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Video Game Technology in the Operating Room?

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Joint Presentation
by Sonia Ramamoorthy, Jurgen Schultz, & Larry Smarr, UCSD
Fleet Science Center
San Diego, CA
December 13, 2017

Published in: Healthcare
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Video Game Technology in the Operating Room?

  1. 1. Video Game Technology in the Operating Room? Sonia Ramamoorthy, M.D. Department of Surgery University of California, San Diego
  2. 2. “Video Game Technology in the Operating Room?” Joint Presentation by Sonia Ramamoorthy, Jurgen Schultz, & Larry Smarr, UCSD Fleet Science Center San Diego, CA December 13, 2017
  3. 3. Needs Assessment • 246 General Surgery training programs with 1185 new trainees annually • 1981 first laparoscopic appendectomy • Today over 7.5 million laparoscopic operations are performed each year worldwide • American Board of Surgery requires FLS certification for Board eligibility
  4. 4. • Duty hours restrictions have reduced resident case logs by an estimated 20%. • Virtual Reality surgical simulation has been shown to improve timing and performance compared to no simulation and to box-trainers Evidence for Simulation
  5. 5. • See one, do one, teach one • Dry Lab • Animal lab • Virtual lab – Simulated procedures Evolution of Training……
  6. 6. Dry lab…….a good start
  7. 7. • Residents randomized to XBOX 360, Nintendo DS, or laparoscopic simulation – Average: XBOX 6 hours/week, Nintendo DS 3 hrs/week, lap simulator 2 hours/week – At 6 weeks, XBOX group improved 17.7 seconds, Nintendo group improved 11.8 seconds, lap simulator improved 4.6 seconds. Usability / Playability
  8. 8. Anatomic Options • Laparoscopic • Endoscopy • Angiography • Arthroscopy • Bronchoscopy • da Vinci Robotics • Urogenital • IR • OB/GYN pelvis Current VR Surgical Simulation Platform Options
  9. 9. • Lap Mentor III – Haptic Feedback – Grasping, probing, sweeping – Tasks and Skill Modules – Model FLS: peg transfer, pattern cutting, loop ligation – Procedure Modules – Cholecystectomy, appendectomy, incisional hernia, gastric bypass, sigmoidectomy, nephrectomy, Hysterectomy • MentorLearn curriculum • Trainee monitoring Simbionix
  10. 10. Simbionix View
  11. 11. • Haptic Feedback • Tasks and Skills – FLS – Peg transfer, pattern cutting, ligating loop, knot tying • Procedure Modules – Cholecystectomy, appendectomy, bariatric, nephrectomy, GYN • Training course curriculum • Multimedia training program Surgical Science
  12. 12. Surgical Science
  13. 13. Robotic Simulation
  14. 14. Overall
  15. 15. Validated Outcomes- Results you can trust! • Lap Colectomy: – Accuracy of achieving objectives – Instrument path length – risk of colon wall injury • Cholecystectomy – Speed – Correctional movements
  16. 16. Current and Future VR • Visual interface • Haptic control / user input • Usability / Playability
  17. 17. VR Visual Interface • 2D high definition video – 30  60 fps 1080p • Virtual environments • Oculus Rift – 60 fps
  18. 18. • Virtual simulation operate on your patient before you operate for real…… • Dr Larry Smarr The Holy Grail of Simulation……..
  19. 19. Full Body CAT Scan at mm Resolution, Including Virtual Colonoscopy June 2016 Convinced Me Time Had Come for Surgery No Air Source: June 2016 Dr. Harvey Eisenberg, Body Scan Intl., Irvine, CA Dr. Ramamoorthy 10/6/17: “This is perfect- this is your indication for surgery.”
  20. 20. 3D IMAGE SEGMENTATION
  21. 21. HOW TO TURN CROSS-SECTION MRI IMAGES…
  22. 22. HERE ARE ALL 48 IMAGES AS A VIDEO
  23. 23. …INTO A 3D MODEL
  24. 24. Image Stack Slice Compositing Rendering Image Stacks
  25. 25. THIS PROCESS IS CALLED IMAGE SEGMENTATION
  26. 26. WE USE 3D SLICER
  27. 27. Pre-Surgical Planning in QI Virtual Reality: Using Virtual Reality As Input for Positioning The Two Resection Cuts Colon visualization by Jurgen Schulze, Calit2; Photo credit Tom DeFanti, Calit2 Surgeon Sonia Ramamoorthy, MD in Calit2 Virtual Reality CAVE Friday November 21, 2016
  28. 28. Using QI Organ Segmentation in Jacobs OR on Tuesday November 29, 2016 Patient Smarr With da Vinci Robot Arms Inside Him OR Team Using Large Screens To Watch Dr. Schulze’s da Vinci Images Dr. Ramamoorthy Operating Da Vinci Xi Robot During Surgery Dr. Schulze Rotating 3D Organs To Match Up With da Vinci Arms and Internal Camera
  29. 29. Dr. Ramamoorthy’s Use of 3D Interactive Anatomy To Guide Surgical Team on Site For Bowel Division
  30. 30. Next Steps • Automate • Allow editing in 3D
  31. 31. VR CALMING APP
  32. 32. Motivation • VR is perfect for calming and teaching kids on the spectrum – Inexpensive viewers  broad availability – VR avoids visual distraction from environment
  33. 33. Developed for Google Cardboard

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