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Practice on Patients or Virtual Patients?

Image from the UK based VERT trainer

This article was written as a response to an article in the Telegraph news service, "I'd like my surgeon to have practised on people first", published on 11th April 2009. In it, the author states:

The Secretary of State for Health said that working longer hours "did not necessarily mean better training" and anyway, only very urgent surgery is carried out in the dead of night. "Surgery is a technical skill," he said, knowledgeably, and "developments in new technology, such as virtual reality surgical simulators, mean that there is increasingly and thankfully less need for inexperienced trainee surgeons to practise their skills directly on patients".

Virtual reality simulators? Crikey. I'd want my surgeon to have "practised his skills" by cutting open enough people in actuality.

This is an odd position to take, and is almost as if the author of that article does not truly possess a firm grasp of the nature of the technology she is so keen to deride.

Virtual reality based surgical simulators are not the same as operating on an actual patient, at least not currently, and not for some decades yet. No-one is proposing that they take the place of actual surgery, yet these training tools do provide a myriad of potentially lifesaving benefits. Or, is the author saying that she would be willing to be the first experience a new surgeon has at surgery, herself?

After all, the surgeon has to learn how much pressure to apply, somehow. All watching others does is teach technique. Tactile sensations and pressure exertion are things the individual has to learn for themselves. They either risk doing more harm than good to a live body - or a cadaver -, or they practice in a simulated body, constructed from real patient data. In the latter, the computer system can analyse the pressure exerted, provide force feedback, and alert the young surgeon when they are pressing too lightly or too hard.

When virtual surgery is finished, if a mess has been made, the data can just be reset. Try doing that with a living person, well, a previously living person.

Other times a surgical simulator is used, include when a patient has the misfortune of requiring a tricky procedure to be carried out. Even a highly skilled surgeon can benefit greatly, from a 3D simulation built up from the patient's own medical data such as MRI or CT scans, laid out in the simulator, where the surgeon can practice, familiarising themselves with different approaches, and finding ahead of time which work and do not work.

Surely this is better than just seeing the patient fresh, and well, if that approach was doomed from the start, too bad?

The Telegraph article goes on to mention a 40 hour working week, which the reporter feels VR based training cuts too deeply into, is not enough for surgons to perform as well as they have in the past. Well, one of the side benefits of VR surgical training is that unlike operating on actual patients, it can be done outside of working hours, if necessary. A good surgeon may well do this, if they desire to try different approaches on a particular patient, or if they are nervous about conducting a type of surgery they have never experienced before. This is human nature.

The working week length, technology cannot help; that is a political issue. But, to accuse the technology of being at fault, when it offers the benefit of surgeons being far less green when they cut living flesh, is sheer lunacy.


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