January 2, 2023 /OrthoSpineNews/ – In December 2022, history was made by Dr. Brian Fiani when he hosted a virtual reality spine surgery seminar in the Metaverse for 50 spine surgeons from 10 different countries. The demonstration was a massive success. Dr. Fiani was one of the very first neurosurgeons to publish on virtual reality when he published his paper “Virtual Reality in Neurosurgery: “Can You See It?”-A Review of the Current Applications and Future Potential” in early 2020, a paper with more than 20,000 views and cited over 1600 times to-date. Since then, he has continued to be a pioneer in the evolution of surgical technology and an advocate for its use in the operating room. Dr. Fiani has always been intrigued by the power of innovation and what it offers surgeons and patients. As a boy, he was a creative thinker coming up with new inventions and he credits this passion as one of his motivations for pursuing spine surgery. He has worked with several companies over the years to develop software and hardware components for intraoperative technology that has been breaking barriers in the operating room and expanding capabilities. Already a patent holder, Dr. Fiani’s ultimate goal with surgical technology is to improve patient care in the operating room.
Dr. Fiani says that technology and innovation are constantly evolving and new developments keep the modernization of medicine interesting. To him, virtual reality is the meeting place of creativity and science. Virtual reality gives participants the ability to do things that we cannot do in the real world. Some of the special surgical teaching features include visualizing 3-dimentional reconstructions pre-operatively, surgical planning, surgical simulations, and post-operative analysis all while decentralizing surgical education so that participants can be anywhere in the world at that particular time.
The virtual reality seminar was held at the New York City Minimally Invasive Spine Surgery (NYC-MISS) Symposium in New York City, New York, USA on December 15-17, 2022. During the 2-day lesson plan, participants activated headsets that produced 3-dimentional visualization capabilities and hand controls for limitless movement and action features.
50 spine surgeons from 10 different countries joined! Over 30 of the world’s masters in spine surgery joined in the Metaverse and another 20 spine surgeons chose to watch without headsets because the virtual reality world was simultaneously broadcasted into the real world auditorium screens by one of the representatives within the Metaverse.
In preparation, Dr. Fiani worked with a company named Non Nocere from Germany. The company gains its name from the phrase “primum non nocere” which in Latin means “first, do no harm”. They shipped all the state-of-the-art headsets and hand controls to New York City for the event. They overnight mailed him a headset and controls to practice one week before the event. The program technicians and sales representatives from Germany and Turkey trained him and helped him practice using the Metaverse features for several days. It was proof of product that they met in the Metaverse from three different countries at the same time to accomplish a goal. The company made the process very user-friendly for him. They downloaded preoperative and postoperative imaging, as well as, his slideshow presentations from 4 surgical cases. The 4 surgeries were categorized as degenerative spine surgery, spinal tumor surgery, deformity surgery, and revision surgery. Within the few days of preparation, he became comfortable with the Metaverse surgical auditorium which functions as a lecture hall and virtual anatomy lab and also the virtual reality operating room which functions as a surgical simulator lab.
Dr. Fiani commented that the system was very intuitive and after a few minutes you feel at one with the virtual reality world and its ongoings. The hand controls make maneuvering simple and the actions give haptic feedback. The system is instantaneously responsive without glitch or delay.
Dr. Fiani says that virtual reality is transforming spine surgery education. During the Covid-19 pandemic and even afterwards, people were gathering on Zoom as a platform for meetings. He believes virtual reality is the natural evolution for enhancing engagement by creating a space for discussions and interaction. Decentralizing surgical education allows international participation which is particularly important in the fields of medicine and surgery. The virtual reality Metaverse allows surgeons to simulate surgeries before performing them.
Virtual reality allows the presenter and participants to be engaged in one place while logging on from anywhere in the world internationally. Reconstructed models based on patient imaging allows better visualization of simulated spine models and practice surgeries beforehand. Surgical simulation can help provided repetitious training in a safe environment to create a quicker more efficient workflow in the real world for younger surgeons and lower learning curves with new products for experienced surgeons.
The virtual reality sessions occurred over two days. On the first day, the participants gathered in the real-world auditorium here in New York City and logged on with their headsets and hand controls and learned the basics of maneuvering to become comfortable with the Metaverse. Two technicians and sales representatives were present in the auditorium room to assist participants. One software programmer was inside the Metaverse to assist there. He presented two case presentations, each with an elaborate slideshow presentation that was downloaded into the Metaverse and projected onto what would appear to be a 100 foot screen by real-world estimation. Pre-operative imaging was shown including xrays, CT scans, and MRI scans with scrolling capability. One case was cervical spondylotic myelopathy and one was lumbar deformity. The software constructed large 30 foot models using preoperative imaging. The imaging was also superimposed onto the model and we used features to select-in or select-out parts of the anatomy to better view what was behind or around it, for example, removing the bone to see the compression on the spinal cord. These two cases were presented so that participants could perform their desired surgical plan in the real-world cadaver lab the following morning. On the second day, participants were now more comfortable with the Metaverse which allowed excellent academic discussion to take place. He hosted 2 more case presentations with slideshow presentations including intraoperative footage. The constructed pre-op model displayed the tumor with great specificity and the postop model displayed its resection and placement on instrumentation for our tumor case. The revision surgery case demonstrated the virtual reality ability to preoperatively measure screw and rod sizes and compare to our postoperative model constructed from imaging.
The participants were in awe. The world’s best spine surgeons of master-class level were having the time of their lives. The participants enjoyed the audio-visual quality with haptic feedback, the life-like spine anatomy models, the projection of imported CT and MRI scans, and the surgical simulation features. The surgeons were like children discovering new toys on Christmas morning. The site of smiles, the sound of laughter, and the appearance of curiosity filled the auditorium.
Dr. Fiani is excited about the future of virtual reality (VR) and augmented reality (AR) for spine surgery. VR will continue to be more life-like with computer-brain synchronizing and the headsets will become lighter to the point where they become glasses and maybe even contact lens. VR hand controls will likely become gloves for more realistic movements and control to simulate actions and surgical simulations. In regards to AR, headsets will also become lighter and smaller and shift to glasses or contact lens. More companies will be created and competition will grow. When it comes to the future Dr. Fiani says “in the very near future, quite possibly in the year 2023, I will be hosting the first annual virtual reality spine surgery conference. Stay tuned, planning has already begun.”
Dr. Brian Fiani