R. C. P. I. T.

Department of Electronics & Telecommunication

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1. Introduction
Rapid change in most segments of the society is occurring as a result of
increasingly more sophisticated, affordable and ubiquitous computing power. One clear
example of this change process is the internet, which provides interactive and
instantaneous access to information that must scarcely conceivable only a few years ago.
Same is the case in the medical field. Adv in instrumentation, visualisation and
monitoring have enabled continual growth in the medical field. The information
revolution has enabled fundamental changes in this field. Of the many disciplines arising
from this new information era, virtual reality holds the greatest promise. The term virtual
reality was coined by Jaron Lanier, founded of VPL research, in the late 1980’s. Virtual
reality is defined as human computer interface that simulate realistic environments while
enabling participant interaction, as a 3D digital world that accurately models actual
environment, or simply as cyberspace.
Virtual reality is just beginning to come to that threshold level where we can begin
using Simulators in Medicine the way that the Aviation industry has been using it for the
past 50 Years — to avoid errors.
In surgery, the life of the patient is of utmost importance and surgeon cannot
experiment on the patient body. VR provide a good tool to experiment the various
complications arise during surgery.

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2. What is virtual surgery…?

Virtual surgery, in general is a Virtual Reality Technique of simulating surgery
procedure, which help Surgeons improve surgery plans and practice surgery process on
3D models. The simulator surgery results can be evaluated before the surgery is carried
out on real patient. Thus helping the surgeon to have clear picture of the outcome of
surgery. If the surgeon finds some errors, he can correct by repeating the surgical
procedure as many number of times and finalising the parameters for good surgical
results. The surgeon can view the anatomy from wide range of angles. This process,
which cannot be done on a real patient in the surgery, helps the surgeon correct the
incision, cutting, gain experience and therefore improve the surgical skills.
The virtual surgery is based on the patient specific model, so when the real
surgery takes place, the surgeon is already familiar with all the specific operations that are
to be employed.
The VR simulator basically consists of a powerful PC which runs the software and
an interface called hapticinterfacer for the user to interact with the virtual environment.
Usually the haptic interfacer works on force feedback loop. The force feedback systems
are haptic interfaces that output forces reflecting input forces and position information
obtained from the participant. These devices come in the form of gloves, pens, joystick
and exoskeletons.

Fig. (1) Representation of a Haptic feedback loop and how human sense of touch
interacting with a VR system.

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A human hands moves the end effecter-shown here with hemostat-of a haptic
device causing the device to relay its position via sensors to a computer running a VR
simulation Physical model is made assuming that tissues are polygon meshes that interact
like an array of masses connected by springs and dampers. The parameter values are
derived using The computer determines what force should oppose that collision and
relays force information to actuators or brakes or both, which push back against the end
effecter. In the left hand loop, forces on the end effecter are detected and relayed to user’s
brain. The brain, for example, commands the muscle to contract, in order to balance or
overcome the force at the end effecter. In medical applications, it is important that the
haptic devices convey the entire spectrum of textures from rigid to elastic to fluid
materials. It also essential that force feedback occur in real time to convey a sense of
realism.

The rest of the system consists mostly of off-the-shelf components. The haptic
device’s driver card plugs into usually a 500MHz PC equipped with a standard graphic
card and a regular color monitor. The software includes a database of graphical and haptic
information representing the surgery part.
The graphics, including deformation of virtual objects is calculated separately from
the haptic feedback, because the latter must be updated much more frequently.

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3. Virtual reality applications in surgery

The highly visual and interactive nature of virtual surgery has proven to be useful
in understanding complex 3D structures and for training in visuospatial tasks. Virtual
reality application in surgery can be subdivided as follows:
3.1. Training and education
The similarities between pilots and surgeons responsibilities are striking; both
must, be ready to manage potentially life-threatening situations in dynamic, unpredictable
environments. The long and successful use of flight simulation in air and space flight
training has inspired the application of this technology to surgical and education.
Traditionally, textbook images or cadavers were used for training purposes, the
former ie textbook images, limiting one’s perspective of anatomical structures to 2D
plane and the latter, cadavers; limited in supply and generally allowing one-time use only.
Today VR simulators are becoming the training methods of choice in medical schools.
Unlike textbook examples, VR simulators allow users to view the anatomy from a wide
range of angles and “fly through” organs to examine bodies from inside.
The experience can be highly interactive allowing students to strip
away the various layers of tissues and muscles to examine each organ separately. Unlike
cadavers, VR models enable the user to perform a procedure countless times. Perhaps
because of the number of complications resulting from the uncontrolled growth of
laparoscopic procedures in early 1990’s many groups have pursed simulation of
minimally invasive and endoscopic procedures. Advances in tissue modeling, graphics
and haptic instrumentation have enabled the development of open abdominal and hollow-
tube anastomosis simulators. Initial validation studies using simulators have shown
differences between experienced and novice surgeons, that training scores improve
overtime and that simulated task performances is correlated to actual task performances.

