Stanford Surgeons Use VR to Enhance Education

October 18, 2017

Pediatric Surgeon Dr. Matias Bruzoni (right) performs an operation while wearing a GoPRO camera.

The room is dark except for the small section of abdomen illuminated by the surgical lights overhead. The steady chirp of the heart monitor fills your ears, and you glance up to see the anesthesiologist monitoring your patient’s vitals before holding out your hand for the scrub nurse to place the scalpel. 

But the sensation of cold, hard surgical steel in your hand never comes. Because you aren’t performing surgery. You aren’t even in an operating room (OR). This is virtual reality (VR). 

“The gold standard in surgical education is to observe a procedure in-person, a video gives you one angle which is usually on the focal point of the surgery, but VR brings you closer to that immersive feeling,” said Dr. James Wall, an assistant professor of pediatric surgery and assistant fellowship director at the Stanford Byers Center for Biodesign at Stanford University. 

In 2015, Wall received an email pitch from Brian Conyer, then an MBA student at the University of Southern California, about his desire to create the “Netflix of surgical education.” 

“I get an email like his once a week, but this one caught my eye,” said Wall. “I’m a big advocate of education through video having used videos from WebSurg as a resident to prepare for cases. I think videos should be required preparation for medical students and trainees who will be participating in procedures.”

Wall has been offering mentorship and encouragement to Conyer ever since. Today, Conyer is CEO and co-founder of GIBLIB, an online library of surgical videos and medical lectures.

“I saw the opportunity to build a database of videos showing every surgical procedure performed by the best surgeons,” said Conyer. “No matter what period you’re at in your education, you could search GIBLIB and see the surgery.” 

Conyer and GIBLIB started filming Wall’s surgeries at Lucile Packard Children’s Hospital (LPCH) earlier this year and has since expanded, recording procedures performed by other surgeons in the Division of Pediatric Surgery as well as doctors in the Division of Plastic and Reconstructive Surgery and the Department of Neurosurgery.

“Unlike most surgical videos, there’s very little editing [with GIBLIB], because they want to make it as real as possible,” said Dr. Matias Bruzoni, an assistant professor of pediatric surgery at Stanford. “With VR you can see the whole OR. You can see the graspers and then look back at the screen. You can see what the scrub tech is doing and the anesthesiologist. There’s a lot happening in the OR beyond the surgery itself.”

With VR you can see the whole OR. You can see the graspers and then look back at the screen. You can see what the scrub tech is doing and the anesthesiologist. There’s a lot happening in the OR beyond the surgery itself.

Bruzoni says he hopes to use the videos to augment his instruction for surgical residents and fellows. 

“If I ever have any of these same cases, I can sit down with the resident or fellow beforehand and go over the procedure,” said Bruzoni.

Dr. Rohit Khosla, an assistant professor of plastic and reconstructive surgery at Stanford, also says that he plans to use the videos with Stanford plastic surgery residents and fellows as well as medical students.

“Once I record more craniofacial videos, I’ll have our residents and fellows log in to GIBLIB so they can familiarize themselves with the procedures and techniques before they ever get into the operating room,” said Khosla, who has published two videos with GIBLIB and is excited to do more. 

Educational applications for the GIBLIB videos seem limitless. While Khosla is taking his videos abroad to help teach surgeons in Vietnam, Bruzoni hopes to submit his video of a rare common bile duct exploration of a 3-month-old to medical conferences. Wall has particular interest in GIBLIB not only as an instructional tool for surgical residents but for non-medical professionals as well. 

“Biodesign is all about observing problems in healthcare and developing technology to solve them,” said Wall. “You can get five to 10 students into the hospital, but you can’t scale it to hundreds or thousands. GIBLIB allows great minds see what we’re doing and help improve it.”

GIBLIB uses a plethora of tools to record each surgery so they can be offered to viewers in a variety of formats including 4K and VR. 

“I tasked my team with figuring out how to produce the best quality videos without scaring the hospital and interfering with the surgery,” said Conyer. “All of the equipment is battery-operated, Wi-Fi-enabled, and fits in a backpack.”

Far from intruding on their work, the surgeons who have filmed with GIBLIB say the technology makes them better teachers. 

“[Teaching a procedure] challenges me to describe every step, think out loud, and that’s what keeps you on your toes as an academic surgeon,” said Wall. “That’s even more true when filming a GIBLIB, because you’re thinking in your mind ‘how big of an audience is this?’ You want to make the content approachable for every level of learner.”

Currently, GIBLIB has only been approved to film in the operating rooms at LPCH, but both Conyer and those at the Division of Plastic and Reconstructive Surgery are hopeful the technology will be approved for use at Stanford Hospital soon. 

 “As a division, we recognize that these technologies have the ability to positively impact and improve how we educate future surgeons and provide care to our patients,” said Laksman Veeravagu, an administrative associate in the Division of Plastic Surgery who was tasked with identifying new ways their surgeons could integrate technology into their program. “We look forward to continuing the relationship with GIBLIB and other organizations that are disrupting the medical field for good.”

*None of the LPCH physicians mentioned in this article have a financial interest in GIBLIB.