'We're inside the patient, looking directly at the tumour': Gaming experience aids surgery

An Ontario teen is among the first patients in the country to have a rare bone cancer surgically removed by doctors who used a new Canadian-designed virtual reality system. The system allows them to "walk" within a patient's body as they plan out complex surgeries.

"Every time we go into the headset, we're literally inside the patient, looking directly at the tumour, and it's quite exciting," said Dr. Kawan Rakhra, a radiologist and part of the orthopedic surgical team at the Ottawa Hospital.

Patient Emeric Leblanc was 14 when pain in one of his legs led to a diagnosis of Ewing sarcoma. It's a rare cancer that had engulfed much of his left hip bone.

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The Gatineau, Que., teen first had to endure 62 days of chemotherapy and 25 radiation treatments to shrink the tumour, before undergoing surgery to remove it by amputating part of the pelvis.

Dr. Joel Werier, who led the surgical team at the Ottawa Hospital Cancer Program, faced a daunting challenge: remove the 12-centimetre tumour, while leaving enough pelvic bone to support Emeric's hip joint. Otherwise, Emeric would lose his entire left leg.

"We wanted to understand where was the tumour in relation to his hip joint, and could we save the hip joint? Could we do that safely?" said Werier.

"I think it's a very powerful tool," he added. "Didn't I wish I had this 15 years ago...?"

Wearing head goggles and holding a hand device, just like gamers, he and Rakhra recreated the pre-surgical journey into Emeric's pelvic area for CTV News.

"I'm just going to show you right into the tumour," said Rakhra, as the two doctors stood side by side in a hospital office. They measured the tumour and moved all around it, using their hands to stretch the images as they checked out arteries and organs they needed to avoid injury during the long and complex surgery.

"This does tell me that we do have enough bone to work with. At the same time...doing a safe cancer operation," said Warier.

The morning of the surgery, doctors let Emeric and his mother, Helene Lachance, see inside his body.

"It was very cool with the headset, and you could move it around, check it from every angle, and you could see in red there was an important blood vessel and a bunch of details on it," said Emeric.

His mother said the images were both impressive and comforting.

"It made me feel really reassured that Emeric was supported by the best in the medical field ....and the best technology," she said.

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The idea began in 2016, after a medical physicist at the Ottawa Hospital, Justin Sutherland, played a few VR games. While immersed in the world of car racing and imaginary battles, his thoughts turned to adapting headsets and images to the field of medicine.

From his work developing radiation plans for cancer patients, Sutherland knew that medical teams relied on Computed Tomography (CT) scans and magnetic resonance imaging scans (MRIs) to map out how they would remove tumours. But the scans are two-dimensional and involve hundreds of slices of the body. It takes time and much training to mentally translate and visualize.

The idea led to the creation of the Ottawa start-up Realize Medical, as Sutherland and colleagues applied for a patent through the Ottawa Hospital Research Institute.

Researchers developed programs that take scans and develop 3D images of areas requested by the surgeons, with all the structures and tissue that can be included coloured, and programed in a way where they can be virtually extracted, so those using the programs for training can focus on the exact area of the operation.

And all images are moved by the doctors' hands.

"The whole thing is natural and you feel as if you're really interacting with this data in a way that's not possible in the real world," said Sutherland.

"It never gets old to have a doctor try on the headset see what's available and then have their eyes light up," said Sutherland, now the company CEO.

There are a growing number of firms worldwide vying for a spot in medical training using virtual reality, with increasing interest in immersive planning systems like Elucis.

The question now is does this advanced virtual preparation make a difference to how well patients do?

"Preliminary data suggests to us (surgeons are) feeling a lot more confident," said Rakhra."That's leading to shorter operating times, which in turn should lead to better outcomes for the patient," he said.

Studies continue in Canada for use in planning cancer surgeries, as well as for use in heart, lung and even transplant operations.

"I think we've looked at it critically from a data point of view, from 13 or 14 patients. I think that's where we are right now, and we have three or four scheduled on the docket to do in the next few months," said Warier.

In January 2023, the U.S. Food and Drug Administration green-lit the Canadian system for use south of the border, where it is now being used in 18 hospitals, said Sutherland.

Remote consultations with doctors anywhere in the world are an added feature.

"We've connected as far as Australia, the U.K., Saudi Arabia... and put them in the same environment as if they're there, face-to-face interaction," according to Sutherland.

Emeric's surgery stands among the team’s successes. It took 14 long hours but his leg was spared, and after several months of physiotherapy, the teen is now healthy and back at school.

The only reminders are the hole where his left hip bone sat, and the fact that his left leg is now slightly shorter as a result. For that, he uses lifts in his shoes.

"I still do whatever I want. And I don't let that stop me." Emeric told CTV News.

And he says he's happy he aided Ottawa scientists testing out a new way of seeing patients, inside and out.

"I always wanted to help," he said.