Scientists to develop virtual reality simulator to improve training on hiatal hernia surgery

Baylor Scott & White Research Institute has received funding for a study from the National Institute of Biomedical Imaging and Bioengineering, one of the 27 institutes and centers of the National Institutes of Health (NIH), the nation's premier medical research agency.

The study, titled Development and Validation of a Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS), will be led by principal investigator Ganesh Sankaranarayanan, Ph.D., the assistant director of the Center for Evidence-Based Simulation with Baylor Scott & White Health's Academic Simulation Program.

Sankaranarayanan, together with a research team of surgeons and engineers, will develop and establish a virtual reality simulator designed with the intent to improve hiatal hernia surgery training, and ultimately, surgical outcomes.

Helping surgeons gain proficiency in a complex procedure

Hiatal hernias, which occur when a part of the stomach pushes through a small opening in the diaphragm called the hiatus, have been linked to gastroesophageal reflux disease (GERD), which affects roughly 20 percent of the U.S. population.

If left untreated, GERD can cause esophagitis, Barrett's esophagus, and esophageal adenocarcinoma, a form of esophageal cancer considered one of the fastest-growing causes of cancer mortality. In fact, the presence of hiatal hernia is thought to double the risk of esophageal cancer.

Hiatal hernia surgery commonly is used to correct these hernias. However, the anatomical location of the esophagus and the esophageal hiatus make this procedure incredibly complex. It typically has a learning curve of about 50 cases for a surgeon to gain enough skill to reduce the recurrence of the hernia after surgery. To improve training for the complex procedure, Sankaranarayanan and his team will develop a real-time interactive hiatal hernia surgical simulator.

Unique features such as accurate tissue properties and haptic (force) feedback will help enhance the experience for surgical residents and attendings and more effectively hone their skills in the virtual reality simulator, thereby improving outcomes by reducing surgical errors. Effectiveness of the VLaHSS will be measured by performing validation studies at Baylor Scott & White with general surgery residents and attendings.

Sankaranarayanan will be assisted in the NIH project by co-investigators Steven G. Leeds, MD, and Marc Ward, MD, from Baylor Scott & White, and by co-investigators Venkata Sreekanth Arikatla, Ph.D., and Andinet Enquobahrie, Ph.D., members of the medical computing team at Kitware Inc.

"With continued advancements in technologies such as virtual, augmented, and immersive realities, virtual reality simulators are coming to the forefront as more accessible educational tools," said Sankaranarayanan.

Virtual reality simulators provide a standardized training environment where a procedure can be practiced repeatedly to gain proficiency. They are presenting reliable and cost-effective options for training and education."

Ganesh Sankaranarayanan, PhD, Principal Investigator and Assistant Director, Center for Evidence-Based Simulation, Baylor Scott & White Research Institute

This work is just the latest in a deep portfolio of work by Sankaranarayanan in the use of virtual reality simulation training. Other projects include virtual reality simulation for colorectal surgery, emergency airway training, and immersive virtual reality simulation for safe medication administration.