Computer-based training has many potential advantages:

• It is interactive.
• An instructor presence is not necessary, so student’ can practice in their free moment.
• Changes can be made that demonstrate variation in anatomy or disease state.
• Simulated position and forces can be recorded to compare with established performance
matrices for assessment and credentialing.

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• Students could also try different technique and loot at tissues from perspective that
would be impossible during real operations.

3.2. Surgical planning

In traditional surgery planning, the surgeon calculates various parameters and
procedure for surgery from his earlier experience and imagination. The surgeon does not
have an exact idea about the result of the surgery after it has been performed. So the result
of the surgery depends mainly on human factors. This leads to lots of errors and even to
the risk of losing the life of the patients. The incorporation of the virtual reality
techniques helps in reducing the errors and plan the surgery in the most reliable manner.
The virtual reality technology can serve as useful adjunct to traditional surgical
planning techniques. Basic research in image processing and segmentation of computed
tomography and magnetic resonance scans has enabled reliable 3D reconstruction of
important anatomical structures. This 3D imaging data have been used to further
understand complex anatomical relationships in specific patient prior to surgery and also
to examine and display the microsurgical anatomy of various internal operations.
3D reconstruction has proven particularly useful in planning stereostatic and
minimally invasive neurosurgical procedures. Modeling of deformable facial tissues has
enabled simulations of tissue changes and the postoperative outcome of craniofacial
surgery. Other soft tissue application includes planning Liver resection on a 3D
deformable liver model with aid of a virtual laparoscopic tool.

3.3. Image guidance

The integration of advanced imaging technology, image processing and 3D
graphical capabilities has led to great interest in image guided and computer-aided
surgery. The application of computational algorithm and VR visualization to diagnostic
imaging, preoperative surgical planning and interaoperative surgical navigation is referred
to as Computer Aided Surgery. Navigation in surgery relates on stereotatic principles,
based on the ability to locate a given point using geometric reference. Most of the work
done in this field has been within neurosurgery.
It also proved useful in Robotic Surgery, a new technique in which surgeon
remotely manipulate robotic tool inside the patient body. An image guided operating
robot has been developed Lavellee et al, and Shahide et al have described a micro’
surgical guidance system that allows navigation based on a 3D volumetric image data set.
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In one case, we use intra operative mapping of 3D image overlays on live video provides
the surgeon with something like ‘X-ray vision’. This has been used in conjunction with an
open MRI scan to allow precise, updated views of deformable brain tissues. Other
researchers have focused on applications for orthopedic procedures. Improvements in
sensor and imaging technology should eventually allow updates of patient’s position and
intra operative shape changes in soft tissues with in reasonable time frame.

3.4. Telesurgery
Tele-surgery allows surgeons to operate on people who are physically separated
from themselves. This is usually done through a master-slave robot, with imaging
supplies through video cameras configured to provide a stereoscopic view. The surgeon
relies on a 3D virtual representation of the patient and benefit from dexterity
enhancement afforded by the robotic apparatus’ prototype tele manipulator has been used
to successfully perform basic vascular and urologic procedures in swine’s. More
advanced system has been used to perform Coronary Anastomosis on exvivo swine hearts
and in human undergoing endoscopic Coronary Artery Bypass grafting.

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4. Virtual surgery simulation

