Christmas afternoon, 1979. I’m in my pajamas, fiddling with some wiring in the back of the family television. Beside me is a recently opened box that had previously contained, in garish red and green gift wrap, my gift from Santa for having just a few more “nices” than “naughties” — an Atari 2600 gaming system. My mother has advised me to wait for a family friend, who’s a television guy, to hook it up. But, the delay of several hours being a bit too long for an eight-year-old to tolerate, I take it upon myself to hook up the darn thing. I power up the console, turn the TV dial to channel 3, and begin a lifetime habit of playing and enjoying video games.
Throughout my childhood, my very patient parents would often have to remind me to put the console away to focus on homework or go outside, frequently adding, “Besides, video games are a waste of time,” or “Video games won’t help you with schoolwork,” or even “No one makes a living playing video games.”
But here’s the thing. Video games do help. They’ve turned out to be far from a waste of time.
Fast forward three decades. After years of education and training, intermingled with a continued habit of playing increasingly sophisticated and immersive computer games, I now find myself performing cardiac procedures 30 to 40 hours every week. During these procedures, I use X-rays to visualize the instruments while performing angioplasty and placing stents inside the arteries of patients with coronary disease.
I don’t want to belittle the seriousness of my occupation, nor do I intend any misunderstanding of the frequent high stakes involved in performing the procedures, but let’s take a closer look at the set up. I am controlling the action inside the artery remotely, from outside of the patient, via manipulating wires and other devices that pass through a yard-long but very narrow plastic catheter. During the majority of the procedure, including the most delicate sequences, my eyes are not focused on my hands nor the area in front of me where I am manipulating the equipment. Instead, I look at the live video feed from the X-ray. Sound familiar?
Cardiology is not unique in this, as more and more medical and surgical procedures move to the “less invasive” paradigm. My colleagues in Interventional Radiology and Endovascular Surgery use an almost identical setup to perform procedures in other organ systems. During endoscopy, gastroenterologists manipulate their equipment through the digestive tract while looking at the live video feed from the end of the fiber optic endoscope.
Playing video games may not have been essential in developing my skills in the cardiac catheterization lab. I’ve always been pretty good with my hands. And the video-game generation only started doing these procedures recently, while the three-decade-old field has a rich history of highly skilled and innovative operators. But, I’d argue, those hours and hours of practice certainly have helped.
But don’t take my word for it. There is a burgeoning field within medical education that is co-opting video games to enhance procedural skills. The University of Vermont and the UVM Medical Center have built a clinical simulation suite where medical trainees can learn procedures without the risk of harming a patient during the process. There are actually catheterization lab simulators available as well. These machines look very much like glorified XBoxes; however, instead of a control pad, the system has sensors on mock catheters and wires that translate movement onto a simulated procedure on a screen in front of the operator. As part of my requirement for maintenance of certification, I actually had to perform a monitored series of simulated cases on one of these systems last year.
And to come full circle, there is a company that has designed a robot that can perform coronary angioplasty and stenting procedures. The physician does not stand immediately at the patient’s side as in conventional procedures. Instead, the physician sits at a video console a few feet from the patient controlling a robot that actually manipulates the wires and catheters. And how does the physician control the robot? With joysticks, of course!
Prospero B. Gogo, MD, is Director of the Cardiac Catheterization Laboratory at the University of Vermont Medical Center and Interventional Cardiologist. He is an Associate Professor at the Larner College of Medicine at UVM.