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A Flight Simulator For Surgery

How can surgeons improve their skills and increase the safety of the patients? Richard Vincent, the CEO and Founder of Fundamental Surgery may have the answer.
Published April 3, 2019

Is there an issue with surgical procedures today?

I’m enormously supportive of surgeons, their levels of professionalism and the work they do, but we also need to think constructively about where the greatest opportunities are for improvement.

There’s an old adage which refers to how surgeons learn medical procedures, that goes ‘see one, do one, teach one’.

Surprisingly, it is still an attitude that exists in some parts of the medical profession today, despite the fact it’s not just dangerous for patients, but for the clinicians themselves.

Many surgeons have stories of incidents that were the result of a culmination of factors, that involve a lack of practical experience before they arrived in the Operating Room.

Looking at the latest set of data for the UK, there were 6,082 surgical incidents that resulted in compensation claims of £1.4billion pounds. It’s a big problem.

What is your solution?

My company, Fundamental Surgery, has a platform that, in simple terms, is a flight simulator for surgery.

It combines virtual reality and haptic feedback together so a sense of touch along with immersive experience to put surgeons and trainee surgeons into the operating theatre.

It gives them a safe, repeatable and measurable place where they can practice, learn and rehearsing surgical procedures.

There’s been a dramatic shift in the technical aspects of many clinical procedures and in the technology used. The complexity of modern-day surgery has increased significantly but training over the past 150 years really hasn’t changed much at all.

In general terms you’re learning through theory, through observation, through anecdote, some cadaveric practice and then your hands-on experience is an observed but live environment which is high risk for you as a clinician and high risk for the patient for the obvious reasons.

So, our systems seek to solve that problem by providing a simple, safe, repeatable place where people can train.

Many computer-based simulations can cost in the region of £100,000 just in CAPEX and they need a room and technical support, as a result we estimate that less than half of one percent of surgeons have any sort of day-to-day access to a simulation environment where they can practice and that’s what our system seeks to solve.

We use readily available, off the shelf hardware – our headsets are a few hundred pounds, and off-the-shelf PCs, so the expenditure is much, much less; less than 10% of the CAPEX.

When do you think the NHS can make progress in this area in the next 10, 20 or 50 years?

The NHS have a list called ‘never events’ which are surgical situations that should never occur, e.g. leaving forceps in the body or operating on the wrong leg. The numbers have been tracking steadily for the last ten years without improvement.

There should be a focus on better use of training technology, better risk assessment and management.

Often the training processes use pretty labour intensive and subjective measures and once they qualify surgeons have only really got their professional etiquette to keep them in check.

There is also a culture of hiding problems, so people don’t learn from mistakes. They don’t have an opportunity to make mistakes and therefore ‘never events’ continue to run at a certain level.

What our system and technology like ours can do is give those fantastic professionals, a safe place where they can just try a procedure, get it wrong, then press reset and do it again and improve patient outcomes.

How did you begin working in this field?

I’m one of the two co-founders and we’re not medically trained, but we have a brilliant and an extensive global medical panel around us.

We are both technologists by trade and five years ago we started to look at the immersive technology that was starting to surface and agreed it was going to fundamentally change the way that humans and computers interface.

Having focussed on VR, mixed reality and augmented reality we then started looking at the best fit and we were shocked that there was no progression in medical training.

The technical challenge was how to create a physical roadmap for human tissue that allows individuals to practice, so we built what we call our surgical haptic intelligence engine which does just that – so, you know when you pick up a virtual scalpel and place it onto a virtual piece of skin and cut, it behaves and gives you the feedback you would expect so when you hit bone it gives you that feedback, so that’s really been our journey. We always get the same reaction, that this is something the industry has needed for a long time.

What has the uptake been like?

We launched our platform six months ago and we’ve focussed on the US market, primarily because it’s an easier market to access than the NHS. However, we have it here in London in King’s College, in University College London.

In the US we are partnered with the Mayo Clinic, which is ranked as No. 1 across the US. It’s still early, but the adoption has been fairly quick. It’s not mass market yet, but it’s moving fairly quickly.

What are the barriers to this kind of technology being taken up more widely?

Inertia is probably the biggest single barrier, particularly in the European and UK market. There is a risk-averse market place which is built upon protecting the entity and the individual from adverse risk and therefore anything that’s new and does not fit becomes a challenge – and it takes a while for that to change.

Part of that is about a market getting comfortable with change, and part of it is about just the difficulty in giving surgeons exposure to our system, which restricts us getting scale.

The third one would be simply the budgetary environment. What we’ve found is that what you need to overcome that is somebody in that organisation with enough seniority and passion for the vision that they can help it navigate the short-term bumps, that constrain them.

There is an enormous amount of innovation happening in all parts of the healthcare market and inside the NHS absolutely. It’s just not necessarily stable innovation, it’s happening in some very small pockets and the trick is to get the scalability because that’s where everybody starts to really win.

We as an example have been to the very top of NHS England and had our system reviewed and endorsed but the NHS doesn’t operate as a single unit, every operating trust and all of the top sectors have their own way of operating. So, you have to win at the top and you have to win again in every location.

So the US will be where adoption comes from first?

Yes, is the short answer to that one. The market out there is more pro-simulation. Around 65% of the global simulation market currently is in north America so they’re just further down the line. They have the money available and they’ve made investment and bought simulation solutions in the past that they are able to make the transition to this new technology that we’re offering. It’s a shorter journey for them.

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