Virtual Reality

Jaron Lanier introduced the term "virtual reality" in 1989, but the concept that computers would have enough power to interface with a human's sensory perceptions formed the basis of Ivan Sutherland's doctoral thesis from Massachusetts Institute of Technology in 1963. As with most things in the computer world, the first head-mounted display became a reality and a young entrepreneur, Morton Heiling, tried to sell "Sensorama," a simulated computerized motorcycle ride through a virtual city. Computational capacity has been the only limiting factor in the advance of these technologies. Gordon Moore, Intel Corporation's cofounder, is now best known for Moore's law, stating that a computers power would double every 18 to 24 months. He has made this statement from observing trends for the past 35 years. In addition, the cost of that technology has almost halved in the same period of time. In other words, the supercomputer of 1990 that cost $100,000 is today available in a $150 Nintendo system. Randall Tobias, former vice-president of AT&T phone company is widely quoted as saying, " if we had similar progress in the automotive industry, a Lexus would cost $2, it would travel at the speed of sound, and go 600 miles on a thimble full of gas" (93).

One of the first major advances in the development of virtual reality surgical systems came with the Visible Human Project. Sponsored by the National Library of Medicine, 1 mm cross-sectional anatomy was stored on a computer for three-dimensional reconstructive purposes. This database became the first available human subset for computer virtual reality programs (94).

Virtual reality surgery overcomes several of the limitations of education in an operating room. First, the teaching session in the operating room cannot always be well designed or orchestrated. The prime focus remains upon the patient. The scheduled case may not be well suited for the resident at that given time. The corollary to this is that the technical nuances of the particular case may be above or below the skills of the student, making the educational potential limiting. The execution of the surgical procedure may not be altered to satisfy an educational goal. Likewise, the dissection and exposure cannot always proceed in a fashion best structured for educational potential. Finally, the steps of the surgical procedure cannot be repeated. Errors that occur can be corrected, but they cannot be repeated (95). All of these shortcomings are nonexistent in the virtual operating room. In addition, there is more evidence that learning complex tasks is significantly impaired by increasing the amount of stress in the environment (96). An operating room is inherently filled with stress. Factors contributing to the high stress environment of the operating room include time constraints, technical difficulties, concern for the patient, equipment failures, interpersonal issues, handling telephone calls, and lack of rest. Investigators now are sure that the greatest levels of learning and performance occur in environments with moderate stress. The psychomo-tor tasks are learned in three ways, all facilitated in the virtual environment. In the cognitive phase of learning, the student attains a degree of understanding of the task. The second phase is the associative process. During the associative phase, the student practices the task and compares performance with an expert. The differences are considered errors and mastery is achieved by minimizing these errors. Finally comes the autonomous phase, where skill is performed without cognitive awareness (97-99).

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