Dave Toth
Virtual Reality and Laparoscopic Surgery

Virtual reality has become a much talked-about subject in the last few years. However, the average person thinks of it in terms of its entertainment applications, as opposed to its usefulness in many other areas. Virtual reality can also be used in several ways for various kinds of surgery, one of which is laparoscopic surgery. According to Vineet Gupta, Narender Reddy, and Pelin Batur, laparoscopic surgery is also known as MIS, or minimally invasive surgery (Batur, et. al. p. 218). Laparoscopic surgery is done by making small incisions in the patient and inserting one or two foot long tools into the patient through the incisions (Batur, et. al. p. 219). The surgeon then manipulates the tools which have different ends to cut, grasp, and perform other tasks (Batur, et. al. p. 219). The surgeon only sees what is displayed on a 2 dimensional screen or by "the direct video endoscope" (Batur, et. al. p. 219).
Virtual reality is a great help in laparoscopy because of the physical limits imposed upon the surgeon by the situation. The visual aspect of this surgery makes it difficult for the surgeon because he cannot look directly at what he is doing, but must look at a display in front of him instead of directly at the patient, which requires a huge amount of hand-eye coordination (Batur, et. al. 219). Because what the surgeon sees is two dimensional, there are problems with depth perception as well (Batur, et. al. 219). Because the surgeon has his hands on tools outside of the patient rather than inside the patient as in normal surgery, there are additional complications because the surgeon cannot feel resistance from the tissue that he is manipulating (Batur, et. al. 219).
Because of all the difficulties of laparoscopy, there is a need for ways to make it easier. One of these ways is to develop virtual reality systems and trainers that allow surgeons to practice the procedure that they will be doing. In addition to allowing the surgeon to repeatedly perform the procedure, virtual reality would allow some "tactile and force feedback" so that the surgeon gets a better feel for the tools that he will be using (Batur, et. al. 219). The repeated practice of the surgery would help the surgeon because he would get used to using the different muscles that are involved in laparoscopic surgery because of the different tools and positions of the surgeons hands as opposed to conventional surgery (Batur, et. al. 219). Virtual reality would also allow surgeons to teach others how to perform procedures even from remote locations (Noro).
There are currently some virtual reality programs for laparoscopic surgery. One of these is called Mist VR (Virtual Presence Ltd). The simulator consists of two laparoscopic tools linked to a frame and wired to a high powered personal computer (Virtual Presence Ltd). The simulator takes the student through increasingly difficult procedures, allowing him to become familiar with how to manipulate the tools (Virtual Presence Ltd). Another simulator has the user perform the operation by holding a virtual instrument and manipulating it with a DataGlove (Keller, et. al.). This simulator has the procedure that is to be performed broken down into specific tasks and evaluates whether or not they have been performed (Bhoyrul, et. al.). This allows people to figure out what went wrong in a procedure if it was unsuccessful (Bhoyrul, et. al.). The simulator can tell if the problem was the "information processing, cognitive ability, critical decisions, or psychomotor skills" of the person performing the operation (Bhoyrul, et. al.). None of the sources explain whether or not the person using the simulators would be wearing a head-mounted display or goggles, but it is reasonable to assume that they would be looking at a monitor similar to the ones typically used in laparoscopic surgery. What the monitor displayed would be controlled by the simulator.
Virtual reality could also be used to decrease the amount of time spent as a surgical resident (Keller, et.al.). The length of time spent as a resident is 5 years, but it could be cut back to as little as three because residents could practice different procedures before actually having to do them (Keller, et.al.). Thus, they would not have to wait for actual cases to appear (Keller, et.al.). This would also save money so that residents could be trained adequately and not have their training cut back if funding from the government for training is cut (Keller, et.al.).
The assessment of a surgeon or resident's skill is something that is subjective (Keller, et.al.). This problem could be avoided by uses virtual reality simulators to evaluate the skills of the person performing the surgery (Keller, et.al.). This would allow an impartial judgment of whether or not a surgeon should be allowed to begin or continue practicing which could save lives (Keller, et.al.).
In addition to virtual reality's many uses, it could be a very important tool for laparoscopic surgery. It could help to train surgeons quicker, cheaper, and safer than the standard training. It also could lead to advances in laparoscopic surgery, by which many surgical procedures could be made less painful and dehabilitating.
Bibliography

1 Batur, Pelin, Gupta, Vineet, and Reddy, Narender. "Forces in Laparoscopic Surgical Tools". Presence: Teleoperators and Virtual Environments . Vol. 6 Num 2. April 1997: pp. 218-228.

2 Bhoyrul, Sunil, Fletcher, Dexter, Johnston, Rob, Loftin, Bowen, McGovern, Kevin, Rangel, Shawn, Satava, Richard, Way, Lawrence. "Assessing a Virtual Reality Surgical Skills Simulator". [Online] Available http://www.vetl.uh.edu/surgery/mmvr4b.html, September 25, 1997.

3 Keller, James, Lea, Robert, Loftin, Bowen, Ota, David, and Saito, Tim. "Virtual Reality In Surgical Education". [Online] Available http://www.vetl.uh.edu/surgery/vrse.html, September 25, 1997.

4 Noro, Raffaele. "The Virgy Project". [Online] Available http://tcomwww.epfl.ch/~noro/abstract.html, September 25, 1997.

5 Virtual Presence Ltd. "Minimally Invasive Surgery Training by Virtual Reality". [Online] Available http://www.vrweb.com/mistvr.htm, September 25, 1997.