Fundamental Surgery goes mobile and multiplayer 1

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The new @HomeVR and Multiuser features transformed the Fundamental Surgery platform into a mobile and collaborative immersive training solution 

Quick read

➨ Trainee surgeons on the residency programmes at New York University Langone and St George’s Hospital London are trialling them right now
➨ Other potential use cases for Fundamental Surgery are also being explored. It could be used to host pre-operative planning meetings, patient consultations, and even as a vehicle to share cutting-edge techniques across borders
➨ The next step for immersive technology companies such as FundamentalVR will be making training and learning in VR the norm rather than exception across healthcare

The story

Surgery is a highly technical profession fraught with risk that colleges and universities around the world charge considerable amounts of money to teach. A surgeon in training must undertake hours of study and practise to ensure they meet the highest possible standards. Even when they’re fully qualified and practising, a career of continuous professional development awaits, so that those standards are maintained.

When Covid-19 hit earlier this year, trainee surgeons working to make those aspirations a reality were prevented from that study and training. With educational institutions closed and hospitals out of bounds, they had to stay at home just like the rest of us, but without access to the tools and facilities they needed to continue the path toward their chosen careers.

UK- and US-based FundamentalVR, a medical immersive technology company that provides a training and simulation platform for educational institutions, hospitals, medical device manufacturers, and other healthcare-focused organisations, saw an opportunity to overcome this considerable problem.

A photo of Richard Vincent, CEO and founder of FundamentalVR
Richard Vincent, CEO and founder of FundamentalVR

FundamentalVR had been working on several new features for its Royal College of Surgeons of England- and American Academy of Orthopaedic Surgeons-accredited Fundamental Surgery platform when the pandemic struck. The company decided to speed up their release because “we saw a need for collaborative learning outside of the classroom”, says chief executive officer and founder Richard Vincent.

Those new features were @HomeVR and Multiuser, which, when released, transformed the Fundamental Surgery platform into a mobile and collaborative immersive training solution. Already a compelling proposition to a FundamentalVR client base hungry for a greater use of immersive technology in their organisations, the outbreak of Covid-19 increased their interest dramatically.

Covid-19 forced educational institutions, hospitals and medical device manufacturers to quickly reconsider how they conducted training, learning, and sales and marketing in order to “close that physical gap” required to operate safely during and after a pandemic, according to Vincent.

Of course, Fundamental Surgery was already an immersive training solution for the healthcare sector, with HapticVR being its primary modality. This delivered immersive simulations for full rehearsal of medical and surgical procedures through a PC/laptop, VR headset and haptic arms, combined with comprehensive feedback and analytics for both trainee and instructor/administrator.

@HomeVR builds on this platform to provide a flexible and cost-effective learning solution. Through an Oculus Quest headset, @HomeVR complements the ‘kinesthetics’ (force feedback and position) haptic technology of HapticsVR with a ‘cutaneous’ (tactile vibration) version of its own.

As a single platform, each modality is optimised for different stages of the learning process. HapticVR is the primary system on which a trainee can practise the most intricate and precise procedures, Vincent explains, while @Home provides a fully immersive procedural walkthrough based on instructor-led collaborative learning.

A trainee learning on HapticsVR, which uses ‘kinesthetics’ (force feedback and position) haptic technology
HapticsVR uses ‘kinesthetics’ (force feedback and position) haptic technology

Without access to the full system, trainee surgeons, as those on the residency programmes at New York University Langone and St George’s Hospital London are doing right now, can use @HomeVR to get up to speed ahead of their return to their respective organisations when the time comes.

@HomeVR only requires the shipping of a VR headset to the trainee’s location. A single user login ensures a ubiquitous experience with the same high-fidelity graphics, education content, and data tracking capabilities across each modality.

The simulation itself is deeply immersive. An anterior hip replacement demo organised for VRWorldTech showed an accurate recreation of an operating theatre containing the patient, various equipment, and even a ventilator.

Two images of different stages of a hip replacement procedure in @HomeVR, a feature of the Fundamental Surgery training platform
@HomeVR focuses on the visual and audio cues that trainee surgeons are taught to recognise

The instructor, a member of the FundamentalVR team, produced a cautery pen to demonstrate a particular stage of the surgery and all of the typical sounds and sights were present, providing a clear overview of the procedural steps and, crucially, cues trainee surgeons would need to learn.

Vincent says: “Haptics come at different levels of realism. With Oculus Quest, we have cutaneous haptics, so when a trainee is carrying out a procedure, they can feel a vibration, but it’s not realistic enough for them to learn the required muscle memory. To do that, you need a more sophisticated system, such as HapticsVR.”

As Oculus Quest can only simulate a slight sense of touch through the controllers, @HomeVR focuses on the visual and audio cues that trainee surgeons are taught to recognise. For example, a reamer, a cutting tool used in orthopaedic surgery, can be heard slowing down when the cut being made is close to completion, indicating to the trainee that they need to stop before any damage is inflicted on the patient.

@HomeVR also boasts whiteboards for generating discussions, a range of easily accessible surgical tools and equipment and the ability to import diagnostic results such as X-rays to deepen the immersive experience.

What makes @HomevR even more compelling is Multiuser, which allows an unlimited number of users to join the same simulation through a number of devices, not just a VR headset.

This capability takes the Fundamental Surgery platform to the next level, because teaching and training can be delivered to as many users as an organisation wishes, with no limits on location. There is even interest from medical device manufacturers and drug companies, whose reps would traditionally visit a hospital to make a sale. Now, they can meet their prospective clients in VR or otherwise and demonstrate using high faithful recreations of products. 

Vincent says that an upcoming update to the Fundamental Surgery platform will allow instructors to render users invisible, so that, potentially, a thousand users could be present in a single operating theatre and they wouldn’t get in each other’s way. He continues: “We can’t even do that in the real world. No single operating theatre has that scale.”

Other potential use cases for a mobile, immersive platform such as Fundamental Surgery are also being explored. It could be used to host pre-operative planning meetings, patient consultations, and even as a vehicle to share cutting-edge techniques across borders.

Behind the Fundamental Surgery platform is also a comprehensive data dashboard that stores and breaks down the results of each user across every modality. FundamentalVR can show individual, organisation and country results, and is working with customers on visualisation tools that can benefit both trainee and instructor. As Fundamental Surgery is accredited in a number of jurisdictions, results are easily exported and follow regulatory mandated metrics.

In terms of the potential for data and what could be learning from training in VR, Vincent says that FundamentalVR is at the beginning of that journey, focusing on the mapping of known milestones and meeting accreditation requirements, during both a surgeon’s formative years and later on in their career.

FundamentalVR is also doing a number of validation studies and seeing increasingly positive results from training in VR. The immersive technology is well on its way to being validated as a suitable alternative to traditional training. As Vincent says: “We’re not the only ones to see these results.”

The project is now well on its way to becoming mainstream within healthcare. Professional institutions responsible for regulating medical professions have gone from indifferent as to its potential to seriously engaged, as have regulators such as the US Food and Drug Administration, particularly since the outbreak of Covid-19.

The next step for immersive technology companies such as FundamentalVR will be making training and learning in VR the norm rather than exception across healthcare.

FundamentalVR started out in hard skills in orthopaedics and is working on providing simulations in the future for ophthalmology and general surgery, where it’s working with Mayo Clinic, which is also an investor, as a development partner and customer. This work suggests that the limit on how far VR can go in this area has yet to be reached.

Main image: An unlimited number of users can participate in a session on Fundamental Surgery

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