VR Simulations Implementation in Hysteroscopy Medical Training

The global healthcare digitalization trend continues to accelerate worldwide. It is already expected to land at USD1,041 Billion by 2030, driven by the rapidly developing technologies and the growing demand for healthcare digitalization. Fast digitalization has touched every aspect of the medical industry, from new digitally enchanted procedures and innovative devices to diagnostics and data processing. Innovation has long reached medical training and upskilling, with immersive technology like Virtual Reality (VR) opening vast new opportunities for medical specialists around the globe to train and improve their skills in practically any medical direction. In this HealthySimulation.com article, we will talk about healthcare digitalization, particularly the integration of VR simulations into the training and upskilling cycle that covers specialists of different functions, the benefits it can deliver, and the ways it can be used in healthcare simulations. This article will showcase two VR simulation solutions developed by Lucid Reality Labs with Medtronic. These simulations helped overcome the challenges of medical specialists’ onboarding and readiness associated with new medical device integration. Medtronic used them to demonstrate the benefits of an innovative hysteroscopy procedure system to healthcare professionals including gynecologist surgeons and nurses and to train on the proper setup to facilitate the system use during hysteroscopy procedures.

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Even though incorporating new innovative devices is both crucial and promising for healthcare providers, practitioners, and patients, the healthcare frontline workers’ adaptation could be a potential setback. Which can pose quite a challenge for healthcare institutions looking to innovate and expand their medical capabilities. Today we would like to speak about some of these challenges, primarily challenges connected to digitalization, that arise during the medical device integration and how VR can help solve them. With roughly 235 million major surgeries conducted annually, minimally invasive surgeries are most preferred by surgeons. Hysteroscopy is one of the fractions of minimally invasive surgeries that have been gradually adapting to innovation and digitalization. The introduction of hysteroscopy systems like Medtronic TruClear™ Hysteroscopic Tissue Removal System that works together with HysteroLux™ Fluid Management System enables minimal invasive surgeries to prevail over conventional resectoscopes. Introducing such devices helps make medical procedures more sustainable and cost-effective for medical institutions and patients.

VR technology integration played an important role, helping Medtronic demonstrate the benefits of the innovative TruClear™ Hysteroscopic Tissue Removal System through immersive, hands-on training to more gynecologist specialists at global medical events. VR also helped smoothen the training process for nurses responsible for setting up the TruClear™ Hysteroscopic Tissue Removal System in combination with HysteroLux™ Fluid Management System.

To illustrate how VR can help shorten the learning curve, we will look at two perspectives of VR simulation integration into healthcare specialist training, the developed VR experiences methodology, challenges, and solutions. One from the perspective of medical device practical use and the other from the setup. We will cover the capabilities VR can provide for multi-functional simulation training and its role in helping with digitalization.

VR Hysteroscopy Simulation

VR Hysteroscopy Simulation, created with Medtronic, is a fully immersive VR solution that can replicate and enhance the traditional large-scale electronic PC-based simulators. The immersive VR Simulation can be easily used at any exhibition or conference for precise product and procedure demonstration with maximum realism for the user. It presents the handling of the TruClear™ Hysteroscopic Tissue Removal System by educating users on how to perform the hysteroscopy procedure in VR. The core of the VR simulation lies within the “7 degrees of freedom” 1-to-1 visual and tactile replica of 7 moving parts controlled by the doctor during the actual procedure. The VR solution allowed for faster data transfer and update, system and demonstration effectiveness, and the post-procedure feeling of accomplishment triggered by tactile memory and precise hands-on, fully immersive experience.

VR Hysteroscopy Simulation – Experience Methodology

The developed experience carries a significant pedagogical advantage as it allows hands-on education, steepens the learning curve, reduces training time, and makes the onboarding process smoother and user-friendly. Medical practitioners go through the experience with their own hands. Thus, they acquire the skills necessary to evaluate the practical use, compare the device and make an educated decision to opt-in for using it rather than being forced to use the device as a part of a medical institution innovation initiative. Additionally, the VR simulation can also be used for product demonstration. It allows specialists to try the TruClear™ Hysteroscopic Tissue Removal System in a virtual 1-to-1 replica of the exact medical environment. In the same environment, they would conduct the hysteroscopy procedure, be it in an Operation Room (OR), an Ambulatory Surgery Center (ASC), a hospital, or any other medical institution.

