Social surgery in the virtual world - a new era in surgical rehearsal and planning

Garrett Locketz


Today, surgical simulation exists as a valuable tool for surgical training and task rehearsal by reducing the need for cadaver specimens, allowing trainees to receive structured performance assessment, and facilitating repetitive deliberate practice. Nevertheless, simulation platforms are inherently limited by the number of programmed and designed cases/scenarios available for practice, and the anatomy within the virtual environment will invariably differ from that which is subsequently encountered in the operating room. To address these limitations, we have developed CardinalSim – a validated patient-specific virtual surgical rehearsal platform capable of rendering a patient’s preoperative imaging data into a 3-dimensional virtual model upon which a procedure can be rehearsed prior to the actual operation. In its current form, CardinalSim allows a surgeon to explore a particular patient’s anatomy quickly and efficiently in a surgically meaningful manner using a haptic interface, providing valuable insights into the anatomic and physical complexities expected at the time of actual surgery. Nevertheless, as the field of patient-specific surgical simulation is still in its infancy, this technology is only available to experts in academic centers, and thus the full range of its benefits to both patients and surgeons has yet to be realized. Our team, however, is poised to change this.

We are currently developing a dynamic database for managing the storage and discrimination of surgical simulations and related patient data, allowing surgeons across the world to optimally create, access, and share data for surgical rehearsal - eliminating geographic and temporal barriers between peers, mentors, and students.  We are also creating a platform and methodology for collaborative surgical rehearsal and planning, whereby a surgeon will have the ability to attempt and record a virtual surgery and invite another surgeon to examine the dissection, comment on the plan, learn from its strengths, and suggest alternatives to its weaknesses. To further the potential for collaborative rehearsal, we are establishing methods to convert saved rehearsals to formats that can be interactively viewed on smart phones, tablets, head-mounded displays, considerably broadening the size of our potential community of consultative surgeons. 

Effectively, the establishment of this platform will create a “social network” of surgeons, providing physicians and surgeons around the world the ability to learn from the feedback and examples of experts, collaborate with peers, share decision-making with surgeons across multiple locations and disciplines, and rehearse a larger variety and volume of cases than they might encounter organically. By providing surgeons with a network for gaining experience they might not otherwise obtain, we believe our current work has the potential to overcome geographic and economic barriers currently preventing many patients around the globe from accessing the surgical expertise they deserve, and may ultimately revolutionize the methods for which all surgeries are prepared.

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