Middleton, R.

Newman, S.

Wainwright, Tom

Bournemouth University Research Online

10 THE OPERATING THEATRE JOURNAL www.otjonline.comVirtual Reality Simulation – The Future ofOrthopaedic Surgery?Simon Newman, Hip Fellow, Royal Bournemouthand Christchurch Hospitals NHS Foundation Trust;Visiting Fellow, Orthopaedic Research Institute,Bournemouth UniversityTomWainwright,AssociateProfessorofOrthopaedics,Orthopaedic Research Institute, BournemouthUniversityRobert Middleton, Consultant Orthopaedic Surgeon,Royal Bournemouth and Christchurch HospitalsNHS Foundation Trust; Professor of Orthopaedics,Orthopaedic Research Institute, BournemouthUniversityVirtual reality simulation has been a mainstayof training in military and civilian aviationfor decades. The UK government is keen forthe safety culture of the airline industry tobe replicated in the health service and thegrowth of surgical simulation is one exampleof how this is being embraced.The old surgical training methods of learningsurgical techniques through a “see one,do one, teach one” approach on patientsare no longer appropriate. Virtual realitysimulators provide a means to deliver trainingon particular operations through a mediumwhere no one sustains any harm. An additionalbonus is that other members of the theatreteam can participate and understand some ofthe surgical challenges for themselves.Arthroscopic procedures have been mostamenable to virtual reality simulation inorthopaedic surgery, as a standard computerscreen may be used as a realistic substitutefor a theatre monitor. Commercial simulatorsfor knee and shoulder arthroscopy areincreasingly available for trainees in academicor dedicated simulation centres around thecountry. Studies have shown that performanceon these simulators correlates to surgicalexperience levels, suggesting they may haveuse in assessing surgical competence in thefuture.Increasingly attempts have been made tosimulate non-arthroscopic procedures withdynamic hip screw and intra-medullary nailoperations some of the earliest. These havecombined a screen displaying images of surgicalanatomy and ﬂuoroscopy with instrumentsthat provide force feedback (haptics) whenthey come into contact with the virtualtissues. More recently attempts have beenmade to develop simulators for more complexopen operations. At the Orthopaedic ResearchInstitute at Bournemouth University the UK’sﬁrst total knee replacement virtual simulator,developed by Ossim Technologies, is currentlyundergoing validation trials. This technologyrelies on haptic feedback in response toimages on a screen. The Orthopaedic ResearchInstitute is also conducting validation trialsfor knee and hip arthroscopy simulators,developed by VirtaMed.Where next? Despite the advances, orthopaedicvirtual reality simulation still has somewayto go in terms of development. One issue isavailability, with most simulators being quiteexpensive, fragile and bulky to store. Theexcellent TouchSurgery team has opted tolower costs by making simulations availablevia personal technology such as phones andtablets.Whilst this provides a great medium to learnthe steps of a procedure any time, any place,it does not offer the immersive experience ofthe simulators used in the aviation industry. Inthe future higher ﬁdelity immersive simulationsutilising the likes of Microsoft’s HoloLens andOculus Rift are likely to be developed, but willneed to be combined with a new generationof robust and more mobile haptic devices tomeet the demands of users.Currently available virtual reality simulatorsprovide a good method to understand thestages involved in an increasing numberof common procedures for inexperiencedsurgeons and other members of the theatreteam. In the future we can expect better,more immersive simulations that will not onlysatisfy inexperienced practitioners, but alsoallow experienced surgeons to simulate realoperations before they perform them andmaintain their skills much as pilots are able todo so now with modern ﬂight simulators.Newport hospitalleading the way withpioneering “world-ﬁrst” recycling planA NEWPORT hospital is pioneering ahealthcare “world-ﬁrst”.St Woolos Hospital could revolutionise howthe healthcare system deals with medicalwaste wrap material, following a trial witha recycling machine designed by ThermalCompaction Group Ltd.The recycling process sees discarded wrap -which is used to package surgical equipment- reduced in volume size by a machine called‘Sterimelt’.Its heating and reduction process turns theused wrap into a sanitised, solid, briquettewhich can then be re-used to make domesticor industrial products, such as buckets andchairs.“This is the ﬁrst of its kind in the world,” saidMr Tim Hourahine, technical and compliancemanager at Thermal Compaction Group Ltd.“The trial has shown that we can take thewrap as waste, reduce its volume substantially,render it inert and then re-introduce it to thesupply chain.“For a Newport hospital to be able to do this isunique. The Welsh NHS is taking a close interestin what we are doing and other hospitals arevery keen to embrace the technology.“There is so much interest because, at themoment, the majority of the waste wrapis either landﬁlled or incinerated which isexceptionally expensive. The recycling processremoves that cost, plus it produces a workableproduct which will have a commercial value inthe future.”Following the year-long trial, between ThermalCompaction Group and the Aneurin BevanUniversity Health Board, both agreed a deal tobegin using the Sterimelt immediately.Peter White, the waste and environmentalmanager for the health hoard, which agreedto trial the recycling process at St Woolos,one of Wales’ oldest hospitals, said: “Beforewe implemented this system, all the wrap wasgoing out as infectious clinical waste so thereis a signiﬁcant disposal cost when it goes toalternative heat treatment (incineration).“Currently, two tonnes of sterilisation wrapfrom the Royal Gwent Hospital are recycledand diverted from the clinical waste streamper month.“However, this will increase once theother hospital sites within the health boardimplement the new system.”Thomas Davison-Sebry, director of sales andmarketing of the Thermal Compaction Groupadded: “It has all been very positive. Not onlyis it good from an environmental point of view,it is sustainable and provides its own circulareconomy.“It will save the NHS a lot of money, and itcreates a revenue source which obviouslybeneﬁts patient care.”Source: South Wales Argus

Virtual Reality Simulation - The Future of Orthopaedic Surgery?

Abstract

Similar works

Full text

Available Versions

Bournemouth University Research Online