The VR Hysteroscopy Simulation was designed to be expandable, with different levels of difficulty, starting from basic patient scenarios and increasing in difficulty and complexity of in-simulation condition severity and required intubation tasks. The VR simulation incorporates a Lego block-alike constructor, where extra steps can be added, including additional modules and layers of experience complexity. For example, the medical specialist first learns how to use the device, then how to use the entire system, followed by the module where they learn how to program separate fractions or the system as the whole and any other function.

The scalability of the developed solution allows it to be used outside of traditional training facilities to train specialists remotely, without requiring visiting the hospital, medical center or practically relocating. This capability was especially relevant during major Covid lockdowns, when all symposiums, conferences, and events were canceled, remaining relevant indefinitely. In addition to the remote access, the scalability of VR Hysteroscopy Simulation implies a potential expansion of the developed VR experience that could be used simultaneously by many specialists from any location worldwide. A multiplayer option would enable learners and instructors to meet in a virtual space remotely, regardless of their physical locations, and interact in real-time using avatars and spatial sound systems.

Another significant advantage of VR-based training is that it can be easily integrated into the medical institutions learning management system (LMS). This could help make the classic learning and upskilling process faster, more effective, and more hands-on for any specialist around the globe.

The developed experience allowed to collect extensive feedback during the self-guided module, which was used to improve the immersive VR simulation. It could also help see and understand how the device can be enhanced based on the collected and analyzed in-VR user behavior, experience and mistakes. The feedback can include the comfort of use and other predefined assessment metrics, like device angle of use, ergonomics, device usability, and physical parameters. It was a remarkable opportunity to get feedback directly from the users and the subject matter experts.

The VR experience development was based on Lucid Reality Labs’ unique approach, shaped by years of experience developing VR healthcare simulations. Facilitated by the three-scenario approach, the immersive simulations include the following three modes: the Observation Mode, which incorporates the general training subject comprehension; the Training Mode, which involves training with hints; and the Test Mode, which implies a self-guided gamified evaluation, enabling performance evaluation, analytics and feedback.

VR Hysteroscopy Simulation – Challenges & Solutions

The technology behind the developed VR simulation can be broken down into four essential parts – the UI/UX design, the Engineering, the Art, and the Analytics.

The major challenge in UI/UX was for the 3D team to recreate equipment in VR so it wouldn’t lose visual fidelity compared to its real-life counterparts. Something so essential that, unless solved, the experience would not have the exact effect of complete immersion and level of believability necessary for the medical practitioner’s training and upskilling. It was equally challenging to go from 2D to Spatial UI/UX design, developing the experience to be intuitive and straightforward in its interaction for users of any technological literacy level. Yet another challenge was the issue with haptic feedback that had to be overcome by providing medical specialists with a sensation capable of guiding them through the experience and bringing their attention to mistakes made in real-time.

It is always essential to allocate time for the development team to dive into the specifics of the subject and understand the medical context to achieve the necessary level of quality and immersion in the VR experience. When speaking of the engineering aspect of the development process, the biggest challenge for any development company lies in the fact that developers are unable to deliver a fully immersive, close-to real-life experience without the active input and participation from the subject matter experts. This includes taking part in medical training, conferences, symposiums, and industry events. To create a complete experience, the development team observed the manikin and pc-simulation-based training. Likewise, the developed VR Hysteroscopy Simulation had to go through several iterations based on feedback collected from subject matter experts, including Medtronic representatives, medical consultants, and VR simulation end-users that took part in the conferences and training centers. Thus, the development was split into small iterations. This helped make necessary changes promptly, effectively including feedback and comments into each new iteration of the VR simulation.

The Art part was also a relatively important aspect of the VR simulation development, requiring the creation of the digital twins – digital copies of the devices, settings, and environments with visual quality as good as their real-life counterparts. The development team was able to achieve an unprecedented level of realism by creating exceptional levels of textures and materials. They also had to overcome the challenge of the materials physics recreation, including parts of the device that required to bend and move and materials of different levels of transparency. All were designed to look 1-to-1 to their real-life counterparts. Digital twins of materials, patients, actions, and responses, including external visual fidelity, functionality, and spatial sound, were developed. The next part of the Art challenge was to come up with and develop a complex algorithm that would allow all elements to work together in all scenarios, including real-life patient responses in the VR simulation interactions. With all said, achieving an unprecedented level of visual fidelity can be the defining factor that can decide whether medical specialists will follow through with the new technology implementation.

