Virtual Reality Becomes Reality For Plastic Surgeons

"Virtual reality has been available previously, but this study shows that with miniaturization, it can also be used to teach microsurgical skills such as suturing tiny nerves, arteries and veins," said William P. Graham, III, MD, chair, Section of Plastic and Reconstructive Surgery, Pennsylvania State University, Hershey, Pa. "This very sophisticated device provides an extraordinary learning experience."

The study described the development and validation of a virtual reality trainer for the simulation of microsurgical vascular anastomosis (the surgical joining of two blood vessels which allows flow from one to the other). The instrumentation included three components: a graphics computer to provide three dimensional graphics, microsurgical instruments attached to haptic devices to provide tactile feedback to the surgeon's hands, and a personal computer to control the haptic devices.

The haptic device measures how the microsurgical instrument moves and conveys that information to the computer which causes the tool to push back so the surgeon feels the same kind of resistance that would occur in a real life procedure. The computer creates this feeling of resistance by calculating the force with which the instrument is handled; then it causes the object in the visual image to move as a real object would when touched. By viewing the area through three dimensional glasses, the surgeon sees and feels the results of each movement he or she makes.

In addition to miniaturization of the instrumentation, other advances in virtual reality make this training tool unique. The graphic image viewed by the surgeon is updated at 30 cycles per second to ensure realism. Hand movements are continually tracked and positioning arms of the force feedback frames are updated 1,000 times per second. This provides visible results instantaneously in a computer graphic that looks almost real. This study was conducted by Paul J. Gorman, MD, Plastic Surgery Research Fellow.

Virtual reality training in microsurgery provides a number of benefits for plastic surgeons. It allows surgeons to train in a safe, predictable and reproducible setting. In addition, aspects of the surgeon's performance can be measured, such as accuracy, tissue damage and surface damage. Results of virtual reality surgery can be recorded allowing surgeons to review their work and enhance their skills. It also provides an effective way for experienced surgeons to learn and practice new techniques or procedures.

"Our ideal perception would be to use virtual reality training almost as a complete substitution for basic training in microsurgery," said Dr. Graham. "It would be valuable for both vascular surgery and neurosurgery."

Eventually, as other modules are developed, all disciplines of plastic surgery will be encompassed. Because of its capability for measuring, virtual reality may also be used in the future as a tool for granting credentials and hospital privileges to surgeons.

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The American Society of Plastic and Reconstructive Surgeons represents 97 percent of all physicians certified by the American Board of Plastic Surgery (ABPS). By choosing an ASPRS member plastic surgeon who is certified by the ABPS, patients can be assured that the physician has graduated from an accredited medical school and completed at least five years of additional residency, usually three years in general surgery and two years of plastic surgery. To be certified by the ABPS, a physician must also practice plastic surgery for two years and pass comprehensive written and oral examinations. Consumers may call Plastic Surgery Information Service at 1-800- 635-0635 or access the ASPRS website at www.plasticsurgery.org for names of qualified plastic surgeons in their areas and informational brochures.