​Aspiring neurosurgeons now have an additional resource – an immersive virtual reality (VR) experience of brain operations.

These VR modules – recorded, edited and programmed into an online library by Singapore-based technology start-up Kyalio – give viewers a first-person look at brain operative anatomy and teach them surgical techniques as if they were inside the operating theatre.

Neurosurgeons operate in an unforgiving environment, where every cut requires pinpoint precision and every movement is done with extreme care. The use of the wrong type or size of surgical instrument when moving brain tissue can have devastating consequences for the patient.

Neurosurgery procedures are also often lengthy, making it challenging for aspiring neurosurgeons to observe procedures due to their busy schedules.

As such, Singapore’s National Neuroscience Institute (NNI) is working with Kyalio to continually develop bite-sized VR modules of about five to 10 minutes, distilling real life neurosurgical cases into learning material.

Currently, the Kyalio team has filmed about 100 neurosurgery procedures, of which around 40 have been edited and are available in the library. These are part of a larger collection of more than 300 operations from 11 specialities produced by Kyalio.

The content is specifically designed to tackle learning obstacles from a practical standpoint.

Dr Chen Min Wei, an NNI consultant neurosurgeon, uses VR to show real-world challenges faced in the operating room and provide practical means to help neurosurgery residents achieve desirable outcomes.

The clips are narrated by Dr Chen, who explains what the surgeons are doing.

“Often when you watch surgical content online, with the United States being the largest producer of such content, these videos often show successful operations or how a surgeon can perform certain complicated techniques,” he said.

“However, some 90 per cent of surgeons who practise around the world are either never going to see or have to perform such a technique in their entire career, giving these videos limited use.”

“As a trainee, I watched many of these videos and often when I enter the operating theatre, what I see is entirely different because different surgeons do surgery differently, and patients all have slightly different anatomies even if they have the same condition. There is a huge variation.”

This big variation is addressed with the curation of the library as modules of the same procedure on different patients are grouped together. With the modules kept short and easily accessible via the Kyalio app on a phone and a pair of VR glasses, learners can watch them on the go.

The Kyalio team started with just two founders, Ms Cortilia Lin and Mr Samuel Choo, tackling challenges such as establishing working relationships with hospitals and developing operating-theatre-friendly equipment.

Standard equipment on the market was too bulky for operating rooms, so Kyalio developed customised gear to ensure patient safety during the filming process.

The team started work at the end of 2019 and it took them 1½ years to develop teaching content and the production process, all the while handling the limitations brought about by Covid-19 restrictions.

The VR modules also utilise 3D video recordings taken by surgical microscopes that surgeons use to view the insides of the brain.

NNI has partnered with Kyalio to allow trainees and medical colleges to subscribe to this library, which currently covers more than 11 specialities, with more than 100 surgical contributors in Singapore, Taiwan, Vietnam and Europe.

The library will serve learners from all over the world. It is especially useful outside cities or in areas where access to high-quality surgical education is lacking. This will help South-east Asia and other developing economies, where there are five times fewer surgical trainers per trainee than in developed countries.