The digital countdown clocks in the Boston Convention and Exhibition Center were minutes from zero, but Michele Hilgart was too busy to look. It was 10:41 a.m. last Oct. 9, and Congress of Neurological Surgeons (CNS) Annual Meeting attendees were filtering in from their coffee break to Monday’s General Scientific Session — a few hundred surgeons were still slowly making their way to their seats.
Hilgart, CNS director of research and business development, had a lot riding on the next few minutes: demonstration of a virtual reality (VR) application for some 2,000 demanding members, which depended on split-second timing. Oh, and possibly a Guinness Book World Record for the most simultaneous participants in a live VR experience.
This countdown had been set in motion well over a year before, when Hilgart and, at times, CNS’ CEO, board president, and others had discussed options with Surgical Theater CEO Moty Avisar and members of his team. Avisar — a former Israeli Air Force officer and flight simulator expert — co-founded Surgical Theater to bring the same kind of simulator training available to fighter pilots to surgeons, via a VR platform.
“We meet with our corporate partners often to brainstorm,” Hilgart said, in an effort to “bring in something new and exciting versus another sponsored beverage break.”
They had already agreed upon a small immersive area to give a few surgeons the opportunity to try out the technology. The Surgical Theater reps happened to mention that they could bring VR to a bigger audience, although no one ever had done that before in a similar setting. “Of course neurosurgeons like the idea of being the first,” Hilgart said. “And that spiraled into, what if we attempted a new Guinness [World] Record?”
From Virtual to Reality
Throughout 2017, Hilgart and her team immersed themselves in logistical plans for the VR experience, thinking through procedures and the tech setup, figuring out who’d provide what, and communicating with numerous entities. They had to coordinate the initiative with three faculty members and two moderators; planning, creating, and shooting three case studies; and rehearsing the third to coordinate the VR in the mobile app to sync with the live presentation.
Surgical Theater donated all VR expertise and labor and most of the equipment for the session and the VR studio at Xperience Lounge. CNS worked with the company via conference calls to set up floor plans for the stage set and studio, and the company listed what it needed in terms of electric drops, internet connectivity, and the like.
Hilgart coordinated calls with Surgical Theater’s tech team, the Boston Convention and Exhibition Center, and AV partner Freeman. She also connected session faculty with the VR experts to work through presentation details and timing and herded everyone through two on-site rehearsals.
The previous VR participation record to beat was 1,867 people. Hilgart and CNS marketed the VR session heavily to the membership not just as a cool way to publicize its annual meeting, “but because we needed at least 2,000 people in their seats ahead of time, with their 3D viewer in hand, with the app already downloaded on their phone, right after an exhibit-hall coffee break,” she says. “Which is not normal.”
The countdown clocks at registration counters and in the app ran for 48 hours. Even so, surgeons were still out at the tech table minutes before the session, asking staff how to download the app. Meanwhile, Hilgart was handing out VR viewers: “It was a neat little gadget. Neurosurgeons like neat little gadgets.”
The general session began with two brief case studies by faculty surgeons wearing ocular headsets on stage. The audience saw two screens: one with the normal case study view; one with everything from one faculty member’s point of view.
Presenters discussed both the cases themselves and how the technology worked or how they’d used it. Dr. Warren Selman explained that VR helped him map a surgical approach in a way not possible using more traditional imaging, while Dr. John Golfinos said a fuller view had allowed for a plan to avoid the corticospinal tract and other obstacles, making for a much safer procedure.
Only as the second study and a quick Q&A ended did an anxious Hilgart head for the back of the hall to observe. Then Dr. Neil Martin brought up images for the third case study, on spontaneous intracerebral hemorrhage, and announced: “Now pull up your mobile app and join us.” With the VR viewers clipped onto their phones, some 2,000 surgeons held them close to their faces and turned this way and that for different vantage points on hematoma and fiber tracts in vibrant color.
“There was an actual buzz, a hum, in the hall,” Hilgart recalled. “People were excited, almost giddy. The normal decorum of a typical didactic session went into a fun space for a few minutes there.”
Aiming for a Record
Paying for a Guinness consultant wasn’t in the budget, so CNS delegated most of the work to Surgical Theater, which arranged for some 50 validators throughout the crowd. The company later submitted — and resubmitted — reams of paperwork, video, and photographs to document VR participation. CNS recorded 2,057 participants; at press time, Guinness had not confirmed a record.
“The most challenging aspects of the planning and execution were, one, getting the needed engagement and cooperation from over 2,000 attendees — Dr. Martin joked on stage that he was sure we had broken a world record for getting more than six neurosurgeons to follow the same instruction at one time,” Hilgart said. “And, two, getting the timing of the session right so that when the countdown clock ended, Dr. Martin was beginning the presentation of his case and all attendees were viewing it in their devices.”
Afterward, members got to explore three or four other cases in the app on their own time. Faculty mentioned these from the stage, and of course some had already poked around the app and found them. In the Xperience Lounge VR studio, other scenarios were waiting, and attendees could try them out with oculus goggles for the full experience.
Members were enthused at the chance to learn about technology with so many uses, Hilgart said, including educating patients; visualizing and planning surgery; creating safe, realistic resident training; practicing for rare cases; and consulting with outside experts. Several commented that they’d look into incorporating VR in their practice.
“There were a few jokes about what world record we should break [at the next Annual Meeting], but we don’t have any big Guinness attempts planned for Houston,” Hilgart said. But CNS 2018 at Houston’s George R. Brown Convention Center, Oct. 6–11, will still be high-tech. The program offers a full-day robotics symposium with breakout sessions where surgeons can interact with robotic systems. Which demonstrates that for CNS, highlighting innovation is standard operating procedure.
To see the Surgical Theater Congress of Neurological Surgeons teaser video for the VR session, go to convn.org/CNS-VR.