Using Virtual Reality to Teach Bladder Exstrophy Repair
Zoë G. Baker, PhD, MPH, Evalynn Vasquez, MD, MBA, Andy Chang, MD, Huiwen Xie, MD, Zorash Montano, PhD, Roger De Filippo, MD.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
BACKGROUND: In-person observation is the primary method of surgical training, but faces limitations, particularly for rare procedures. Bladder exstrophy affects just 2.15 infants per 100,000 live births, and its surgical repair is considered one of the most technically challenging surgeries in pediatric urology. Many exstrophy patients worldwide are not able to access high-quality surgical care, due to the limited number of surgeons trained in the complex procedure. The limited number of surgeries and limited space in the operating room prevents large-scale training in surgical repair of bladder exstrophy. Virtual reality (VR) is a promising tool that addresses these limitations, and could improve access to surgical training for rare conditions. METHODS: In October 2018, our hospital partnered with Epicenter VR Inc to introduce virtual reality for observation of a live bladder exstrophy repair during an annual international symposium. Fourteen visiting urologists were able to use VR headsets and iPads to observe two pediatric urologists performing a live bladder exstrophy repair on a 7-month old girl. Another expert in bladder exstrophy offered surgical suggestions and described techniques during the VR livestream via video conference. While observing the live surgery, visiting urologists simultaneously viewed a PowerPoint presentation, which provided an overview of the patient's medical history and radiology images (Figures 1 & 2). RESULTS: With the introduction of VR, multiple surgeons received a 360-degree livestream of bladder exstrophy repair, with layered information enhancing the learning environment (Figures 1 & 2). Knowledge learned was brought back to the visiting urologists' home country, and imparted to future exstrophy patients. CONCLUSIONS: Incorporating virtual and augmented reality (AR) into urologic surgery training is safe, feasible and useful. Access to VR and remote technology should be expanded to high-need regions in order to improve surgical training worldwide. Surgeons and researchers at our hospital are continuing to examine how VR, AR, and mobile technology can be used to enhance surgical training and treatment of rare conditions. 
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