Introduction
Medical students and trainees who want to follow the path of surgery are currently being trained mainly
on cadavers. This method is a good way to have a real anatomical visual and touch feedback,
however it is limited by some factors that current technologies could overcome.
Cadavers are first of all really, really expensive. Performing surgery on a cadaver can cost up to
10,000$ according to FundamentalSurgery [1]. One cadaver can be used to train up to 6 medical
students but not more. Moreover, cadavers experience decomposing, which makes them suitable to be
used just for a limited time period. Their tissues stiffness may change after some days which makes
them not realistic compared to the sense of touch students experience when working with real bodies.
FundamentalSurgery proposes to overcome these limitations by providing medical professionals
with a low cost surgical simulator that combines readily available virtual reality hardware with cutting
edge haptics (the sense of touch) to create a simulation system that can be used on any modern PC set
up [2].
According to FundamentalVR, the company that produced FundamentalSurgery, the benefits of
surgical simulation are well documented: by providing medical trainees a more hands-on experience,
trainees learn better and the patients outcomes are better too. Being this currently done either by
simulating on cadavers or on really expensive surgical simulation systems, a low cost and democratized
one was needed to make this possibility to learn more easily accessible.
on cadavers. This method is a good way to have a real anatomical visual and touch feedback,
however it is limited by some factors that current technologies could overcome.
Cadavers are first of all really, really expensive. Performing surgery on a cadaver can cost up to
10,000$ according to FundamentalSurgery [1]. One cadaver can be used to train up to 6 medical
students but not more. Moreover, cadavers experience decomposing, which makes them suitable to be
used just for a limited time period. Their tissues stiffness may change after some days which makes
them not realistic compared to the sense of touch students experience when working with real bodies.
FundamentalSurgery proposes to overcome these limitations by providing medical professionals
with a low cost surgical simulator that combines readily available virtual reality hardware with cutting
edge haptics (the sense of touch) to create a simulation system that can be used on any modern PC set
up [2].
According to FundamentalVR, the company that produced FundamentalSurgery, the benefits of
surgical simulation are well documented: by providing medical trainees a more hands-on experience,
trainees learn better and the patients outcomes are better too. Being this currently done either by
simulating on cadavers or on really expensive surgical simulation systems, a low cost and democratized
one was needed to make this possibility to learn more easily accessible.
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Overview
The surgical simulator is a software simulation system that can be downloaded to a chosen
hardware. The basic requirements that are needed are a PC or a Laptop with a suitable processor and
graphics card; a VR Headset, which can be either and Oculus Rift or a HTC Vive; and two Geomagic
haptic arms, which are the haptic devices that restore the sense of touch, as the Touch system invented
by the company 3DSystems [3]. Specifics of the three requirements can be read on the company
website.
hardware. The basic requirements that are needed are a PC or a Laptop with a suitable processor and
graphics card; a VR Headset, which can be either and Oculus Rift or a HTC Vive; and two Geomagic
haptic arms, which are the haptic devices that restore the sense of touch, as the Touch system invented
by the company 3DSystems [3]. Specifics of the three requirements can be read on the company
website.
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The FundamentalSurgery system is described by the company as a flight simulator for surgeons,
which I believe is a reliable way to describe such system. The user, once the software is downloaded and
the hardware connected, is able to wear the headset and through that is immersed in a surgical
operational room, where a patient is waiting to go through surgery. From there, the use of the haptic
devices allows the student to operate the patient by using surgical tools as the scalpel, the endoscope,
and many more (depending on the procedure). The combination with the haptic devices allows the
surgeon to feel a resistance when touching the patient’s body that resembles the real resistance that he
would feel during surgery, which allows the trainee to learn to calibrate his forces during surgery not to
harm the patient.
which I believe is a reliable way to describe such system. The user, once the software is downloaded and
the hardware connected, is able to wear the headset and through that is immersed in a surgical
operational room, where a patient is waiting to go through surgery. From there, the use of the haptic
devices allows the student to operate the patient by using surgical tools as the scalpel, the endoscope,
and many more (depending on the procedure). The combination with the haptic devices allows the
surgeon to feel a resistance when touching the patient’s body that resembles the real resistance that he
would feel during surgery, which allows the trainee to learn to calibrate his forces during surgery not to
harm the patient.
The simulated procedures up to now are focused on the Orthopedic specialism but will quickly move into other areas as Laparoscopic, General Surgery, Cardiovascular and others.
The main features of the system are based on:
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For each procedure, the overview, the learning objectives and the assessment criteria are listed.
