A New Paradigm in Visualizing Surgical Process Information: Introducing Digital Surgery’s Mixed Reality Partnership with Microsoft and the Holo External Fixation Application

At Digital Surgery, we have spent over 5 years thinking about and designing products that disseminate the right surgical process information, to the right team member, at the right time. Our flagship product, Touch Surgery, a cognitive training tool, utilized the advent of the mobile phone – a power personal computer in the pockets of consumers – to bring high-quality, step-by-step surgical process information to users for training. In this undertaking, we’ve learned a lot about how surgeons and surgical team members cognitively process information.

These learning are why we are so excited about being designated as an official Microsoft Mixed Reality Partner. Humans brains can process images that the eye sees for as little as 13 milliseconds – this means the brain, after very brief exposure to visual cues, can make conceptual links to relevant memories, and redirect our eyes to the next target (Potter MC et al., Attention, Perception, & Psychophysics, 2014). Studies have also estimated that at least 65% of the population are ‘visual learners’. We know this first hand because two years ago, when we began research and development on our intraoperative coordination tool, GoSurgery, we strongly believed the ideal “packing” for intraoperative surgical process information to be simple visual cues. At the time, we even worked with leading surgeons at University College London Hospitals (UCLH) to explore the limits of the available hardware, Google Glass.  

Above: Mr Manish Chad, Consultant Colorectal Surgeon and Senior Lecturer, UCLH, exploring 3D assets we created.

We quickly learned however, that we were going to face large and challenging hardware limitations. This is why we are so excited about the opportunity to partner with Microsoft, which will allow us to develop truly immersive, 3D visual experiences for surgical teams outside of the operating room (OR) for training, and eventually, inside of the OR for performance.

We are extremely proud to have released the world’s first publicly available AR surgical training application for Microsoft HoloLens, Holo External Fixation. This interactive, immersive experience provides step-by-step guidance for performing an external fixation fracture reduction procedure. External fixations are performed by most or all orthopedic surgeons throughout their careers, due to the large number of conditions which require the procedure. Studies have pinpointed a high failure rate for the operation, of about 5-20%, which hold both financial implications for the health system (average cost of the external fixator is around $6000) and clinical implications for the patient. Key steps are visualized using high-quality holograms of the relevant anatomy and instruments, and a medically-reviewed audio narration guides the user through each step of the procedure.

Holo External Fixation is now publicly available. We produced this training application as part of Microsoft’s Mixed Reality Partnership programme, and in collaboration with Orthopaedics and Trauma, University College London Hospitals, who provided their invaluable surgical expertise and advice throughout the process

Preliminary feedback has been positive, with orthopaedic surgeons indicating their confidence in Holo External Fixation’s utility as a learning tool for students and trainees. The training application has been nominated for this year’s Auggie Awards, jointly presented by AWE, IEEE and VR First to recognize innovation and excellence in the field of VR and AR technology.

We see great potential in VR and AR technology to augment the quality and scalability of surgical training, but also the way teams perform surgery. On the training side, traditional educational resources, such as lecture slides, textbooks and videos, simply do not provide adequate development of spatial and cognitive expertise. Hands-on demonstrations and practice on cadavers or live patients, classically regarded as the optimal mode of surgical training, are expensive, time-consuming, and incapable of supporting more than a handful of trainees per session. On the performance side, studies have demonstrated that team communication and the decision-making skills of surgeons and teams are crucial determinants of surgical outcome.

Applications such as our HoloLens Holo External Fixation offer a high-fidelity, portable and infinitely repeatable learning option for medical schools and surgical residency programs. One day, we foresee integration with our GoSurgery product in the OR to help ensure safe surgery for all.