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This UC San Diego Professor Planned His Surgery In Virtual Reality

UC San Diego computer science professor Larry Smarr stands in front of a 3D r...

Photo by Kris Arciaga

Above: UC San Diego computer science professor Larry Smarr stands in front of a 3D representation of his internal organs, Feb. 22, 2017.

UC San Diego's Larry Smarr is the kind of guy who wears a Fitbit, monitors his sleep and has had his DNA sequenced. But he takes the whole self-tracking thing farther than most. He has mapped his internal organs in three dimensions. He even has a 3-D printed model of part of his colon — the part cut out in a recent surgery.

"Just this amount of my body was out of control," Smarr said, clutching the plastic replica. "And to be able to actually hold it was very empowering."

Smarr has an inflammatory bowel disease. When he learned that part of his colon needed to be surgically removed, Smarr got to wondering: If 3D graphics are increasingly being used to bring video games and other forms of entertainment to life, why could they not be used to help protect his life?

In an unusual approach to this kind of operation, Smarr and his surgeon decided to use 3-D imaging in the planning and execution of his recent colon resection surgery. They said the experiment was a success. And now, the man known for evangelizing the concept of the "quantified self" is on a mission to popularize the idea of "quantified surgery."

Reported by Kris Arciaga

This UC San Diego Professor Planned His Surgery In Virtual Reality


Larry Smarr, director, Calit2, UC San Diego


The prospect of going under the knife got one San Diego computer scientist wondering: If 3D graphics are being used to bring video games to life, why can't they be used to help protect his life?

Smarr is very open about his experiments with self-tracking. He is happy to offer people an X-ray view of his body in virtual reality.

"Actually for four years, I've been giving tours of the inside of my body to hundreds of people," he said.

In a dark room at Calit2 — the UC San Diego institute Smarr leads — a computer scientist is pulling up the 3D map of Smarr's colon. The black walls in this "virtual reality cave" surround visitors. Projected onto them is a huge, floating image of Smarr’s insides.

"This is my entire colon," Smarr said, wearing a pair of 3-D glasses. He recently brought his surgeon into this space to show her the bunched up section of his colon causing trouble. He wanted her to see exactly what she would have to cut out before the operation.

Leading up to his surgery, Smarr was bothered by the thought that this kind of imaging — which has been possible for years — is not already used in the operating room. When he brought this up with his surgeon, Dr. Sonia Ramamoorthy of UC San Diego Health, he found that she felt the same way.

"I have teenage boys," she said. "I look at their video games, and it just kills me every time to think: How is it that we have such great gaming graphics and technology and none of that has been applied to surgery and simulation yet?"

Photo by Kris Arciaga

Larry Smarr holds a 3D-printed replica of the section of his colon removed in a recent surgery, Feb. 22, 2017.

Smarr proposed an idea. Why not use this 3-D map to help guide his surgery? Ramamoorthy said this is not the typical approach, but she was all for it.

"He was able to sort of help me visualize more, and put me through a kind of simulation of what it would be like to operate on him before I operated on him," she explained.

Ramamoorthy said surgeons are already good at performing successful colon resections. But they do encounter unique challenges with each patient — challenges they would be better off knowing about before the patient goes under. Perhaps better imaging could reduce the time patients spend in surgery and help them recover faster, she said.

Ramamoorthy notes that 3-D imaging is already used in some other types of surgery, including vascular and liver surgery. But she thinks bowel operations could also be improved by having a kind of GPS for the surgery. She said it could be like drivers using Google Maps to find the best route through an unfamiliar area.

"You want to route it out so you make the most efficient turns, and so that you're aware of any accidents in the area so you can bypass that stuff," Ramamoorthy said. "That's the same kind of information I need before I go into the operating room to operate on someone. I mean, the stakes are high in the operating room."

Ramamoorthy had the 3-D map of Smarr's colon on display throughout his surgery. She even drafted Jurgen Schulze, a UC San Diego computer scientist, into the operating room. He is the one who created the 3-D map by painstakingly layering two-dimensional MRI images, one on top of another.

Photo credit: UC San Diego

Dr. Sonia Ramamoorthy is seen in the operating room on the day of Larry Smarr's surgery, Nov. 29, 2016.

Schulze has no formal training to assist in surgeries, but he was able to help surgeons refer to this 3-D map during the operation.

"Going into that surgery, I was definitely a nervous wreck," said Schulze. "Not only was it an actual surgery on a human, but it was also a surgery on a human that I've worked with for a good 10 years."

Despite Schulze's anxiety, everything turned out fine. A few months after his surgery, Smarr continues to recover well. He relied on his Fitbit to make sure he walked a little more each day during the early stages of recovery.

It remains to be seen whether other bowel surgeons will want to incorporate 3-D imaging into their operating rooms. Ramamoorthy said she is enthusiastic about the idea. She plans to use 3-D imaging with more of her patients in the hopes of standardizing this approach.

"I think that's going to be something that we start here at UCSD that's just going to profoundly shift what we do worldwide in surgery," she said.

Some patients might have been freaked out by the idea of tinkering with a tried-and-true approach to surgery. But Smarr said turning himself into a guinea pig actually reduced his anxiety.

"As a patient, your fundamental enemy is the unknown," he said. "That's what drives anxiety. That's what drives fear. And as a patient, I was learning and helping to form the game plan for what was going to be done to my body. That reduced all kinds of uncertainty."

Smarr likes to say his job is to live in the future and report back. If this is the future of surgery, he said, it is a future where patients will feel more in control of their health care — even when they are under anesthesia.


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