4.1. 3D Image simulation

The first step in this is to generate a 3D model of the part of the body that undergo
surgery Simulating human tissues-beit tooth enamel, skin or blood vessels-often starts
with a sample from a flesh and blood person that is we should have a 3D model of the
part of the body. Using computer graphics we first construct a reference model.
Depending on this simulation needed, anatomical images can be derived from a series of
patient’s Magnetic Resonance Images (MRI), Computed Tomography (CT) or video
recording, which are 2D images. These images are segmented using various segmentation
methods like SNAKE’. The final model is obtained by deforming the reference model
with constraints imposed by segmentation results. The image is digitally mapped on to
the polygonal mesh representing whatever part of the body on organ is being examined.
Each vortex of the polygon is assigned attributes like colour and reflectivity from the
reference model.
For the user to interact with the graphics there must be software algorithms that
can calculate the whereabouts of the virtual instrument and determines whether it has
collide with a body part or anything else. The other thing is, we should have algorithms to
solve how it looks or behave when the body part is cut. We need models of how various
tissues behave when cut, prodded, punctured and so on. Here VR designers often portray
the tissue as polygonal meshes that react like an array of masses connected by springs and
dampers. The parameters of this model can then be tweaked to match what a physician
experiences during an actual procedure. To create graphic that move without flickering
collision detection and tissue deformation must be calculated at least 30 times/sec.
Advances in medical graphic allows ordinary medical scan of a patient anatomy
be enhanced into virtual 3D views-a clear advantage for surgeon who preparing to do
complicated procedures. Scans from MRJ and CT produces a series of things slices of the
anatomy divided into volume data point or voxels, these slices are restacked and turned
into 3D images by a computer. These 3D images are color enhanced to highlight, say
bone or blood vessels.

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4.2. Touch simulation

The second step in the simulation of surgery is simulating haptic-touch sensation.
Physicians rely a great deal on their sense of touch for everything from routine diagnosis
to complex, life saving surgical procedure. So haptics, or the abili to simulate touch, goes
a long way to make virtual reality simulators more life like.
It also add a layer of technology that can stump the standard microprocessor.
While the brain can be tricked into seeing seamless motion by flipping through 30 or so
images per second, touch signals need to be refreshed up to once a millisecond. The
precise rate at which a computer must update a haptic interface varies depending on what
type of virtual surface is encountered-soft object require lower update rates than harder
objects.
A low update rate may not prevent a users surgical instrument from sinking into
the virtual flesh, but in soft tissues that sinking is what is expected. If we want something
to come to an abrupt stop that is in the case of born, etc it requires a higher update rates
than bumping into something a little squishy like skin, liver etc.
But still, simulating squish is no easy task either. The number of collision point
between a virtual squishy object and a virtual instrument is larger and more variable than
between a virtual rigid object and an instrument. Most difficult to simulate is two floppy
objects interacting with each other-such as colon and sigmoidocope, the long bendable
probe used to view the colon-because of multiple collision point. In addition, the
mechanics of such interaction are complicated, because each object may deform the other.
For simulating touch sensation, we have to calculate the forces applied to cut,
prodde, puncture the various tissues. Also how they react or behave when cut, prodded,
punctured using surgical instruments. First we have to make physical models of various
tissues. The major difficulty in modeling organs is the physical behavior as they have all
kinds of complexities-they are anistropic, non homogeneous and nonlinear. In addition, a
great deal more physical measurement of tissues will be needed to make realistic haptic
maps of complicated parts of the body such as abdomen.
Physical model is made assuming that tissues are polygon meshes that interact like
an array of masses connected by springs and dampers. The parameter values are derived
using complex nonlinear equations. The reaction forces are also calculated.
In coming years, VR designers hope to gain a better understanding of true
mechanical behavior of various tissues and organs in the body. If the haptic device is to
give a realistic impression of say pressing the skin on a patient’s arm, the mechanical
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contributions of the skin, the fatty tissue benefit, muscle and even bone must be summed
up. The equations to solve such a complex problem are known, but so far the calculations
cannot be made fast enough to update a display at 30Hz, let alone update a haptic
interface at 500-1000Hz.

