgery

The program aims to educate future surgeons, orthopedists, and scrub nurses on common procedures, such as total joint replacements of the hip and knee or femoral neck fracture fixations using screws. By practicing the basic manipulations within a virtual environment, trainees can efficiently develop procedural automatisms and muscle memory. 

VR training system for orthopedic surgery - Virtual Reality (VR) Simulation in Surgery Training
VR training system for orthopedic surgery

VR platform for cardiovascular applications

The University College London Hospital and Great Ormond Street Hospital has integrated a VR platform, called VheaRts, that employs data from patients’ CT and MRI scans to create highly detailed 3D models of the human heart. With VheaRts, doctors and medical trainees can manipulate, slice, highlight, and measure the internal anatomy of the heart. 

VR platform for cardiovascular applications - Virtual Reality (VR) Simulation in Surgery Training
Students practicing on a patient’s heart model

This immersive experience allows for in-depth examination and analysis of cardiac structures, aiding in medical education, surgical planning, and diagnostic procedures. The report says that 93% of users are satisfied with the result of using VheaRts and over 89% would like to implement the app at their own institutions.

Total hip replacement training simulation

The VR surgical simulator, Fundamental Surgery, has become the first of its kind to receive accreditation from the Royal College of Surgeons of England. The platform combines Virtual Reality with haptic feedback technology, so users can experience the sensation of performing surgical procedures, including making incisions, suturing, and manipulating tissue.

The platform allows surgeons to experience and navigate the same visuals, sounds, and feelings they would during a real surgical procedure and is compatible with any laptop, VR headset, or haptic device. The system has already been deployed by several National Health Service organizations, including St George’s Hospital in London and University College London Hospital, as well as the Mayo Clinic and UCLA in the US and Sana in Germany. 

Key Takeaways

VR simulation for surgery training is an effective educational tool for individual learning, small group learning, and large group learning. It allows trainees to develop critical skills through immersive practice in a controlled environment without risks to patients. 

Major institutions, such as Royal College of Surgeons and Imperial College London, have already reported impressive results from VR integration into existing training programs.

We at HQSoftware continue to enhance learning and drive better standards in surgical education by developing VR solutions that offer a highly promising method for preparing the next generation of doctors. 

Contact us today to set up a consultation where we can discuss how you can enhance surgery training with Virtual Reality.

Educational Design Lead

A professional with over 20 years of experience in sales, marketing, and management across diverse industries, including education and consulting services. Adept at developing new educational products and services.

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