Shafi Ahmed is the Clinical Lead for the International Surgical Training Program at The Royal College of Surgeons and a Laparoscopic Colorectal Surgeon at The Royal London and St. Bartholomew’s Hospitals, but he may be more familiar to Medgadget readers as the “Virtual Surgeon.” Since 2014 Shafi has been using cutting-edge technology to share what he sees during surgery by live streaming to a global audience of medical students, surgical trainees, and the public. His online videos have been watched hundreds of thousands of times, earning him the accolade of most-watched surgeon in human history.
Medgadget editor Tom Peach recently sat down with Shafi at the Minimally Invasive Surgery Congress in London to discuss the increasing use of live streaming and VR in surgery.
Tom Peach, Medgadget: What first sparked your interest in bringing technology into the OR?
Shafi Ahmed: I’ve always looked for innovation in my career, be that in terms of new instrumentation, new ways of working, or new techniques of operating. In my OR we’ve seen that technology has allowed us to move towards minimally invasive surgery from traditional open surgery. We now perform routine laparoscopic surgery, which has been enhanced by the use of a surgical robot. My other big interest and passion is education and training. I’ve been thinking about how we can modernise the experience of teaching—how to teach people better, and how to use technology as an interface to do it. I’ve been working on both those issues for a long time, but recent exponential technology advances have come at a perfect time for me, which has enabled me to start using technology to improve surgical education.
Medgadget: What is it like to perform surgery with so many people watching?
Shafi Ahmed: I’ve actually got used to it now, but when I first started it was definitely difficult. There were many challenges, especially around expectations of how you’re supposed to behave in the OR and the public perception of what you’re doing. Now that I’ve done it many times it’s just like teaching or training somebody who is next to you. In fact when I am operating I get into the zone where my only priority is the operation itself and obtaining the best outcome for the patient. It’s just like what I do every day…but with a much bigger class.
Medgadget: Do you think every surgeon should be live streaming his or her operations?
Shafi Ahmed: It is definitely not for everybody. One important thing to remember in my case is that these are not new and risky operations: I’ve performed them many times before and am very comfortable with them. So, I have no real issue with people watching and I have confidence to deal with any potential complication that could arise.
I think we’re far too obsessed with demonstrating technically perfect operations. If you go to YouTube tomorrow and look up a particular intervention you’ll see perfect operation after perfect operation because we only like showing the “good ones.” Actually it is more important to show operations where there has been a problem or complication to show how surgeons deal with them. We should be showing our trainees things that go wrong—in 20 years as a surgeon I have very rarely seen an operation that has gone perfectly, as every operation is different and poses different problems and dilemmas. In my theater I make a point of being open and transparent when there is a complication and discuss how I’m dealing with it, because that is what ultimately surgical education is about.
Medgadget: How can VR be used in surgical training? Is there a unique benefit for VR in medicine compared to other industries?
Shafi Ahmed: I think what is key is that VR allows completely immersive learning. Compared to a conventional 2D video on a screen, VR let’s you look at the environment around you, hear the noises of the OR, and interact with the space. That is very important for training a surgeon because there are many skills that we don’t train people in and yet, because of some sort of tradition, we expect that they will somehow manage. Traditionally we just haven’t worried about these factors and have seen corresponding problems with trainee surgeons not coping well in the environment or not knowing how to accurately communicate a complication during an intervention. Those things are as important as the technical exercise of surgery. VR is giving us a space to work more on the softer surgical skills of communication and interaction, which are vital complements to the technical training.
Medgadget: There’s obviously a huge benefit in using VR for training, but what about collaboration—could it, say, bring two world experts together?
Shafi Ahmed: At the moment in VR it is more difficult to work alongside someone, but there is exciting technology coming that could HoloPort a colleague into VR so you could collaborate together. In augmented reality (AR) this kind of thing is actually becoming quite common for mentoring and proctoring.
Medgadget: Clearly there are huge opportunities for better medical education, but what is the process of live streaming like for patients and their families?
Shafi Ahmed: Let me give you an example. I had just finished the world’s first live VR operation. I came out of the operating theater and made my way past reporters and TV cameras; as it had gathered worldwide interest. I found the patient’s wife to find out how she was and to tell her that the operation went well. She said “Thank you very much—my sons and I watched the entire operation in real time, and it put our minds at rest.” Now that really shocked me—the family told me that the live streaming actually helped them. Normally during an operation a patient’s family would go away for five or six hours, they would have endless cups of coffee, and obviously would be anxious. But by watching what was going on they could see that their loved one was doing well, and the process reassured them. To me that was incredible.
Medgadget: What’s been the most surprising thing about using all of this technology in your operating theater?
Shafi Ahmed: Definitely the engagement of the public. You’re never quite sure what the public are going to think, especially when it comes to new technologies, but they’ve been very supportive. I’ve learnt that people want their surgeons to be transparent, and they want to see what they’re doing. Frankly, I think that the public are right. Surgery has always been part of this protected mystical realm; we keep it almost hidden and secret, but actually if we’re open about what we do then the public are better educated—and they seem to love it!
Another thing that amazes me is the reach and efficiency of these platforms. I performed an operation on Snapchat the other day, which I thought wasn’t that big a deal. It went viral. I instantly had 5,000 live viewers from across the globe, people were asking questions and I was teaching them—all with a simple spectacle device, a one-hour operation, and the five minutes it took to upload a video clip. It makes you realise the incredible power and opportunities that a simple connection can bring.
Images: Medical Realities and BMI Hospitals…