title: Virtual reality surgery: neurosurgery and the contemporary landscape.
abstract: OBJECTIVE
  Virtual reality-simulated environments have been used for the training of personnel, most notably for military applications, for more than 35 years. The advantages conferred by being able to train novice personnel in a low- to no-risk simulated environment have long been appreciated by the medical community. The recent availability of affordable gigahertz-range microprocessors (once the exclusive domain of the Cray supercomputer) has made photorealistic graphical rendering and manipulation of virtual surgical substrates a reality. Concomitant advances in artificial intelligence systems and the portability of patient-specific magnetic resonance imaging, computed tomographic scanning, and angiographic image data presage the emergence of the surgical simulator as a modern surgical training adjunct. An overview of the status of surgical simulation with regard to its adaptability to current surgical training regimens is presented.
  
  
  METHODS
  Extensive MEDLINE, Internet, and other database searches spanning the years 1960 to 2002 were conducted in an effort to delineate the status of simulated surgical environments.
  
  
  RESULTS
  As would be expected, most articles addressing surgical simulation as their primary focus have been published in the past decade. A review of this literature demonstrates the broadest application in the field of endoscopic (and laparoscopic) procedures, most likely as a result of the reduced engineering burden with respect to incorporation of a haptic interface.
  
  
  CONCLUSIONS
  The realization of ergonomically acceptable haptic interfaces remains elusive. Improvements in graphical rendering and the incorporation of artificial intelligence functions signal the certain emergence of surgical simulators as a viable supplement to the Halstedian method of surgical training.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. mspicer@usc.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Spicer
authors.forename: Michael L J
authors.initials: ML
authors.lastname: Apuzzo
mesh_terms: D006801:Humans; D009422:Nervous System Diseases / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D014584:User-Computer Interface