4.3 Diana Phillips Mahoney

Computer-based surgical simulation has for years been one of the hottest topics in
virtual-reality research. Not only does the technology have the potential to revolutionize
the teaching and practice of medicine, but it also encompasses some of the most pressing
computer visualization challenges of the day: real-time interaction with complex 3D
datasets, photorealistic visualization, and haptic (force-feedback) modeling. What`s more,
it requires that all of these be achieved in the same application. Few other VR
applications are subject to such stringent constraints. Often, in other applications, one or
more of the technical considerations mentioned above can be sacrificed for the sake of
another. For example, if real-time interaction is a priority, it may be achieved at the
expense of photorealistic images or sensitive force feedback and vice versa. In contrast,
for a surgical simulation to be useful as a training and planning tool, it must answer to a
higher technical call. Roger Webster and Randy Haluck know this, and are building their
surgical simulation system accordingly. Webster, a computer scientist at Millersville
University of Pennsylvania, and Haluck, director of minimally invasive surgery at Penn
State`s Hershey Medical Center, have joined forces to develop a surgical simulator that
will not only enable real-time
interaction with photorealistic 3D imagery and sensitive touch feedback, but will also
measure the skills of expert surgeons relative to novice surgeons, providing the novice
with an objective means of identifying areas of strength and weakness.
The simulator will also be used to compare skills measured during live surgery
with those obtained from a virtual procedure to test whether there is indeed a technology
transfer between the two. "The general assumption is that virtual surgery simulation is
beneficial. It seems intuitive, but it has yet to be proven, so we`re setting out to do that.
With funding from the medical center, the researchers have begun developing a
computer-based simulation system representing a range of surgical procedures. An initial
component is a proof-of-concept application that lets surgeons and medical students, via
real-time visual and haptic interaction with a photorealistic model, practice suturing. The
virtual environment for this application comprises polygonal models of patient anatomy.
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The skin covering the models is a grid of dynamic vertices texture-mapped with a
photograph of an actual wound. To interact with the digital model, users manipulate
physical suturing tools that are attached to a haptic device (the Phantom from SensAble
Technologies), while viewing virtual counterparts of the same tools on-screen. The virtual
environment was programmed using EAI/Sense8`s WorldToolKit.
To model the sensations related to the "touch and feel" of the virtual objects in the
environment, the researchers used SensAble`s GHOST software development kit. To
simulate the impact on the skin and underlying tissue of pushing, pulling, cutting, and so
forth, they developed a basic mass-spring model, through which the skin is approximated
to a deformable surface made up of a network of masses and springs. The skin deforms
relative to the weight, or pressure, applied to the springs through the surgical tool. The
software calculates the contact forces in the soft tissue surrounding the wound and applies
the appropriate forces to the user through the Phantom. The resistant forces change when
the needle is inserted into the virtual skin and when it`s pushed through the soft tissue.
The software graphically shows the deformation of the virtual skin as well.
The skills-assessment capability is also based on a mathematical model. To
quantify surgical activity, the researchers are creating a software implementation of the
finite-state machine model. With this, a range of surgical states and transitions between
states will be tracked. The states include idle, grasping, spreading, pushing, sweeping, and
lateral retraction, as well as numerous combinations of these, such as grasping/pulling,
pushing/sweeping/spreading, and so forth. In the virtual environment, these states will be
tracked directly from the motions of the Phantom. In physical surgery, the surgeons`
motion will be tracked by an electromagnetic position and orientation sensor system and
the data will be input to the software for motion analysis.
"The initial state is the idle state, where nothing is happening. When the user starts
the procedure, he or she transitions to other states, like grasping, spreading, or pushing,"
says Webster. "All of these, and combinations of these, will be modeled as the user
progresses from one state to another."
The goal, says Haluck, is to be able to quantify the nature of the states through
which an expert surgeon progresses in performing a suturing operation. "We want to
know how long the expert surgeon spends in each of those states so we can compare that
against novice surgeons to see whether they go through the same states and transitions or
different ones, and how long they spend at each state." For example, novice surgeons
might spend an inordinate amount of time in the idle state, thinking about what to do next,
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or they may be pushing and grasping when, based on the expert`s approach, they`d be
better off pulling at that point in the suturing process.
Such information can be an invaluable training tool, says Haluck. "We can show
the novice surgeon the different states and how long the expert spent in each of the them.
And based on the numbers, we can say something like, `You`re spending too much time
in the grasping and pulling state after you have been in the lateral retraction state.` The
benefit is that it will give concrete skills-assessment feedback, rather than someone
saying, `I don`t like the way you`re suturing.` "
4.3.1 Fine-tuning the Model
The project is still in the investigative stage, notes Webster, adding that there are a
number of daunting technical and conceptual hurdles yet to overcome before the
simulator is deemed surgeon-ready.The first and most significant of these is fine-tuning
the haptic model for soft-tissue deformation. "This is one of the more difficult problems
in virtual surgery. There are a number of classic computer graphics things we can do to
make the simulation look more realistic, but in terms of making it feel more realistic,
we`re just starting to scratch the surface.
In our research, we`re trying to invent an engineering model of how tissues and
organs should feel. We need to tweak the model to get more accurate resistant force
calculation algorithms." Haptic accuracy is mission-critical, says Haluck. "Everything we
do as surgeons relies on force feedback. Organs and blood vessels respond to
manipulation and tissue handling. And the forces involved are essential to identifying
pathology, determining tumor boundaries, and assessing how the repair is going. We have
to have the same sensory involvement in a simulation."
Some of the other obstacles the researchers face relate to the field of computer-based
surgical simulations in general.
"The whole notion of computer-based surgical training outside of the actual
operating room is underappreciated. "For example, the NIH seems to be focused on
molecular-level research, but when it comes to education and training, funds are limited."
Additionally, he says, there is a resistance to change within the surgical community.
"There`s a necessary time commitment to training outside the operating room. The
thought of fitting in extra hours for simulation training has little appeal to a surgical
resident who is already pulling 36-hour shifts. A surgeon beyond residency training in a
busy practice may react similarly."