Last but not least is the analytic aspect of the experience, which requires the development of an evaluation system capable of tracking users’ performance and success KPIs. These were defined in collaboration with Medtronic subject matter experts and consisted of VR-experience procedure performance time tracking and the correctness of device use, including angle, positioning, and steps. The correctness of following the hysteroscopy procedure protocol was evaluated in action.

Medical VR Training for Healthcare Professionals (e.g nurses)

Medical VR training for nurses is an immersive and interactive VR Simulator experience. Created by Lucid Reality Labs with Medtronic to train healthcare professionals (e.g nurses) on how to set up and use HysteroLux™ Fluid Management System, a new generation of fluid management system developed exclusively for hysteroscopy procedures. The idea was to focus on experiential learning, reduce the perception of the complexity of the equipment setup process, develop practical skills and build confidence to use HysteroLux™ Fluid Management System during an actual surgical procedure. The developed solution allows users to practice every stage of the setup process in any order without the risk of making a mistake that would lead to the equipment malfunction.

Medical VR Training for Nurses – Experience Methodology

The VR simulation is an excellent asset for healthcare providers and medical institutions as it enables faster onboarding for medical practitioners through immersive, hands-on capabilities of the VR experience. It also helps demonstrate the advantages of integrating the HysteroLux™ Fluid Management System, used in combination with the TruClear™ Hysteroscopic Tissue Removal System.

The developed experience had to offer a new approach to the onboarding process for the nurses. Like with VR Hysteroscopy Simulation, a smooth and user-friendly process was required, including a hands-on full hysteroscopy procedure environment with visual and tactile submersion. The VR training had to be immersive to the extent that it would submerge users into the environment to hands-on learn how to set up the equipment, building their understanding of the device, confidence in the setup, and the inclination to use the device during an actual hysteroscopy procedure. The exceptional visual fidelity was achieved using the digital twin approach. It was used to recreate both the Operation Room and spatial sound while allowing nurses to train in a fully functional and responsive environment, a 1-to-1 digital replica of the real-life HysteroLux™ Fluid Management System assembly procedure.

The Lucid Reality Labs’ unique three-scenario approach was used to develop the Medical VR Training for Healthcare Professionals. It includes the observation mode, which incorporates the general training subject comprehension, the training mode, which involves training with hints, and the test mode, which implies self-guided training with enabled data collection, analysis, evaluation, and feedback.

Remote capabilities of the developed Medical VR Training for Nurses allowed the training process to continue even during global restrictions and lockdowns. The topic of relocation remains an essential issue for medical specialists around the globe. Even though the lockdowns are not on the same scale, the lack of time for medical specialists can pose a fair challenge when it comes to training and upskilling. The developed VR experience allowed to submerge users remotely. The multiplayer incorporation would simultaneously enable the experience to be accessible from different geographical locations by both the training personnel and expert instructors.

Just like the VR Hysteroscopy Simulation, the Medical VR Training for Healthcare Professionals can be integrated into the medical institutions’ LMS, enhancing traditional learning and upskilling with immersive technology.

Medical VR Training for Healthcare Professionals (e.g nurses) – Challenges & Solutions

The Medical VR Training for Healthcare Professionals has had more challenges similar to VR Hysteroscopy Simulation. One of the main challenges was the user’s readiness for change for a new and innovative system.

Additionally, the functional setup of TruClear™ Hysteroscopic Tissue Removal System in combination with the HysteroLux™ Fluid Management System, requires a short learning curve by practicing necessary steps. VR enabled users to submerge and learn how to set up the new equipment in a risk-free cost-efficient environment, eliminating the risk of hurting the real patients or misusing the equipment.
One of the more considerable challenges was to keep the experience engaging and gamified while remaining authentically real and believable for the users. The physics, logic, and ergonomics of the device and the environment had to be recreated in full.

Medical VR Training for Healthcare Professionals incorporated numerous 3D assets. The OR elements and HysteroLux™ Fluid Management System, including the related consumable products. This allowed replicating the real-life setup and interaction physics. Like with VR Hysteroscopy Simulation, the level of visual fidelity required to be on par with the real-life equipment. Incorporated haptic feedback, achieved through controller vibration, helped identify mistakes and provide feedback for users in real-time.

