SEOUL, KOREA —  Korea’s remarkable strengths in display technology, IT and especially gaming offers a unique opportunity to play a key role in a field not traditionally considered a Korean strength: surgery. The convergence of technologies today promises to radically transform surgery over the next ten years, providing unprecedented  opportunities for innovation, in a word, whereas surgery today resembles flying a biplane with much dependence on visual confirmation and physical strength, surgery of the future will be akin to operating a 747, employing an array of tools to visualize the invisible internal aspects of the body in 3-dimensions and to do be able to do so on a 24 hour basis before and after a surgical procedure.

 The technology of gaming will be absolutely critical to this process in that it provides a medium for presenting the task in an easily comprehensible, compelling and manipulatable format in three dimensions. By building an interface that renders the human body, from the level of the cell (or even the molecule) up through tissue and whole sections of the body, visible and comprehensible, the surgeon would be able to visualize easily the task at hand and its full significance. Tissue which is normally pink or grey can be tinted in this medium to be blue or red or green and the color can be used to identify features other than visual, including, ultimately, cancerous cells.

 Moreover, the surgeon would be able to zoom in for manipulation to the level of individual cells and then zoom out to look at the total body as part of a smooth continuum. The manipulation of devices for cutting, sampling or stitching would not be stressful at all, but rather could be visually represented in an enhanced, exaggerated, manner that makes the process far easier. The cartoon-like representation of the physical space within the body makes surgery much easier—direct physical representation of tissue is by contrast much more stressful and ambiguous.

 At present we find that surgery is in a process of transition. Doctors employ microscopes and other visual aids, but then go back to old-fashioned surgical approaches. Moreover, there is no effective manner of storing all the diverse information from MRIs, X-rays or other sources in a single easily accessible format that can be applied in real time during surgery in 3 dimensions.

 The new fields of drug delivery employing nano-technology, and other cutting edge technologies for manipulation at the cell-level, or sub-cell level, are seen as a distinct fields, separated from surgery. The complete integration of all forms of therapy, combined with creative strategies for visual representation could revolutionize surgery.

 

Points to consider:

1) The first step would be to create essentially complete models of the body in 3D that can be navigated via computer in much the same way that one travels through a virtual world while gaming. These models of the body would start with an idealized human body which can be explored using a joystick at every level: from looking at the body from a distance to plunging into a tiny bit of tissue in the liver, and moving between cells, or even within cells.

Each of these models of an ideal body would essentially have every single cell of the body represented and also allow one to enter into cells using idealized versions of each cell in the human body. Such a model can be extremely carefully designed to essentially allow the doctor to explore with maximum ease the entire body, at any level. The model can also be altered to allow different perspectives, and trial surgery, or other treatments, could be attempted on the model to see how the body responds in cyberspace.

2) Based on the information gathered through a series of tests, the model body could be customized to match the body of a particular individual. Data from X-rays, MRIs and a variety of other sources are analyzed and compiled to build a customized version of the patient’s body in remarkable detail. Moreover, that cyber body would be the location where all information derived from tests is stored. Although it may seem a bit far fetched to suggest that every single cell of the individual could be represented in the model body in cyberspace, it is not impossible that a close to that level might eventually be achieved. In any case, it certainly is possible to input much of the information obtained from different sources to customize the model body for the patient.

3) Use of all sources of information to update the model of the body for a specific region. Instead of looking over a variety of X-rays, ultrasound scans, MRIs and CAT scans, all that information from those sources would be integrated to create a more detailed map of the body in three dimensions. The doctor could then travel around within that space and observe from any angle the tissue in question.  Older MRI information can be kept as a history of a specific part of the body.

4) Part of the integration of information means that in surgery the surgeon does not have to rely primarily on the use of visible light. Information generated through sound, ultrasound, or other forms of radiation can be used in real time to provide a detailed picture of the part of the body the doctor is examining.  The real question is how that information can be integrated into a total image, an image that can be modified to reveal the flow of blood, or temperature, or different kinds of cells, etc.

5) The final result of such an approach is not only a more accurate representation of the surgical site, but a transformation of the process of surgery itself. In many cases it would not be necessary to cut open the body more than a centimeter. For most surgical procedures there would be no need for the incision to be particularly large since there is no need for the surgeon to see the site directly.  The tools employed for surgery would consist of:

6) Cutting device:The “bland” is mounted inside a thin wire that can be manipulated from outside the body. This thin wire works its way through the tissue to the location where it is required and the cutting device then cuts the tissue, to the degree of precision required.

Device for illumination: This device emits radiation to illuminate the exact location for surgery. The Device can use visible light, but can also use sound or other forms of radiation as appropriate. The surgeon watches a monitor with an enhanced graphic of what is being illuminated rather than the tissue being illuminated by this source per se. Whether ultrasound or light is used, the information is interpreted and added to the 3-D recreation visible on the screen.   

Removal device: This small tube with a manipulatable head allows the doctor to remove unwanted materials quickly and silently.

7) The need for two forms of representation: the literal representation of information in three dimensions; the enhanced, game-like environment in which the surgeon sees the information presented in an exaggerated and easily manipulated format: a format that allows him to zoom down to the cellular level, or out to the entire body, allows him to compare the exact location with its state one month, or one year ago, or to compare with other samples from the data base. Allows color coding of tissue and objects.

 

 Because digital surgery would be less invasive than by-hand surgery, the information is closer to the actual normal state of the tissue and allows for a far smoother operation. Because of the low stress, and the information stored as a physical representation, follow up surgery is also less traumatic.

 Although many aspects of gaming are already slowly finding their way into surgery, we have yet to see an integrated, systematic, effort. There is tremendous potential in grasping such a greater vision.