Intended for healthcare professionals

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

Surgery in the digital era

I congratulate Rory McCloy et al upon their ‘virtual surgical’
technologies overview. One of the problems of using the term virtual
reality (VR) is the lack of a clear definition of the oxymoron, but I
would consider it delivery of virtual environments that portray sensory
stimuli, which are convincing to the user. This is multimedia. The key to
development of sophisticated virtual environments is to generate
satisfactory realism to convey the experience required for the (learning)
task. This provides autonomy of the model, interactivity and the sense of

The question then arises; What is useful? In 1998 a population of trainee
surgeons using the Exeter Virtual Worlds Simulator (EVW) demonstrated the
need for visual and haptic (force) feedback to be the most important
aspects of developing useful surgical simulation. The ‘Holy Grail’ is the
all encompassing totally realistic near real time simulation that is both
fully interactive and behaves like the real world. Groups across Europe
are striving to develop such systems, for example the EU sponsored Virtual
Orthopaedic European University Project (IST 13079-1999) involving four
different approaches of which the EVW system is one. Let us hope that the
fusion of experience from the MIST and Mentice commercial systems outlined
in the article would assist with the ongoing evolutionary process.

Perhaps key issue is not one of whether we can creep forward through
evolution of digital substitutes for other education, training and archive
technologies, but whether we can promote the revolution of clinical
practise through the integration of pervasive computing technologies, e.g.
using both ‘Just In Time’ as well as ‘Just In Case’ educational
strategies, providing tools that where of benefit, deliver anonymised
patient specific data to the user in a virtual environment that is
seamlessly integrated into an educational pedagogy. People need to strive
for the vision.

Competing interests: No competing interests

02 November 2001
Simon Grange
Orthopaedic Specialist Registrar
Tim Bunker
Salisbury District Hospital