Lydia Coutré | September 24, 2017 | Crain’s Cleveland Business

Although the patient is a simulated projection, the user of a new tool at MetroHealth can feel the resistance of skin and then bone as they pierce a virtual needle into the body. The "needle" tool is part of new virtual reality technology for surgeons to practice complex operations in a 3-D environment. MetroHealth is the exclusive testing site for MissionRehearsal, created by Chicago-based ImmersiveTouch, Inc.

The technology takes a specific patient's imaging from CT scans, MRIs and angiograms and reconstructs it in a 3-D model that allows a surgeon to create a detailed plan in virtual surgical reality. This can be key for unusual or complex cases in which a surgeon would have less specific experience than a more routine case, said Dr. Ben Roitberg, chair of neurosurgery at MetroHealth.

The technology also can be used to expand the teaching libraries.

"The ability to do rapid virtualization and have highly interactive, much more advanced simulation allows for not only … the experienced surgeon to prepare for a particular case but for that experience to be then transferred more easily to trainees at a more advanced level than is currently possible," said Roitberg, who has worked with ImmersiveTouch to develop virtual reality simulations since 2007, long before he joined MetroHealth in 2016.

About 45 institutions in the country have ImmersiveTouch's technology. Dozens, including Cleveland Clinic, are using it to train residents with procedural modules and generic cases. But MetroHealth is the only site that has the next generation of that technology, which it is helping to develop and test.

The old model helped in teaching students, but the time it took to virtualize patients' imaging made using it in surgery preparation completely unrealistic, Roitberg said.

"I've worked with a number of simulation programs, but this has been, from my perspective, the most advanced and the best for where I see the future should be going," he said.

The idea is to be able to have a patient get a scan and see the virtualization in the same appointment, said Patrick Kania, biomedical visualization manager for ImmersiveTouch.

"The doctor can consult with the patient before the patient goes home," he said. "So we would be able to educate the patient enough and then be able to build a little bit more complexity in for the doctors to practice."

Surgeons can show the details and surgical path of a procedure to a patient using a virtual reality headset, iPad or desktop monitor. The ability to show patients 3-D images and explain what a doctor is doing is a huge benefit, Roitberg said. In cases where he is able to show a patient the 3-D reconstruction of their pathology, the patients "responded to this amazingly," he said.

"We are the first company in the nation to integrate surgical training, planning and patient education in a virtual environment with haptic technology," said Pat Banerjee, CEO of ImmersiveTouch, in a statement. "This allows your hand to feel the resistance of a surgery and be able to tell the difference between skin, muscle and bone."

The platform is scalable for academic and community hospitals, meaning any health system with an operating room can use MissionRehearsal to improve surgical planning and patient education, which can mean lower costs and better outcomes, Banerjee said.

In the roughly one month that MetroHealth has had the technology, it already has used it for one case and Roitberg is planning a multicenter collaboration to apply it. He said he sees it being used a couple of times a week by surgeons, but notes that the estimate includes only the applications he knows about. Other surgeons or experts might see other ways to use the technology.

"When you're doing another routine, minor operation that you've done 100 times, you probably don't need to go and prepare, but many operations are special or unusual or require specific planning," Roitberg said. "Being able to pre-do it on a virtual model of the patient is a safety and confidence component."

The training component also is a huge help for fellows and residents, who often rely on complex cases to enter the doors of their hospital to learn the nuances of certain procedures.

"Certain things are just not common enough that you meet it frequently enough in a fellowship, and yet once you've graduated, you're expected to be an expert," Roitberg said. "If you can re-operate then on the expert's case in virtual reality, you get a much better understanding of the real surgical anatomy."

Dwight Mann