Intended for healthcare professionals

Rapid response to:

Clinical Review Science, medicine, and the future

Virtual reality in surgery

BMJ 2001; 323 doi: (Published 20 October 2001) Cite this as: BMJ 2001;323:912

Rapid Response:

3D Simulations, not true Virtual Reality?

We disagree with aspects of McCloy’s article Virtual Reality in
Surgery (1). Whilst agreeing that simulated training in surgery is vital
and is becoming more important in the training of junior surgeons; his
definition of virtual reality is flawed.
He defines Virtual Reality (VR) as “A collection of technologies that
allow people to interact efficiently with 3D interactive computerised
databases in real time using their natural senses and skills and
innovative sub-conscious.” The definition states only 10% of applications
warrant the use of headsets, gloves and suits.

Virtual Reality was initially defined by Lanier (2) as an Immersive
Virtual Reality where the user becomes fully immersed in an artificial,
three dimensional world that is completely generated by a computer. Today
the term ‘Virtual Reality’ is used in a variety of ways and often in a
confusing and misleading manner. Originally the ‘Virtual Reality’ referred
to by Lanier was a completely immersive 3D environment using the headsets,
gloves and suits that McCloy dismisses. These are the devices that placed
the operator completely inside any virtual environment ensuring that
everything seen and heard, irrespective of location, was a three
dimensional computer generated image. This is now termed ‘Immersive
Virtual Reality’.

McCloy’s article refers to the MIST system, VR simulators for
venepuncture, gastroscopy, cholagiopancreatography, colonoscopy,
angiography and lumbar puncture procedures. These Virtual Reality
simulators should not be termed ‘Virtual Reality’ but in fact ‘Non-
Immersive Virtual Reality’ as all of the simulators mentioned in the
article are 3D images viewed on a 2 dimensional screen. They are exactly
the same as any 3D computer game interacted with different controllers,
for example a mouse or a joystick.

We believe Immersive Virtual Reality in a truly virtual environment has
much greater potential in the development of surgical training systems
rather than in a non-immersive virtual environment.


Vascular Surgery SHO

Mr M J G O’Reilly FRCS

Consultant Vascular Surgeon
Vascular Unit – Level 5,
Belfast City Hospital,


1) Rory McCloy, Robert Stone, BMJ2001;323:912-915

2) Jaron Lanier – Founder of VPL Research Inc. 1989 (Visual Programming
Language) Ref. to

Competing interests: No competing interests

11 December 2001
Jonathan Kirk
Vascular Surgical SHO
Belfast City Hospital BT9 7AM