Before scrubbing up, power up the game
By Michel Marriott The New York Times
Saturday, February 26, 2005
The running joke that playfully follows James Clarence Rosser Jr. when he prepares to operate at the Beth Israel Medical Center in New York is that this ebullient man possesses hands too large to perform traditional surgery.
Instead, Rosser prefers laparoscopic surgery, which 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 frame loomed over a surgical simulator using instruments that 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, showing 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 3-foot-long chopsticks" while watching it all on television.
But in recent months, Rosser, whose height is 6 feet 4 inches, or 1.93 meters, has been emphasizing a comparison he believes is more apt: video gaming.
The manual dexterity required to be a stellar video gamer and minimally invasive surgeon are strikingly similar, said Rosser, chief of minimally invasive surgery and director of the Advanced Medical Technology Institute at the hospital. 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," 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. Rosser, 50, practices what he preaches. He keeps an Xbox, along with PlayStation 2 and GameCube consoles, just a few strides away from the operating room so he can warm up with a favorite, Super Monkey Ball, just before surgery. Last year, Rosser was the 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 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 Antonacci, chairman of Beth Israel's department of surgery. It was Antonacci, convinced that his old colleague was on to something, who helped lure Rosser from the Yale University School of Medicine to Beth Israel three years ago.
"He is a virtuoso," Antonacci said of 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 added, noting the need for other means to honing and maintaining surgical skills.
As a pilot, Antonacci said that 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. 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. Rosser said he had been using one, "but that thing was costing $200,000 - how many people are going to have one of those?" he said.
Recently, Rosser has been working with Hollywood visual effects experts to help apply motion-capture technologies 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 "The Polar Express," a notable computer-generated movie in 2004.
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. Menache and Rosser said they were 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," 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. 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."
Rosser, a native of Rome, Mississippi, spent a good part of his youth playing coin-operated video games. It was a pixilated pastime that 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,"' Rosser 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."
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 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?" Rosser said he once asked himself during his early training. "Because the other ones were struggling. They weren't gamers."
These days, however, Rosser said he was helping to turn out increasing numbers of young doctors who not only show promise in becoming excellent laparoscopic surgeons but also 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," Rosser said.
"I have a video-game training course that I invented trying to trick these doctors into learning new tricks."