The Art fraction of the experience required the digital twin approach to replicate every element of the device setup from both the visual and functional aspects, conveying the level of realism through every level of the scenario. As hand-tracking was incorporated into the experience, the other essential element was for the created assets to have the same response physics and mechanics as their real-life counterparts. If a real-life pressure cylinder was too heavy to lift with one hand, it could only be picked up and moved around using both hands in VR.

A well-developed onboarding system can be the go-to solution for many healthcare institutions looking into incorporating new devices to accelerate performance, effectiveness, and patient outcomes. Virtual Reality has the capabilities necessary to enhance the traditional education methods to inspire and grow interest in specialists, making the onboarding transition a smooth and painless process for specialists of different profiles and, thus, the entire medical system.

Last but not least, when integrating immersive technology as part of the medical institution’s digital transformation, it is essential to account for users for whom VR headsets are unsuitable for various reasons. Primarily, some fraction of users may experience motion sickness, nausea, and headaches due to a variety of conditions. With all being said, VR is an excellent tool that can help flatten the learning curve and make onboarding smooth and seamless. It can enhance traditional learning methods with digital capabilities and thus help medical specialists develop their skills and train without the restrictions imposed by their physical location more effectively and sustainably.

Alex Dzyuba Lucid Reality Labs CEO
“Today, healthcare is booming with innovation like no other industry. Like with any great new-coming, we must keep the end users, the medical practitioners, in mind, especially their need for rapid and seamless accommodation to new medical technology and devices. VR is one of the technologies that can serve as a game changer for specialists to adopt new technologies. If we look beyond medical specialist training, immersive experiences could serve to educate generations of future doctors, serving to enhance traditional education methods.”

As Virtual Reality continues its rapid adaptation into healthcare simulations, more specialists and healthcare institutions are opting for the technological solution due to its mobility, scalability, and possibility of tracking and collecting user data. VR technology can give a tremendous advantage to healthcare simulations, medical practitioners’ training, and upskilling. At the same time, to deliver better patient outcomes, combining VR with traditional education methods can give specialists the full scope of knowledge and learning opportunities, enhancing the experience while not replacing it. Additionally, VR is an excellent tool that can help demonstrate any device’s capabilities regardless of its scale or physical location. It can also be used to recreate the procedures in full scale, from diagnostics to pre-operative and post-operative activities, performed in virtually created real-life settings, like hospitals, clinics, ASCs, or ORs.

More About TruClear™ Hysteroscopic Tissue Removal System

The TruClear™ system offers a complete technology platform for the removal of a range of intrauterine abnormalities. Unlike other intrauterine abnormality treatment options that use a high-frequency electric current, the TruClear™ hysteroscopic tissue removal system uses a simple mechanical approach to remove intrauterine tissue. Therefore there is no scarring from thermal energy or energy discharge.

More About HysteroLux™ Fluid Management System

The HysteroLux™ system offers procedural flexibility, enhanced safety†, and optimized uterine distension†. With a touchscreen user interface, improved operation settings, and rapid response to changes in intrauterine pressure, the HysteroLux™ system offers a next-generation solution for hysteroscopic procedures. The HysteroLux™ system enables continuous, real-time monitoring of fluid deficit when its scale is in use.1 And it reduces the risk of fluid overload by continuously monitoring fluid volume deficit.

More About Medtronic

Medtronic, a global healthcare technology leader — boldly attacking the most challenging health problems facing humanity with innovations that transform lives.

More About Lucid Reality Labs

Lucid Reality Labs is the World’s leading Immersive Technology consulting, design and development company with the primary focus on creating immersive XR training & simulations for Healthcare, MedTech, Pharma, Aerospace & Defense. Lucid Reality Labs is a team of diversely skilled professionals that develop the World’s first, unique, immersive, groundbreaking technological solutions for Fortune 500 clients around the globe.

Learn More About VR Hysteroscopy Simulation and Medical VR training for Healthcare Professionals

RESOURCES
† Compared to our legacy hysteroscopic fluid management system.
1. HysteroLux™ Fluid Management System [instructions for use]. New Haven, CT: Medtronic; 2018.