Surgery is no longer subjective. A surgeon's skill can now be given a score and monitored

Rory McCloy

A surgeon can now hone their skills for a particular operation before they enter the operating theatre.

One such system is called minimally invasive surgical trainer (Mist).

It was developed by a team at Manchester Royal Infirmary (MRI), headed by Rory McCloy, senior lecturer in surgery at the Wolfson Centre for Minimally Invasive Therapy.

He said: "Surgery is no longer subjective. A surgeon's skill can now be given a score and monitored."

The time taken to perform a surgical procedure and the accuracy of each hand of a surgeon in an operation can be given scores by the simulator system.

Regular practice

Mist allows surgeons to practice not only particular operations prior to surgery but a particular operation on a particular patient by using the patient's "virtual" organs on screen.

CT and magnetic resonance imaging (MRI) scans from the patient's body are used to create these images on screen in the Mist system for surgeons to practice on before the operation.

The Mist computer is made up of an ordinary PC linked to instruments, manipulated in the air by the surgeon.

Advanced technology

The position of these instruments is then relayed to virtual instruments on the computer screen via a sophisticated joystick.

Ultimately, virtual training environments may even mean that surgeons do not have to train on animals

Francesco Rubino

Mr McCloy said: "These virtual reality computer simulators are being used to test a surgeon's hand-eye co-ordination.

"If a surgeon's score during a virtual operation is low they could be drunk or ready to retire."

Mr McCloy believes Mist will enable students with exceptional surgical skills to be identified and fast-tracked through medical school.

"Fast-tracking good students of surgery through their courses is of particular importance after the government's announcement last month to shorten medical courses to supply more doctors quickly."

Benefits

Mist is also beneficial for other reasons.

"Previously a professional surgeon could not measure if their skill was waning with age, or if their drinking was affecting their performance," said McCloy.

Mist is used in 30 centres in the UK including the Royal College of Surgeons and St George's Hospital training unit in London.

Advances in "virtual reality" are also helping mental health patients around the world.

UK hospitals are now offering headsets attached to a PC to help people suffering from phobias, like agoraphobics.

The headset allows a patient to become accustomed to stepping outside a room.

A "virtual" room with a door and garden is seen through the headset.

The patient can control when they want to go outside into the virtual garden via a joystick.

Other headsets are being used to make patients feel relaxed in hospital and reduce pain after an operation.

Ear phones playing soothing sounds and music are combined with pictures of nature via a headset and have been shown to reduce post-operative pain.

"Virtual environments have huge potential in health," said Francesco Rubino, from the European Institute of Telesurgery in France.

Currently Mr Rubino and his colleagues are using virtual reality surgery techniques for colonoscopy as well as to detect lesions such as in the liver.

He said: "Surgeons will always be needed. But these virtual techniques, as well as robotics and telesurgery, will allow them to perfect their technique and treat people in remote locations with patients not needing to travel for an operation.

"Ultimately, virtual training environments may even mean that surgeons do not have to train on animals."