Based on what the website lists, it is impressive how many assessment criteria there are. The user
seems to be graded based on many different factors which makes me wonder how accurate this system
can be and how they evaluate the performance.
Based on what the website lists, it is impressive how many assessment criteria there are. The user
seems to be graded based on many different factors which makes me wonder how accurate this system
can be and how they evaluate the performance.
Specifics
FundamentalSurgery needs specific requirements to give the user the intended experience.
Besided the three fundamental hardware parts cited above, the computer needs to have a suitable
processor (Intel i7 or above) and a graphics card (GTX 1080 or a above). The space needed for simulation
needs to be ideally 5ftx5ft, but can be set up also in smaller spaces. The height of the haptics arms needs
to be adjusted to a correct height depending on the user height. Internet access is required only to
launch the application and verify the license number, after that, it is not needed anymore.
Besided the three fundamental hardware parts cited above, the computer needs to have a suitable
processor (Intel i7 or above) and a graphics card (GTX 1080 or a above). The space needed for simulation
needs to be ideally 5ftx5ft, but can be set up also in smaller spaces. The height of the haptics arms needs
to be adjusted to a correct height depending on the user height. Internet access is required only to
launch the application and verify the license number, after that, it is not needed anymore.
Accreditation
FundamentalSurgery simulations are confirmed as activities that can contribute to the
Continuing Professional Development (CPD) of the individual surgeon, for which up to 6 CPD points can
be claimed. CPD is a process that recognizes surgeons as clinical specialists but also experts in other
multidisciplinary settings - as manager and communicators. The company continues to seek and work
with other medical companies to increase their value and justify in medical training.
Continuing Professional Development (CPD) of the individual surgeon, for which up to 6 CPD points can
be claimed. CPD is a process that recognizes surgeons as clinical specialists but also experts in other
multidisciplinary settings - as manager and communicators. The company continues to seek and work
with other medical companies to increase their value and justify in medical training.
Fundamental Surgery is a tool developed by FundamentalVR [4]. FundamentalVR aims at
training experts and technologist through simulations that are low cost and use easy accessible
technology.
training experts and technologist through simulations that are low cost and use easy accessible
technology.
Use of VR
It is clear how the use of Virtual Reality in FundamentalSurgery is needed to deliver the best
experience possible to the user. Having a VR Headset that immerses the user into the OR makes everything
more realistic as well as allowing the user to see and interact with the virtual patient. The virtual reality
environment allows the development of multiple surgical outcomes with realistic visuals representing an
alive body reacting to the procedure: blood, tissue damage, deformation and so on. Through VR, the
same simulator can be used practically infinite times at almost zero cost besides the set up and hardware
cost, which is still presumed to be around 1⁄4 of the cadaver's cost. The same set up can train multiple students (one
at a time).
experience possible to the user. Having a VR Headset that immerses the user into the OR makes everything
more realistic as well as allowing the user to see and interact with the virtual patient. The virtual reality
environment allows the development of multiple surgical outcomes with realistic visuals representing an
alive body reacting to the procedure: blood, tissue damage, deformation and so on. Through VR, the
same simulator can be used practically infinite times at almost zero cost besides the set up and hardware
cost, which is still presumed to be around 1⁄4 of the cadaver's cost. The same set up can train multiple students (one
at a time).
Quality control and evaluation
Fundamental Surgery has been studied under different validation research projects to ensure the
validity of their products. The main aim of these project was to validate whether the platform provided
realistic virtual reality and haptic experience but also an effective learning tool. The platform learning
objectives suggest that the company aims at teaching both medical students but also attending level
surgeons. The users are validated both on their surgical objectives and their technical skills. Two validation
studies were published by FundamentalVR to provide further evidence of the company validity and
product value. Both studies ([5] and [6]) can be found on the FundamentalSurgery platform website.
The company collaborates with experts to continuously evaluate the education experience provided and
provide feedback during platform development.
Being the quality of simulation the most important requirement and objective of the company, the
platform is evaluated through a multisensory surgical task analysis in which the most important aspects
of the the surgical procedure are assessed. The company collaborates with world leading key opinion
leaders (KOLs) in surgery. Through the multisensory surgical task analysis a simulation that focuses on the
key learning outcomes is created.
validity of their products. The main aim of these project was to validate whether the platform provided
realistic virtual reality and haptic experience but also an effective learning tool. The platform learning
objectives suggest that the company aims at teaching both medical students but also attending level
surgeons. The users are validated both on their surgical objectives and their technical skills. Two validation
studies were published by FundamentalVR to provide further evidence of the company validity and
product value. Both studies ([5] and [6]) can be found on the FundamentalSurgery platform website.
