Introduction to Virtual Reality and Robotics in Neurosurgery

Sutherland, Garnette MD

doi: 10.1227/NEU.0b013e31827530c1

ABBREVIATION: VR, virtual reality

University of Calgary, Health Research Innovation Centre, Calgary, Alberta, Canada

Correspondence: Garnette Sutherland, MD, Professor of Neurosurgery, University of Calgary, Health Research Innovation Centre, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6. E-mail:

Received September 13, 2012

Accepted September 14, 2012

Article Outline

Virtual reality (VR) and robotics are 2 rapidly expanding fields with growing application within neurosurgery. We present a supplement that discusses both the benefits and ongoing challenges related to the latest incarnations of these technologies. VR creates 3-dimensional environments with increasing the capability for sensory immersion, which provides the sensation of being present in the virtual space. The applications of VR include surgical planning, case rehearsal, and case playback, which could change the paradigm of surgical training, which is especially necessary as the regulations surrounding residencies continue to change. Surgeons will be able to practice in controlled situations with preset variables to gain experience in a wide variety of surgical scenarios.

Robotics provides mechanical assistance with surgical tasks, contributing greater precision and accuracy and allowing automation. Robots contain features that can augment surgical performance, for instance, by steadying a surgeon’s hand or scaling the surgeon’s hand motions. Current robots work in tandem with human operators to combine the advantages of human thinking with the capabilities of robots to provide data, to optimize localization on a moving subject, to operate in difficult positions, or to perform without muscle fatigue.

Surgical robots require spatial orientation between the robotic manipulators and the human operator, which can be provided by VR environments that re-create the surgical space. This enables surgeons to perform with the advantage of mechanical assistance but without being alienated from the sights, sounds, and touch of surgery.

The ongoing challenges of both VR and surgical robotics are the high cost of technology development, the complexity of re-creating human senses, and the limitations of computer processing. An absolute virtual environment requires that sensory information be processed at speeds equal to or faster than the human brain can perceive it to eliminate the delay between sensory input and output. For instance, with haptics, the refresh speed must be 500 Hz, or < 2 milliseconds, for humans to perceive the feedback as continuous. If the refresh speed is any slower, the operator will be able to feel the pauses between information updates. Another challenge is the difficulty of accurately modeling human tissue in VR; current 3-dimensional models derive the surface texture of the brain and replicate it, which means that a virtual brain does not quite resemble the real thing.

Technology is constantly moving forward. Other areas of medicine have already begun the integration of robotic and VR technologies into practice; neurosurgery has been slow to adopt them because of the complexities of brain anatomy and physiology. However, as illustrated by several articles included in this supplement, technology is catching up to the demand for improved localization and minimalism in neurosurgery. Interesting technologies have been developed for neurosurgical use, although one of the current obstacles to widespread adoption is the need to demonstrate benefit in relation to cost. The consumer market plays an important role in driving the further development of visual, haptic, and computer technologies, which in turn leads to both lower costs and smaller component sizes. Miniaturization is particularly meaningful in the creation of robots that can perform microsurgery in constrained environments such as within an imaging environment. Collaboration between the fields of medicine, engineering, science, and technology will allow innovations in these fields to converge in new products that will benefit patients with neurosurgical disease. This supplement discusses the current applications, ongoing challenges, and future potential of VR and robotics in neurosurgery.

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The author holds shares in and is named on many of the founding patents of IMRIS Inc, the company marketing both iMRI and neuroArm technologies.

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