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Not making the time, however, is an increasingly dangerous pattern, particularly

in these days of rapid-fire high-tech advances that are meant to help save lives. "Every
day, new technology is being tossed at us. In the good old days, you could train by
learning to cut, sew, and tie, and those skills would get you through an entire career.
Today, especially as computer power increases, we`re faced with new technology all the
time--different visualization techniques, and different skills requirements, such as
laparoscopic surgery and robotic surgery," says Haluck. "The technology is coming so
fast that the opportunities for complete training are limited. Obviously, research into
better teaching methods and better skills assessment methods will make the transition
safer. A critical component of that is computer-based simulation."

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5. Hardware Research Issues

There are two main areas in the development of the hardware on which SME’s
appear to differ; these are the requirement for 3-D and the requirement for force and
kinaesthetic feedback. This difference of opinion may be because of some difference in
the applications which the SME are concerned with, or differences in the training and
execution of the surgeons skills (and the cues they are accustomed to using). Or it may be
confusion or unfamiliarity with the potential of each of these technical possibilities as
opposed to their limitations. It is clear that both 3-D and Force feedback are issues
requiring further research.

5.1 Force/Kinaesthetic Feedback

Many surgeons say that any MAS training system must have force and
kinaesthetic feedback for the surgical tools. But it is clear that one of the problems in this
environment is the low levels of force feedback present which can be exacerbated by the
flexibility, damping and adsorption of the surgical tool being used.
The high cost of force feedback in the system meant that its contribution to
training effectiveness was one of the first areas to be addressed. Pilot studies (Kelly &
Cotter 1998) have indicated that the simple model for force feedback implemented in
VISTA can have a beneficial effect on the accuracy and speed with which a training task
is performed in the system.

5.2 3-D
Early MAS systems did not have colour displays and few now have 3-D.
Technology is now able to offer 3-D to the MAS surgeon and it is likely that unless there
is a strong reaction to it 3-D displays will form part of future MAS surgical suits.
Nonetheless the benefit from its use is still unclear, and while lightweight headsets that
still allow a degree of peripheral and local normal vision are now available, some
surgeons still find their use uncomfortable and restricting.
It is clear that many MAS tasks require depth perception but it is also clear that
depth cues are present in normal displays (e.g. shading, shadows, occlusion etc.) and that
not all surgeons benefit from enhanced 3-D. There is some evidence that two-handed
tasks can be carried out faster using 3-D, but the conclusive research remains to be done.
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VISTA has a selectable 3-D output to enable the contribution of the 3-D displays to
training effectiveness to be researched.

5.3 Ergonomics
The variety of designs of MAS systems available for surgeons indicate that there
is still a need for some basic ergonomic studies on relative screen, body, and hand
positioning, and to consider the possibility in some cases of seating or supporting the
surgeon. Studies of operating theatre team interactions are being carried out (Helmreich
& Schaefer, 1994) and VISTA has been sourced to provide the operational task in these
studies.

5.4 Training Media

The development of Objective Performance Measures (timings, error rates,
positioning and placing accuracy - see, Johnston, Bhoru, Satava, McGovern, Fletcher,
Rangel, & Loftin, 1995 ) to support the traditional subjective assessment of performance
normally found in surgical training is seen as a key area of research for MAS. Objective
Performance Measures (OPM) will be developed using the analysis of MAS skills and
additional information from SME interviews and the examination of current training
practices. These measures support the setting of training performance standards and aid in
the provision of feedback during skill development. It is also seen as important that the
training material is based on the training analysis and on existing training theory. This is
to ensure that training is effectively structured, with appropriate sequencing, level of
exercise detail and feedback. This will lead to the development of a series of training tests
that can aid in the development of an auditable training trail for MAS.

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6. What is a virtual surgery simulator ..?

