Cutting Edge - Dr. James Clarence
Rosser Jr., chief of minimally invasive surgery at Beth Israel Medical Center
in Manhattan, trains other doctors to use gaming to improve their
operating-room skills.
By MICHEL MARRIOTT
Published: NYTimes, February 24,
2005, page G4
THE running joke that playfully
follows Dr. James Clarence Rosser Jr. when he prepares to operate at Beth
Israel Medical Center in New York is that this ebullient man possesses hands
too large to perform traditional surgery.
Instead, Dr. Rosser prefers
laparoscopic surgery, a technique that relies on an ultrasmall video camera to
help him manipulate long, slender instruments inserted into patients through
small incisions. It is, he said recently, as his hulking 6-foot-4 frame loomed
over a surgical simulator using instruments he designed, an elegantly efficient
approach to repairing the human body.
"In this new realm of
laparoscopic surgery, you don't cut people open, or put your hands inside
them," he said, demonstrating his mastery of hand-eye coordination and his
keen depth perception by delicately tying tiny knots in a piece of suturing
thread in a procedure he has long described as akin to "tying your
shoelaces with three-foot-long chopsticks" while watching it all on
television.
But in recent months, Dr. Rosser,
who also goes by the nickname Butch, has been emphasizing a comparison he
believes is more apt: video gaming.
The complex manual dexterity
required to be a stellar video gamer and minimally invasive surgeon are
strikingly similar, said Dr. Rosser, chief of minimally invasive surgery and
director of the hospital's Advanced Medical Technology Institute. More
important, he is using video games to help develop and train a new generation
of surgeons who may have unwittingly acquired an aptitude for laparoscopic
surgery while wiling away thousands of hours playing Mortal Kombat, BloodRayne
and the like.
"I could come in, sit down
and put this in my hand," Dr. Rosser said, referring to his instruments
with touch-sensitive handles that resemble triggers, "and not find it
foreign to look on that screen and do something with my hands."
It is exactly what anyone who has
ever played a video game, from computer Solitaire to Halo 2, routinely does for
fun.
Dr. Rosser, 50, practices what he
preaches. He keeps an Xbox, along with PlayStation 2 and GameCube consoles,
just a few strides from the operating room so he can warm up with a favorite,
Super Monkey Ball, just before surgery.
Last year Dr. Rosser was a
co-author of a study that concluded that surgeons who played video games for at
least three hours a week were 27 percent faster and made 37 percent fewer
mistakes than surgeons who did not play video games.
And as Dr. Rosser conducts his
Rosser Top Gun Laparoscopic Skills and Suturing Program, which, among other
things, introduces video games to medical training, he collects information on
the proficiency of surgeons he instructs. So far, he said, he has a database
measuring how more than 5,000 doctors actually perform.
Precisely measuring how surgeons
work and then using training tools, like video games, to help impart those
skills is vitally important to the medical profession, said Anthony C.
Antonacci, Beth Israel's chairman of the department of surgery.
It was Dr. Antonacci, convinced
that his old colleague was on to something, who helped lure Dr. Rosser from the
Yale University School of Medicine to Beth Israel three years ago.
"He is a virtuoso," Dr.
Antonacci said of Dr. Rosser's surgical skills. "And common to all
virtuosos is that they devote an incredible amount of work to developing their
discipline. They never stop practicing.
"But you can't operate on
people every day," he said, noting the need for other means to honing and
maintaining surgical skills. As a pilot, Dr. Antonacci said he recognized the
importance of flight simulators, but believed that the next step was
determining whether such special training translated into clinical outcomes
like lower postsurgery death rates.
Dr. Rosser, an aviation history
buff who also builds and flies radio-controlled aircraft, said he was convinced
that better training would lead to better patient care, and video games in many
ways could serve as low-cost surgical simulators of sorts.
Many medical simulators are almost
prohibitively expensive, he suggested. He said he had been using one, "but
that thing was costing $200,000 - how many people are going to have one of
those?"
Recently, Dr. Rosser has been
working with Hollywood visual effects experts to help apply motion-capture
technologies - used in creating lifelike virtual characters in movies and video
games - to produce new types of surgical training techniques and devices.
"I think basically that Dr.
Rosser is brilliant in his thinking," said Alberto Menache, the digital
effects supervisor for last year's notable computer-generated movie "The
Polar Express." Mr. Menache helped pioneer the motion-capture technology
that enabled filmmakers to reflect an actor's performance, including subtle facial
expressions, in a computer-generated character.
Mr. Menache and Dr. Rosser said
they are working with Sony Pictures to use even more advanced radio-frequency
motion-capture techniques to gather the precise movements of doctors in
surgery.
"We could capture all motion
of expert doctors, create some software, and tell students what he is doing
wrong when he is doing the work," Mr. Menache said of the project's
possibilities.
"We have developed a lot of
software that involved a lot of research in anatomy, in how muscles work, how
the face works," Mr. Menache said. "We have tremendously high budgets
to do this kind of stuff for movies. I have always been thinking that if we
take this research a little further we could make a difference in medicine and
other fields."
But Dr. Rosser said he realized
that many of his ideas were greeted with skepticism, particularly in a
profession that tends to cling closely to tradition.
He typically throws back his head
and laughs loudly at the notion of resistance, something he faced as a black
boy growing up in the segregated South.
"I step up," Dr. Rosser
said in his characteristic blend of hip-hop swagger and scientific exactitude.
"I have a way of convincing people to do things they don't think they want
to do."
Dr. Rosser spent a good part of
his youth playing coin-operated video games. It was a pixilated pastime he said
he fervidly pursued even while completing his medical training at the
University of Mississippi School of Medicine in Oxford and throughout his five-year
residency at the Akron General Medical Center in Ohio.
"My dad used to say: 'Boy,
you are going to be worthless. You're not going to get out of school playing
these crazy video games,' " Dr. Rosser, a native of Rome, Miss., recalled
with a chuckle.
"I started with Pong, just
having fun," he said of the primitive video tennis game. "But you
know what? I kept looking at this and I saw how it could hold my
attention."
Dr. Rosser, who briefly played
college football, said he also began to realize that he could test principles
and strategies on the video game that could be helpful in playing tennis on an
actual court.
As video games evolved, so did Dr.
Rosser's understanding that there may be useful correlations between skills he
acquired with a joystick and skills he began to acquire in medical school.
"Is this why I can actually
do this kind of surgery better than the other surgeons?" Dr. Rosser said
he once asked himself during his early training. "Because the other ones
were struggling. They weren't gamers."
These days, however, Dr. Rosser
said he was helping to turn out increasing numbers of young doctors who not
only show promise in becoming excellent laparoscopic surgeons, but more than a
few who can play a mean game of Super Monkey Ball.
"We're going all over the world training people, trying to give them the skills that seems like I was able to nurture with video games," Dr. Rosser said. "I have a video-game training course that I invented trying to trick these doctors into learning new tricks."