Virtual Reality, Intraoperative Navigation, and Telepresence Surgery

Abstract

A part of the expertise of the operating surgeon is the practiced development of motor skills. These skills are attained by practice in multiple environments, including the animal laboratory and the operating room. The surgeon starts as a surgical assistant and gradually is granted increased responsibilities in performing the critical portions of operative procedures. Building on many years of experience using types of radiographic images of the brain and spine for intraoperative navigation, neurosurgeons, working with bioengineers and computer scientists, have developed methods of image-guided computer-assisted and computer-directed operative procedures using anatomic and pathologic structures identified in volumetric three dimension reformatted brain and spine images co-registered to the physical operative workspace using a variety of three-dimensional digitizers. With the computation power available today, such image sets can be used to create a virtual environment within which a surgeon could realistically both practice skills and attain new skills. This can now be accomplished with partial immersion. It is realistic to contemplate in the near future a total immersion environment realistically simulating all of the sensations and forces associated with an actual operative field. We have termed this development a “surgical holodeck.” This chapter reviews the development and application of these methods, which are the foundation of a simulation environment close to the real operative suite.