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Medecine - Virtual reality

Jean-Michel Prima - 4/08/2015

Training Surgical Teams in a Virtual Operating Room

Salle d'opération virtuelle vue par un occulus Salle d'opération virtuelle vue par un occulus

Surgical education could greatly benefit from VR-based training systems. Yet, devising such simulators calls for innovative methods meant to model not just the surgical processes but also the medical knowledge and the doctor's multifaceted expertise. Overcoming these methodological deadlocks is the purpose of S3PM, a new research project carried out in Rennes, Brittany, France, by three scientific teams in conjunction with the University Hospital.

Surgeons should be given the opportunity to train on surgical simulators just like airline pilots learn the ropes on flight simulators, ” says Pierre Jannin, head of MediCIS, a scientific team of LTSI institute affiliated to Inserm, the French National Institute of Health and Scientific Research. But building a virtual operating room for training purposes is no easy undertaking. Many problems emerge. Many questions remain. “What defines a good surgeon to begin with? ” Golden fingers, one would thought. “Well, dexterity only accounts for 25% of the expertise according to international literature. The remaining 75% comprise medical knowledge and mastery of surgical procedures as well as non-technical aspects such as cognitive and interpersonal skills. ” All of this ought to be encapsulated into the system one way or another, which will require a long-haul effort of conceptual modeling.
Against this backdrop, S3PM is a research project meant to be a first step in such direction. “It focusses specifically on surgical processes. The goal is to devise a training environment that will enable scrub nurses to learn and rehearse procedures. ” In other words: the scenario. “What should I do first? What am I supposed to do next? So on and so forth. ” For such a simulator to be of practical value, it has to be deeply rooted into real world. “We collect recordings of real cases. We describe every single step of the procedure that was applied during the surgery. And we gather a representative set of such procedures. ” But how do you put surgery into words? “That's clearly one of our challenges. We need cogent description methods. My colleague Bernard Gibaud is developing an ontology that we will make available to the community. Our ambition is that it will become a standard.

A Graph of Possible Pathways

After building the ontology, yet another scientific hurdle immediately arises: “fitting this corpus of procedures into a graph of possible pathways. During surgery, things do not always unfold the same way. Depending on different parameters, the surgeon will chose to do this or to do that. Anyhow, this level of variability has to be factored in. ” That's where Benoît Caillaud comes into play. Head of Hycomes research team, “Benoît has a vast expertise of Petri nets that he successfully applied in various industrial fields. His method presents a huge advantage: it takes into account not only pathways that were once observed but also unobserved pathways that are not contradicted by logic and observations. And that could prove very interesting when training in a simulator. Of course, experts will have to confirm that these new pathways make sense from a medical point of view. This is yet another challenge in and of itself.
Next step down the line comes simulation. “We got in touch with Bruno Arnaldi and Valérie Gouranton. ” Both are scientists with Hybrid, the third research team involved in this partnership. “In recent years, they have come up with a top-notch collaborative virtual environment for industrial training. What makes their system so innovative is that it offers a high level of interaction between a real trainee and a virtual co-worker. It will enable real scrub nurses to train with virtual surgeons. ” But this particular collaboration doesn't boil down to merely feeding the system with a medical scenario. “The ontology that we are bringing along is bound to enrich the formalism on which this virtual environment is predicated. Our contribution could enhance their technology and, in the end of the day, benefit industrial training as a whole.
A first demonstrator is expected to be available in a about three years from now. “We work hand in hand with the scrub nurses of Rennes University Hospital's neuro-surgery department. We want our simulator to be of real help to them in their professional training. They are very committed to seeing the project through. Indeed, Jannin remarks, there is tremendous demand for such tools in the medical field. And there will be a market opportunity for manufacturers capable of coming up with cutting-edge solutions.