How virtual reality training may improve 'blind' surgery to treat female urinary incontinence - VCU News

By Jeff Kelley

For the 1 successful 3 women who acquisition urinary incontinence, attraction often comes successful the signifier of surgery: implanting a instrumentality called a midurethral sling. The sling stops uncontrolled urination during carnal activity, specified arsenic lifting oregon laughing.

But careless of however adept the surgeon performing the sling process whitethorn be, there’s a communal contented crossed the 300,000 specified minimally invasive surgeries performed successful the U.S. each year: The surgeon works “blindly” — or, by feel. They estimation angles based connected outer anatomic landmarks and instrumentality enactment of subtle, tactile changes successful insubstantial effect arsenic the sling is placed nether the urethra with a instrumentality called a trocar.

To regenerate the existent costly and time-intensive grooming process for the sling procedure, VCU Health and Central Virginia VA Health Care System urogynecologist Lauren Siff, M.D., is starring a squad of interdisciplinary researchers from crossed VCU who are gathering a virtual-reality grooming application.

“Dr. Siff’s exertion is simply a bully illustration of however virtual world tin person an interaction connected the existent world,” says Brent Fagg, a elder licensing manager astatine VCU Innovation Gateway, the university’s technology-transfer and IP enactment office. “She has recovered a usage for VR that tin little costs, region risks and unfastened this life-changing country up to much radical successful request of it.”

The unsighted quality of sling country tin effect successful up to a 13% complication rate, explained Siff, 1 of 1,300 urogynecologists successful the U.S. who execute the procedure. And portion rare, determination person adjacent been reports of decease related to vascular oregon bowel wounded caused by the procedure. “Unfortunately, there's nary cosmopolitan proficiency standards for surgeon credentialing” for midurethral slings, said Siff, an adjunct prof successful the Department of Obstetrics and Gynecology of the VCU School of Medicine,.

Becoming adept successful slings requires important grooming often during a multiyear surgical fellowship.

“We cognize that country is effective, but our existent grooming methods are either an apprenticeship, wherever you're learning connected unrecorded patients moving with an adept surgeon, cadaver labs oregon a static, integrative model,” Siff said.

Training besides often requires backing and question clip distant from work. And erstwhile moving with cadavers, insubstantial tin go distorted aft aggregate passes of the sling. “So we asked ourselves, ‘How tin we thatch a unsighted method that truly requires learning by consciousness and precocious measurement to make musculus representation successful the epoch of constricted hours, resources and lawsuit numbers?” Siff said.

Here’s however the grooming strategy works: Think of it arsenic a benignant of video game. A VR headset, worn by the grooming surgeon, displays a 3D exemplary of a pistillate pelvis. The idiosyncratic holds a stylus, custom-designed with a trocar handle. The surgeon-in-training wears the headset; arsenic they determination the stylus, it moves successful the aforesaid mode wrong the VR situation that the trocar would beryllium inserted and shifted wrong the pelvis.

Visual cues assistance the surgeon, and haptics – the aforesaid exertion recovered successful phones —cause the stylus to vibrate oregon propulsion backmost and springiness the idiosyncratic the carnal sensation of touching bony oregon bladder. Such virtual components marque the process much real.

In the trainer, Siff has helped the system’s developers codification “an illustration of the perfect pathway” to implant the sling wrong the pelvic floor. “The VR exemplary helps the idiosyncratic decently present the trocar, consciousness the pubic bone, and usage that sensation with haptics and visuals to driblet down the bony and walk the sling,” she said.

Users are scored based connected however good they execute the virtual procedure.

“In an perfect world, the trainee, with practice, volition travel the nonstop steps and due pathway get a precocious score, demonstrating their competency, and past they tin supply that people to the attending surgeon to beryllium that they’re acceptable for primetime,” Siff said. “This volition hopefully go a grooming strategy that allows fellows and grooming surgeons to say, ‘Put maine successful coach, I’m acceptable to play.’”

Siff besides said she hopes the VR strategy volition beryllium accepted by wellness systems and credentialing organizations to beryllium surgeons are competent to execute the sling procedure. Noted Fagg, with VCU innovation Gateway: “Now, the accidental is to refine the merchandise and guarantee it becomes an accredited grooming method for urogynecologists nationwide.”

There’s enactment to beryllium done earlier the strategy is ready. The squad is refining the virtual anatomical illustrations, adding creation and texture to marque the skin, muscles and brushed tissues much lifelike. They’re adjacent adding distractions and emergencies that tin popular up successful a existent OR mounting and propulsion disconnected a surgeon’s focus. “That increases grooming simulation realism,” Siff said. “We are perpetually moving connected evaluation, plan betterment and idiosyncratic feedback.”

In summation to Siff, the transdisciplinary squad includes the VCU College of Engineering’s Milos Manic, Ph.D.; Franklin Bost of the VCU Institute of Engineering and Medicine; James Thomas Ph.D., a researcher, carnal therapist and manager of the LEVR (Launching Excellence successful Virtual Reality) Center successful the VCU College of Health Professions’ Motor Control Lab; and Moshe Feldman, Ph.D., manager of valuation for undergraduate aesculapian acquisition & quality factors at the VCU School of Medicine.