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Doctor Rajiv Singal tests the Portable PCNL Trainer platform at Michael Garron Hospital in Toronto on May 4.Tuan Minh Nguyen/The Globe and Mail

Ben Sainsbury was working as a screenwriter a decade ago, when the release of the Oculus Rift, one of the first widely available virtual reality headsets, changed the course of his life.

In 2013, intrigued by the technology but unsure what he would do with it, he enrolled in a computer science PhD program at Ontario Tech University. He took a course in “serious gaming” – the use of video-game technology for business applications instead of entertainment. It was there that he learned surgeons were beginning to do some of their training in VR.

Now, the company he founded in 2017, Niagara Falls-based Marion Surgical, has designed a virtual reality simulator for percutaneous nephrolithotomy, a procedure for removing kidney stones, and landed a $1-million deal with the Spanish Ministry of Science and Innovation to build a second simulator, this one for robot-assisted surgery.

Traditionally, surgeons have learned their trade by operating on pigs, or human cadavers. But some countries have deemed the use of animals inhumane, and cadavers can be used only a limited number of times. Mr. Sainsbury said simulators are a better option.

Virtual reality, he said, can “reanimate” a body to create emergency scenarios surgeons must work through.

“It gives you a scorecard,” he added. “It tells you if you were shaky and gives you a way to improve and then you can try it again.”

For the kidney stone surgical training, the user dons a virtual reality headset, which makes it appear as though they are in an operating room with a patient. While wearing the headset, the user works with physical tools, including a needle, wire and a grasping tool. Although the tools are real objects, the user can also see them in the virtual space. Real surgical tool-end bits are used, Mr. Sainsbury said.

Haptics, which use vibrations to replicate physical sensations, make virtual objects in the simulation feel real when touched. This allows a trainee to sense the difference between skin, fat, muscle and a kidney.

Mr. Sainsbury said the VR technology is so realistic that, when taking a break, he has set his physical tools down on a virtual table.

“And then of course, they fall to the ground because the table is not real,” he said.

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Marion Surgical CEO & Co-founder Ben Sainsbury assists Dr. Singal with the the Portable PCNL Trainer.Tuan Minh Nguyen/The Globe and Mail

Marion Surgical now has seven permanent employees, including Mr. Sainsbury and his co-founder, Rajiv Singal, who is chief of surgery at Michael Garron Hospital in Toronto and an associate professor at the University of Toronto. As a urologic surgeon, his areas of expertise include kidney stones and urologic cancers, as well as minimally invasive robotic and laparoscopic procedures.

Dr. Singal said virtual reality simulators have the potential to be used in medical residency programs across the country. In the past 20 to 25 years, he noted, there has been increased investment in simulation and skill assessment in every surgical program.

“The goal is that by the time a trainee comes into the room and is ready to participate in the surgical procedure, they’re not coming at a level X, they’re coming at a level X plus 80 per cent,” he said.

While the specific models Marion Surgical has created so far are for use on kidneys, Mr. Sainsbury said the company can create simulations of any surgical procedure, and is currently working on the liver.

When Marion works on a new procedure, it reuses many of the tools and workflows from its other simulators. The tricky part is working closely with expert surgeons to get the procedure and feeling right, Mr. Sainsbury said.

“That’s the part that takes time: to be procedurally and haptically accurate at a literal surgeon level.”

The robot-assisted surgery simulator Marion is developing for the Spanish Ministry of Science and Innovation will be different from the other simulators it has built, because it won’t use haptics. In these types of procedures, robots perform surgical tasks while surgeons control the proceedings from a distance. The company will soon begin working with practitioners to test and refine the new system.

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