AAMC surgical residents watch Dr. Adrian Park perform a hiatal hernia surgery via Oculus headsets. (The Daily Record/Johanna Alonso)
ANNAPOLIS — In front of you, a surgeon, clad in stereotypical blue scrubs, performs surgery on a patient suffering from a hiatal hernia, which is when the upper part of the stomach pushes through the diaphragm into the chest cavity.
A live video of the procedure, seen through a small camera known as a laparoscope, is displayed on a screen slightly to your right. Turn your head left or right to watch the anesthesiologist and the nurse at work. Keep looking around to see the mundane details of the operating room — the desk, the doorway, the ceiling and floor.
This scene, surprisingly, doesn’t take place inside of the operating room where the surgery is being performed. Instead, it takes place in a room on the opposite side of the hospital, where the Luminis Health Anne Arundel Medical Center Surgery Residents are watching an operation via a brand-new virtual reality system — one that offers them a 360-degree, real-time view of the surgery, with the view of the laparoscope superimposed in front of the video, without actually having to be in the operating room.
At the same time, the residents, gathered together in a small hospital conference room, can talk among themselves and even relay questions to the surgeon.
“This is, like, one of my favorite surgeries,” one of the residents says as he watches the surgeon carefully pull the patient’s stomach back into her abdomen.
It’s only the second time AAMC, which is part of the Luminis Health system, has offered this VR experience to its surgical residents. Like many institutions across the world, the hospital has previously shown its residents surgeries via a more traditional, two-dimensional broadcast, in order to help them see the surgeon work through problems in real time.
Even as the residents watch through the lens of Oculus headsets, a regular video of the procedure is also projected on a screen at the front of the room.
But the 360 view has unique advantages, AAMC leaders say — the experience is more immersive for the learners, who are less distracted by outside stimuli like their cellphones when wearing the VR headset. It also allows them to focus on whatever part of the surgery most interests them and take in the full “choreography” of the operating room, as second-year resident Trevor Dorey put it.
Innovative training methods
Alejandro Gandsas, a surgeon at AAMC as well as the surgery residency program director, has long been interested in finding the best ways to train doctors. He was a very early proponent of broadcasting surgeries via the Internet; as a third-year surgical resident in 1996, he used the internet to broadcast a surgery from his Michigan hospital to two institutions, one in California and one in his native Argentina.
“At that time, the window was probably one-third of your current cellphone. The frame rate was one or two frames per second,” he recalled.
As soon as he learned about the Oculus, a VR technology brand now owned by Facebook’s parent company, Meta, he began brainstorming ways to use the sleek headsets to improve AAMC’s surgical training. He worked for months to connect a series of existing technologies — 360-degree cameras, VR headsets, streaming video technology and a high-powered gaming computer — to create the system AAMC now uses.
The process hasn’t been without its hiccups. The resolution on the headsets isn’t as high as Gandsas wishes it was. The headsets can grow uncomfortable for residents wearing them for hours at a time. And, as with most live video, there is often a lag (though, during the surgery, one resident notes that the lag is “way better” than the previous VR-streamed surgery: “his audio-to-video lag is nonexistent!”).
Becca Allen, another surgical resident, said she had been unsure about the new technology at first but has found it a useful tool for getting a closer look at complex surgeries.
“Having more time to learn and become familiar with the anatomy is so key,” she said.
Allen has had her own struggles with the headset — she wears glasses and had to finagle with a glasses extender to get everything to fit together — but, overall, likes the immersion of using VR technology to watch surgeries.
Dorey feels that having the full view of the operating room allows the residents, many of whom will not actually be present for a surgery until further into their residency, to learn the rhythms and patterns of these procedures.
“One of the things that you don’t see if you were to watch a surgery on a standard 2D video … is you kind of miss the dance or choreography that’s involved in getting a patient appropriately set up, and the way that the other parts of the operating team work around you while you’re doing the case,” he said. “Having this immersive experience means that when we walk into the operating room in real life, so to speak, in fourth or fifth year, we can almost feel like we’ve already been in there.”
The future of VR
VR has long been pitched as a training tool for doctors and surgeons, with COVID-19 only accelerating interest in this and other so-called telesurgery tools.
Adrian Park, the chair of AAMC’s Department of Surgery and the surgeon who completed the VR-displayed procedure on Tuesday, said that Zoom fatigue has made immersive learning options more appealing than ever to medical learners.
“They’re in their late 20s, early 30s so they’re far more techno-comfortable and geekish than my generation. And so, they love it. They love the facility of it, they love the ease of use,” said Park, who noted that, on the surgeon’s end, there is no significant difference between the three-dimensional and two-dimensional broadcasts.
In addition to using VR to watch surgeries, there is also interest in using it to simulate surgeries, in an effort to give residents more opportunities to practice procedures. Some VR surgical simulation tools are available, but they have not achieved widespread adoption.
Gandsas hopes that AAMC will eventually be able to use virtual reality equipment for real-time collaboration. Dorey and Allen are also planning to archive recordings of each VR procedure, so that future cohorts of residents have access to a whole library of 360-degree surgery videos.