The company collaborates with experts to continuously evaluate the education experience provided and
provide feedback during platform development.
Being the quality of simulation the most important requirement and objective of the company, the
platform is evaluated through a multisensory surgical task analysis in which the most important aspects
of the the surgical procedure are assessed. The company collaborates with world leading key opinion
leaders (KOLs) in surgery. Through the multisensory surgical task analysis a simulation that focuses on the
key learning outcomes is created.
Reviews
The surgical simulator has received this April the Continuing Professional Development (CPD)
accreditation from the Royal College of Surgeons of England, which makes it a full fledged training
platform for medical students and surgeons able to contribuite to their CPD score.
It has become part of some hospitals’ training program as St. George’s University Hospitals NHS
Foundation Trust, which is just the latest (as of May 23, 2019) to adopt this system for spine and
orthopaedic training. Omar Sabri, who is the lead consultant for the integration of FundamentalSurgery
into the program said: "Through this integration, trainees can now demonstrate the skills they’ve learned
by using this technology and have it reflected in their educational portfolio and Intercollegiate Surgical
Curriculum Project. This along with the Royal College approval are just the start for Fundamental Surgery’s
platform and the team’s effort to integrate it into all surgical training programs across the country.”[7]
accreditation from the Royal College of Surgeons of England, which makes it a full fledged training
platform for medical students and surgeons able to contribuite to their CPD score.
It has become part of some hospitals’ training program as St. George’s University Hospitals NHS
Foundation Trust, which is just the latest (as of May 23, 2019) to adopt this system for spine and
orthopaedic training. Omar Sabri, who is the lead consultant for the integration of FundamentalSurgery
into the program said: "Through this integration, trainees can now demonstrate the skills they’ve learned
by using this technology and have it reflected in their educational portfolio and Intercollegiate Surgical
Curriculum Project. This along with the Royal College approval are just the start for Fundamental Surgery’s
platform and the team’s effort to integrate it into all surgical training programs across the country.”[7]
Final Thoughts
I believe FundamentalSurgery and similar technologies are the future of surgical training thanks to their
low cost applications and high accurate results and feedback. More and more companies seem to be
interested in VR applied to medicine especially in the surgical field, where if applications are combined
with haptics the experience can be so immersive that it feels (for multiple senses) real. Augmented Reality
is another possible technology that can be integrated in this field as it is already being done by
FundamentalVR and other companies too, for example as a guide during surgery in locating specific
structures.
low cost applications and high accurate results and feedback. More and more companies seem to be
interested in VR applied to medicine especially in the surgical field, where if applications are combined
with haptics the experience can be so immersive that it feels (for multiple senses) real. Augmented Reality
is another possible technology that can be integrated in this field as it is already being done by
FundamentalVR and other companies too, for example as a guide during surgery in locating specific
structures.
References
[1] https://www.theengineer.co.uk/haptic-vr-surgery-simulation/
[2] https://www.fundamentalsurgery.com/
[3] https://it.3dsystems.com/
[4] http://www.fundamentalvr.com/
[5] Validation of Fundamental Surgery, a haptic VR education platform, in conjunction with the British
Orthopaedic Training Association. Peter Rainger, Chief Learning Officer; Publication date 29th January
[6] Spinal Pedicle Screw Haptic VR Simulation: Validation of Fundamental Surgert Educational Simulation.
Peter Rainger, Chief Learning Officer; Publication date 1st March.
[7] http://digitalhealthage.com/fundamental-vr-education-platform-becomes-part-of-south-west-
london-training-programme/
[2] https://www.fundamentalsurgery.com/
[3] https://it.3dsystems.com/
[4] http://www.fundamentalvr.com/
[5] Validation of Fundamental Surgery, a haptic VR education platform, in conjunction with the British
Orthopaedic Training Association. Peter Rainger, Chief Learning Officer; Publication date 29th January
[6] Spinal Pedicle Screw Haptic VR Simulation: Validation of Fundamental Surgert Educational Simulation.
Peter Rainger, Chief Learning Officer; Publication date 1st March.
[7] http://digitalhealthage.com/fundamental-vr-education-platform-becomes-part-of-south-west-
london-training-programme/
All the images and videos are property of Fundamental Surgery (https://www.fundamentalsurgery.com/).