TeleMed.Virtual: Surgeons in cyberspace

Virtual reality, the ultimate "telemedicine" technology, is getting closer to reality.

"Telepresence surgery," during which a surgeon operates on a patient by remote control, appears likely to become the first virtual-reality technology in use. Defense Department researchers have used it in simulations that range from placing stitches to slicing a grape.

Even more ambitious work is under way to develop a "virtual person," a three-dimensional computer program that would put surgical students in anatomical cyberspace. This lifelike animation would present nearly every sight, sound and tactile dimension of actual surgery.

Sound impossible? Think again.

"We are two or three years away from the feasibility of using telepresence surgery and another two or three years away from developing the virtual person," said Army Brig. Gen. Russ Zajtchuk, MD, who heads a Defense Department project on the subject. Dr. Zajtchuk formerly was commander of Brooke Army Medical Center in San Antonio, which is affiliated with the Health Science Center.

Virtual reality's supporters say it has immeasurable potential for medical training and for treating battlefield casualties or the injured at the scene of a catastrophe.

"You could have your specialist in a room at Fort Bragg, and he could be operating on casualties halfway around the world," said Jay D. Mabrey, MD, a former Army major who joined the Health Science Science in 1993 as an assistant professor of orthopaedics. "The surgeon transmits all his instructions to a robot that can manipulate the patient, make incisions and sew."

Dr. Mabrey is acquainted with high-tech battlefield medicine. He was a staff orthopaedic surgeon with the 24th Infantry Division at Fort Stewart, Ga., and later did reconstructive surgery at Brooke. He also was a consultant to the John F. Kennedy Special Warfare Center and School in Fort Bragg, which runs a think tank on medical issues that affect special-operations units such as the SEALS and Green Berets.

"We brainstormed ideas by asking ourselves, 'How do we provide the best medical care in the world without parachuting in the best doctors in the world?'" Dr. Mabrey said.

"My idea was the 'doc in the box,'" he said.

The "doc in the box," or surgipod, would be a self-powered unit shaped like a shoe box, but about 10 feet long and 4 feet wide and high. Airplanes could drop the surgipod into a battle zone. Medics would place the patient in the surgipod cocoon. An audio-video hookup would activate and robotic devices inside would perform surgery as directed by a surgeon at a remote site.

The surgeon would wear a DataGlove, a highly-evolved descendant of the joy stick that responds to any finger or hand motion and imparts tactile sensations back to the user. "For example, I would pick up a needle and start sewing. I would feel the resistance and feel where I am putting it in," said Dr. Zajtchuk.

The military also is adapting the technology for "telementoring," which would allow a specialist at a remote site to consult or even help with a distant surgery.

"Let's say I'm a surgeon and I need to perform a very complex heart operation. I could summon any of the top experts in this field to be present with me in the operating room. They don't necessarily have to put the stitches in, but they could advise me as to what to do and what not to do," said Dr. Zajtchuk.

"This is dual-use technology. It has obvious advantages on the battlefield, where you don't have a neurosurgeon, a heart surgeon or other specialists. But it also could be of great help to victims of an accident or major disaster," he said.

The military is working with SRI International in Menlo Park, Calif., on the virtual-reality applications.

Dr. Zajtchuk said virtual-reality "humans" would be excellent for training surgeons, and might one day become an accepted instructional tool much like flight simulators for pilots. Users manipulate objects with the DataGlove and view their work using stereo goggles.

There is one drawback -- computer power. Defense researchers developing a virtual-reality abdomen say that the imagery and accompanying requirements for movement and tactile dimension are too great for present-day computers. Workstations now can generate about 50 percent to 75 percent of the power needed to support the virtual reality program, they said.

But technology's hurdles seem to vanish with time and futurists see a major role for this new generation of telemedicine by the year 2020.