Keyhole surgery could account for 80% of all operations within the next 10 years, says a UK government report commissioned by the Scottish Office and Department of Health. But reports of complications during operations, even death, has led the Department to clamp down on its usage. Called keyhole surgery because the surgeon operates through a small incision, viewing the patient’s insides via a miniature camera inserted using an endoscope, it has been claimed to be less painful, cause fewer wound infections and involve a quicker recovery period than open surgery. But it takes excellent eye-to-hand co-ordination to guide the telescopic tube into the correct position by viewing what’s happening on a television monitor. And this needs different skills and, therefore, training from what most surgeons have. Lack of proper training is cited as the main reason behind the failed operations. But now Virtual Presence Ltd, a small London-based virtual reality software developer and reseller believes that it has the solution.
Simulator for surgeons
It has developed a simulator for surgeons to perform virtual keyhole surgery. The company says the simulator, called MISTvr, is a cheaper alternative to practising on dead people. It enables surgeons to develop the necessary co-ordination skills by teaching them how to manipulate endoscopic instruments. Virtual reality systems for surgical training already exist but they have been targeted at full-blown anatomical and physiological simulations requiring the use of expensive graphics supercomputers, says the company. In contrast, MistVR runs under Windows on a Pentium personal computer. The simulator costs ú10,000 for the basic system, including the cost of installation, maintenance and support. The three authorised training centres for minimally-invasive surgery in Leeds, London and Dundee charge ú500 per hour so the system would not take long to pay for itself. MISTvr was developed in conjunction with Intelligent Systems Solutions Ltd, a virtual reality systems and software house in Salford, Lancashire. It is being tested at the Manchester Royal Infirmary. If installed, the system will replace the non-computer-based simulation techniques still widely used. These mainly involve practice on headless and armless torsos covered with raw chicken tissue or the type of material used in wetsuits, to simulate human tissue. MISTvr comprises a pair of forceps, linked to a personal computer with a Diamond Viper graphics board to boost graphics performance. The forceps contain sensors that link their movements to the movement of objects on the screen. Trainees use the forceps to simulate actions they would perform in an operation. Users follow on-screen instructions to complete particular tasks, such as moving an object around a circle without touching the sides, or picking up a block and placing it exactly on top of another. If an object is mistakenly touched it flashes and the user tries again.
By Krishna Roy
The system is linked to a central database so trainees can record their scores and compare them with an experienced surgeon, class average or their own previous results. Intelligent Solutions developed the multimedia speech and video functions that explain the relevance of each stage in the training procedure to actual surgical practice. The forceps are supplied by US robotic arm and surgical tools specialist Emersion Corp. Virtual Presence developed the three-dimensional graphics for the current system and is working on future enhancements. One such improvement will be the addition of force feedback, which enables users to feel resistance through the forceps when they mistakenly touch or cut through objects, to try to recreate the sensation of cutting through skin. Virtual Presence has not always been in the business of virtual reality. It started out in 1991 producing bespoke accounting and database software. But John Hough, managing director, soon realised the company needed to change direction if it were to prosper. Nobody will pay for bespoke
databases at the end of the 1990s so we had to find some future-proof technology, we looked at artificial intelligence and neural networks but we needed something cheaper, he said. Hough plumped for virtual reality, steering the company towards the reseller market and Virtual Presence became the main European reseller for Sens8 Corp, Mill Valley, California, which created the WorldToolKit software package for developing virtual reality applications for Sparc and Silicon Graphics Inc workstations. A cut-down version was used to develop MISTvr. Hough reckons Virtual Presence is now the largest independent virtual reality vendor in Europe. In addition to the role of product vendor, Hough set up a consultancy service for company’s looking into the commercial possibilities of virtual reality software. Last year Virtual Presence sold off the company’s accounting and database business, Strategy in Computing Ltd, in order to focus entirely on the virtual reality business. Since then it has developed its software development business and has set up an applications division. The first product, launched last year, was Genesis, a virtual reality application development package, originally developed to work with WorldToolkit, but now an off-the-shelf rapid prototyping tool for creating virtual worlds. The company then took Genesis, substituted the programmer libraries within it for Virtual Reality Mark-up Language design libraries, and created G Web, an authoring tool for creating three-dimensional Web pages launched earlier this year (CI No 2,671). Hough sees G Web being used in three main areas, as a marketing tool for companies promoting or selling their products on the Web – British Telecommunications Plc is using it to create a virtual shopping mall which users walk through to look at products; as a means to share three-dimensional data such as architectural files across the Internet; and as a basic programing tool for games writers.
Virtual Web pages
He believes it’s the only authoring tool currently on the market specifically designed for virtual reality Web pages. We’d like to ship 1,000 units in the first year, he says. In-house software product development seems to be the direction in which the company is now heading. We’ve gone from selling low volume products with high profit margins to higher volume cheaper products, he said. The company’s revenues reached ú1m in 1994, 80% of which came from the reseller business, 20% from software sales. Hough wants to shift the balance towards a 60-40 split. To achieve this, the company needs to concentrate on product development and it needs capital to do this. To safeguard Virtual Presence’s future, Hough is now looking to raise ú500,000 from outside sources within the next six months, and is also considering a US partner to take G Web to US markets.
