VR flythrough helps surgeons, patients alike prepare for surgery

At Hoag Hospital in California, the same technology is paying dividends for patient engagement and surgical outcomes.
By Jonah Comstock
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(L to R) Dr. Nick Patel, an audience volunteer, and Dr. Robert Louis demonstrate the system (Photo by Jonah Comstock).

Dr. Robert Louis, director of the skull base and pituitary tumor program at the Hoag Neurosciences Institute, didn’t set out to use virtual reality as a tool for patient engagement. 

Originally, Louis explained during a session at HIMSS19, his department was using the technology — which turns two-dimensional radiology images into a three-dimensional virtual reality flythrough — for surgical preparation, as a sort of virtual trial run of surgeries.

“I was practicing a surgical case and using it to rehearse, and based on the VR rehearsal I realized that the plan that I had was not going to work for this patient,” Louis said.

The perspective offered by the tool let Louis see that a small part of the brain tumor he was removing would be obscured by the optic nerve, and had he gone in the way he originally planned the patient might have lost their vision, or he wouldn’t have been able to fully remove the tumor. So he found an alternate approach.

“Then I’m stuck with ‘The second plan is the right way to do this,' but now I’m thinking about how I go back to the patient and say ‘You know what, we really didn’t know what we were doing 15 minutes ago’,” he said. “…So we said, let’s show him. Let’s take the surgical theater system out to the pre-op theater and show the patient.”

Not only did it work in that first instance, but the patient’s response was so positive Louis and his colleagues started thinking about using the system in that way on a regular basis. Now they’ve rolled it out across a number of different specialties and studied the effect of the intervention in several different facilities.

For one thing, they found that the original use case of surgical planning and practice was very worthwhile.

“[A] paper that was published at NYU showed that senior surgeons, planning based off of 2D MRIs and then redoing the planning based on virtual reality, changed their surgical plan 24 percent of the time,” he said. “They found the same thing at Stanford, and we found the same thing. Nearly a quarter of the time, the surgeons would have done an incorrect or suboptimal operation had it not been for rehearsing in VR.”

But the patient engagement use case also produced a large measurable effect. Namely, Hoag dropped its attrition rate, the rate of patients that choose to go elsewhere for a surgery after a consult at Hoag, from 36 percent to 4 percent since they started using VR for patient education.

“When we’re trying to talk to the administration about the ROI for this, they say ‘This is a cool toy but do you really need it?’,” Louis said. “Well when we’re holding on to an additional 50, 60, 100 neurosurgery patients a year as a result, then it pays for itself in less than a year.”