How do you become a surgeon? Really, there’s only one way. You can read all the textbooks you like, but sooner or later you’re going to have to grab a scalpel and start slicing. For millennia this has been the preferred method of on-the-job training for new surgeons, usually summarized with the worryingly abrupt expression “see one, do one, teach one.”

But at the headquarters of London startup FundamentalVR, I got to try out what might be the surgical training tool of the future. It uses cheap virtual reality components combined with haptic feedback to give doctors as realistic a training experience as current tech will allow. Wearing an HTC Vive headset and wielding a pair of pen-shaped 3D manipulators, I sawed off a knee bone and bored holes in the spine of an unprotesting virtual patient. And while I don’t quite feel confident enough to don scrubs and head to the nearest OR, the simulation felt to me like much more than a novelty. It felt like a learning experience.

It’s normal for pilots to train using VR, so why not surgeons, too?

Richard Vincent, CEO of FundamentalVR, explains that virtual reality is an established training tool for surgeons and has been for many years. Studies repeatedly show its benefits for trainees: it helps them perform operations faster and with fewer accidents. But institutional inertia and high cost of equipment mean VR trainers are still not widely used.

“A good comparison is commercial pilots,” says Vincent. “Flight simulators are just a regular part of training for them, and the same should be true of surgery.”

So while there are VR surgery trainers already available, FundamentalVR — which launches in the US today — says its tech is uniquely appealing for two reasons. First, the incorporation of haptic feedback, and second, prices that won’t break the hospital budget.

Haptic feedback or “haptics” is the deployment of vibration or physical resistance to engage your sense of touch when using technology. The most common example is your phone’s vibrate function, which buzzes to let you know when a friend is calling or if the president has just tweeted out the nuclear codes. But in virtual reality, haptic feedback does so much more, adding a physical dimension to the simulated world.

With FundamentalVR’s technology, when you run your VR scalpel up and down a VR spine, the resistance created by the handheld peripherals means you can feel the tip of your knife bouncing off each vertebra. It’s not a seamless experience, and if you push hard enough you’ll go right through your patient (which, fair enough, could also happen in real life). But it’s certainly much more immersive than operating on empty air.

“Surgery is about sight and touch, and if you’ve got a simulator that only has one of those two, you’ve only got 50 percent of the experience.”

FundamentalVR has recruited a panel of medical experts including active surgeons to help to calibrate this experience, tweaking the levels of resistance in the simulation so that they recreate the physical experience as closely as possible. “Surgery is about sight and touch, and if you’ve got a simulator that only has one of those two, you’ve only got 50 percent of the experience,” says Vincent.

This is a big part of FundamentalVR’s pitch, but the company also has another important selling point: the cost. While the current going price for a haptic-enabled VR surgery simulator is around $100,000 (with maintenance costs of $25,000 a year), the hardware needed to run FundamentalVR’s system can be bought for around $7,500, with subscription fees in the hundreds of dollars.

This discount is mainly thanks to the recent(ish) boom in consumer VR, which has raised technical baselines while lowering prices. This means the hardware side of FundamentalVR’s tech can use off-the-shelf components, rather than custom models. All you need is a midrange PC, a pair of haptic peripherals, and a VR headset of your choice.

FundamentalVR has been developing its tech in the UK for a while now (Vincent says that hiring top talent is just a lot cheaper in London than Silicon Valley), but it’s the US market that’s the big prize. Many large hospitals in America already have a VR simulator of some sort, and with its greater spend on R&D, the US is home to around two-thirds of global sales for these devices. FundamentalVR says it’s already got a few big contracts with some “household name” hospitals lined up, but won’t be able to announce them until September.

As well as the low cost of its hardware, FundamentalVR’s system seems more flexible. It’s planning to design a number of peripherals that fit onto the 3D manipulators and while its current simulations only focus on orthopedic procedures, it wants to expand to general surgery next year. Hospitals will be able to buy only the simulations they need, piece by piece. Think of it like the DLC model in video games, but instead of paying extra for access to new quests, you’re getting hot content like “Spinal Pedicle Screw Placement” and “Total Knee Arthroplasty” (two of the three orthopedic procedures currently on offer).

So the hardware and business model are in place, but FundamentalVR needs to do more work to prove the basic functionality of its system: does it make someone a better surgeon? Although the general benefits of VR simulators are established, FundamentalVR’s tech has not been involved in any studies yet. And while haptic feedback in simulations certainly feels compelling to laypeople like myself, the scientific research on its utility is mixed.

The benefits of VR are proven, but haptics are not as well-established

Studies looking at the benefits of haptics in VR are inconsistent. Some have found that this sort of force feedback is actually worse for students, while others have found benefits with serious limitations.

A 2018 report in the Journal Of Surgical Education found that haptic feedback helped with learning complex procedures, but offered only “minor improvements for novice surgeons.” A 2012 study looking at VR training for suturing found that surgeons learned to perform the procedure faster when training with haptic feedback, but that this advantage was only apparent during the first five hours of training. After this period, those training using non-haptic systems quickly caught up. And a report published in April this year even suggested that there might be an “uncanny valley of haptics,” where, when the simulated sensation is close to real life but still imperfect, it actually becomes a distraction.

FundamentalVR will have to prove its tech is better than this record if it wants to attract customers. Dr. Phil Pucher, part of the company’s panel of medical experts, tells The Verge that the firm is setting a new round of tests of their equipment with Imperial College London, “one of the global leaders in simulation research.”

“We’re going to be running studies, looking at assessing the efficacy of the system,” says Pucher. “You do that by taking it to a lot of orthopedic surgeons and looking at their performance with the system. Does an expert perform better with this than a novice?” He adds that while it’s right to test the company’s system, past studies on VR trainers suggest its benefits are a “no-brainer.”

And getting VR surgery simulators into more hospitals might only be the beginning. In the future, says Vincent, modeling software might allow the company to turn patient’s data (like CT and MRI scans) into 3D models that can be inserted into the simulation. This would allow surgeons to practice operations on a facsimile of their patient, potentially reducing risk even further. Vincent stresses that this is just a sketch of what’s technically possible, not an active area of research, but it’s a tantalizing concept. The old adage of “see one, do one, teach one” may finally be getting an upgrade.