VR Made This Complex Surgery Possible

A team of doctors collaborating across continents leveraged virtual reality tech to perform a risky surgery that successfully separated conjoined twins who had a fused brain, a condition scientifically described as a craniopagus. The three-year-old twins Bernardo and Arthur are the oldest pair with a common skull to undergo the separation procedure.

Ahead of the complex surgery, a group of surgeons practiced for it in a virtual reality operation room setup while seated in different countries. CT and MRI scans of the twins were used as the test bed during the VR training and trial phase that lasted for months before the final surgery. In the words of lead surgeon Noor ul Owase Jeelani, it was the first time that experts from different countries connected with each other while wearing virtual reality headsets to collaborate and practice a surgical endeavor. 

The twins had already undergone seven surgeries, but it was the final operation lasting 27 hours that achieved the objective. The monumental surgical effort involved a team of roughly 100 medical experts, while directions for the surgery were relayed from the Great Ormond Street Hospital in London to the team working on the ground in Rio de Janeiro.

In a BBC interview, Dr. Jeelani explained that not all craniopagus twins can be separated, and they actually had to decline multiple cases before they decided to move ahead with the surgical separation of the Brazilian twins. Touted as one of the most complex surgeries ever performed, the procedure required meticulous planning and practice months in advance. According to Dr. Jeelani, the team involved in the process did commit errors as part of the test simulations, allowing them to rethink their strategy every time they hit a dead end. "All of the surgery was done in virtual reality, all the steps were taken, before we actually lifted the scalpel," he adds.

Dr. Jeelani — a pediatric neurosurgeon who is considered a pioneer in the field of separating conjoined twins with numerous successful operations under his belt — described the latest VR-assisted endeavor as "space-age stuff" to the BBC. As the twins recover, the team will now wait for about six months following the surgery to monitor their progress and present a more accurate prognosis for the future. Talking about the journey, Dr. Jeelani told the BBC, "In some ways, these operations are considered the hardest of our time, and to do it in virtual reality was just really man-on-Mars stuff."

Born in a rural region of Brazil, the craniopagus twins were under the care of Instituto Estadual do Cérebro Paulo Niemeyer in Rio de Janeiro. Experts at the institution subsequently reached out to Gemini Untwined, a global charitable foundation co-founded by Dr. Jeelani for research and treatment support for CPT twins (via Evening Standard). But the operation was deemed challenging from the get-go, as the two boys shared the same important veins in their fused brain. Following the surgery, the boys' vital stats like heart rate and blood pressure were off the charts, the experts told the BBC, but things stabilized once the two twins were brought back together a few days later and allowed to hold hands.

A first-of-its-kind trial surgery was conducted in advance with experts in Brazil and the U.K. participating in the process wearing VR gear. Regarding the prospects of such surgeries in the future, Dr. Jeelani remarked that "we have equipped the local team with the capabilities and confidence to undertake such complex work successfully again in the future." The aforementioned VR-assisted surgery is nothing short of a marvel, but this is not the first time virtual reality has found its way into a hospital.

In November 2021, the BBC reported that a technique invented by Dr. Jeelani for correcting a brain-related condition called Sagittal Synostosis was presented using VR simulations to the parents of a baby who suffered from the condition. The VR system gave the parents an idea of how the skull would shape up following the surgery and was described as a way to help them make a more informed decision about whether to proceed with the procedure.

In July 2022, research published in "The Journal of Urology" revealed that using VR models for advanced surgical planning helped doctors perform surgeries to address prostate cancer while reducing the number of surgical consequences, such as nerve damage. A year prior to that, FundamentalVR showcased its virtual reality surgery training platform that blends haptic feedback and 3D spatial technology to provide a more realistic surgical training experience to doctors.

The U.S. Food and Drug Administration (FDA) also approved the marketing of a VR-based surgical planning solution called Invision OS that allows surgeons to plan an operation in advance while wearing an Oculus VR headset. According to a study published in the "Journal of Bone and Joint Surgery," VR-based training helped surgeons learn things 570% times faster (via Unreal Engine). Aside from surgical training, VR is also being used to address phobias, assist patients with pain management, and help with addiction recovery using gradual exposure techniques, among others.