The VR simulator basically consists of a powerful PC which runs the software and
an interfacer- haptic interfacer- for the user to interact with the virtual environment.
Usually the haptic interfacer works on force feedback loop.
The force feedback systems are haptic interfaces that output forces reflecting input
forces and position information obtained from the participant. These devices come in the
form of gloves, pens, joystick and exoskeletons.

figure (5.1) Haptic feedback loop.

The figure (5.1) shows a haptic feedback loop, how human sense of touch
interacting with a. VR system. A human hands moves the end effecter-shown here with
haemostat-of a haptic device causing the device to relay its position via sensors to a
computer running a VR simulation.
The computer determines what force should oppose that collision and relays force
information to actuators or brakes or both, which push back against the end effecter. In
the left hand loop, forces on the end effecter are detected and relayed to user’s brain. The
brain, for example, commands the muscle to contract, in order to balance or overcome the
force at the end effecter.
In medical applications, it is important that the haptic devices convey the entire
spectrum of textures from rigid to elastic to fluid materials. It also essential that force
feedback occur in real time to convey a sense of realism.

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The rest of the system consists mostly of off-the-shelf components. The haptic
device’s driver card plugs into usually a 500MHz PC equipped with a standard graphic
card and a regular colour monitor. The software includes a database of graphical and
haptic information representing the surgery part. The graphics, including deformation of
virtual objects is calculated separately from the haptic feedback, because the latter must
be updated much more frequently.

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7. Phantom desktop 3D touch system-a haptic interface

Senseable technologies, a manufacture of force- feedback interface devices, has

developed Phantom Desktop 3D Touch System, which supports a workspace of 6 x 5 x 5
inch. About the size of a desk lamp, the device resembles a robotic arm and has either 3
or 6 degrees of freedom and senses for relaying the arm’s position to PC. The system
incorporates position sensing with 6 degrees of freedom and force-feedback with 3
degrees of freedom. A stylus with a range of motion that approximates the lower arm
pivoting at the user’s wrist enables-user to feel the point of stylus in all axes and to track
its orientation, including pitch, roll and yaw movement. A number of companies are
incorporating haptic interfaces into VR systems to extent or enhance interactive
functionality.

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The Phantom haptic device has been incorporated into the desktop display by
Reachln Technologies AB Developed for a range of medical simulation and dental
training applications, the system combines a stereo visual display, haptic interface and 6
degrees of freedom positioner. A software package aptly named GHOST, translates
characteristics such as elasticity and roughness into commands for the arm, and the arm’s
actuators in turn produce the force needed to simulate the virtual environment. The user
interacts with the virtual world using one hand for navigation and control and other hand
to touch and feel the virtual object. A semitransparent mirror creates an interface where
graphic and haptics are collocated. The result is the user can see and feel the object in
same place. Among the medical procedures that can be simulated are catheter insertion,
needle injection, suturing and surgical operations.

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8. Importance of virtual surgical field

A recent report released by Institute of Medicine in Washington DC, estimates

that medical errors may cause 1,00,000 patient deaths each year in US alone. Proponent
of virtual reality believes that incorporation of this technology into medical training will
bring this grim statistic down.
The main advantages of virtual reality in surgery are:
Intelligent computer backup minimizes the number of medical ‘mistakes’.
• More effective use of minimal-access surgical technique, which reduces the long
length of hospital stays and rest of postoperative complications.
• Better training in anatomy and surgical skill, with reduced need for cadavers.

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9. Conclusion

Medical virtual reality has come a long way in the past 10 years as a result of
advances in computer imaging, software, hardware and display devices.
Commercialization of VR systems will depend on proving that they are cost effective and
can improve the quality of care. One of the current limitations of VR implementation is
shortcomings in the realism of the simulations.
The main Impediment to realistic simulators is the cost and processing power of
available hardware. Another factor hindering the progress and acceptability of VR
applications is the need to improve human-computer interfaces, which can involve use of
heavy head-mounted displays or bulky VR gloves that impede movement. There is also
the problem of time delays in the simulator’s response to the users movements. Conflicts
between sensory information can result in stimulator sickness, which includes side effects
such as eyestrain, nausea, loss of balance and disorientation. Commercialization of VR
systems must also address certain legal and regulatory issues.
Despite these concerns, the benefits of VR systems in medicines have clearly been
established in several areas, including improved training, better access to services, and
increase cost effectiveness and accuracy in performing certain conventional surgical
procedures.

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Virtual Surgery
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