There are only so many ways to practice surgery, and mistakes aren’t forgiven easily. For medical students and physicians in need of continuing surgical education, the options in institutional settings are cadavers (open only to students) or in the few surgical simulation centers around the country. So Chicago-based technology company Level EX is addressing that by bringing the visual effects from the entertainment and gaming industries into medicine with mobile apps. 

Airway EX, the company's first app, is a surgical training simulator built by video game developers and physicians from real footage of surgeries. Now in beta and available for free on iOS and Android, their first app Airway Ex offers physicians the opportunity to perform virtual airway surgery on realistic patients – which are detailed down to their pores – across 18 different procedures on the airway. The game is designed for anesthesiologists, otolaryngologists, critical care specialists, emergency room physicians and pulmonologists. Along the way, they can earn Continuing Medical Education credit by playing the game. 

Through realistic simulations of human tissue dynamics, endoscopic device optics and moving fluids to recreate life-life surgeries, doctors who need to practice surgical techniques can do so in a way that doesn’t run the risk of harming anyone, even though mistakes in the game can end up a bit shocking.

“It bleeds, it coughs, it reacts and it’s running on a device you already own,” Sam Glassenberg, CEO of Level EX told MobiHealthNews in an interview. “It’s a totally reactive patient.”

The idea came to Glassenberg after realizing there was a dearth of surgical simulation centers around the country, and that the simulators lacked the sophisticated graphics and video he saw in the video game industry. Glassenberg, a game developer who comes from a family of doctors and has many friends in medicine, had also been asked several times to help build surgical training programs.

“There is a big gap between surgery training simulations and the video game industry. It’s like the old business video game distribution model where the equipment was expensive, so you'd grab your roll of quarters and go across town to an arcade,” Glassenberg said. “Of course, now you don’t do that, because what you have in game consoles and computers is way better, but the surgical training simulators of today are still like the Pac-Man arcade games. It's that level."

Glassenberg has worked in the video game industry for decades, and worked with graphics technology teams to develop Microsoft’s video game consoles and gaming applications. Level EX came about after he created a prototype of a virtual surgery airway app that was tested with 100,000 doctors at a demonstration. Soon after, he was able to assemble of team of game developers who worked with physicians and device makers to build video game versions of surgery footage and photos. The company now has 20 employees, an advisory board, and 50 physicians around the country submitting information and materials.

“We’ve been working hand in hand with physicians since the beginning,” Glassenberg said. “We know how to do virtual reality, but we needed access to the reality, and the medical community has been walking us through key challenges and feeding us all of these videos to build simulation cases from.”

Level EX has also received considerable feedback throughout the development of the game and has tested the product at numerous top academic hospitals in the US including Mount Sinai.
 
“There are only so many hours for training and perfecting your skills outside of seeing patients,” Dr. Errol Gordon, director of Neuro ICU at Mount Sinai said in a statement. “Level EX addresses roadblocks that hold physicians back by offering an easy-to-use, realistic mobile application that provides them with an edge in learning procedures through detailed patient scenarios. The use of the application enables physicians at all levels to maximize learning and improve surgical outcomes.”

Walking through a demo of Airway EX, Glassenberg also explained that the game will have leaderboards in tournaments in the future, and name-brand devices in place of the current generic tools.

“Right now, in beta, everything is generic,” he said, demonstrating how to cauterize a bleeding wound in the virtual patient’s throat. “But we are working with partnerships with medical device companies. There’s this huge opportunity where you could expose a massive audience to certain tools. At the end of the day, the doctors want to try out all the devices.”

While Airway EX may not quite be like driving games where doctors select their tools the way Grand Theft Auto players select their cars, Glassenberg said the game will continue to be updated and will span into other regions in the body with more and more tool sets.

“Right now, if you want to try out a new device, they reserve a cadaver lab, or you a mannequin in a room,” he said. “But the beauty of this is you have it on a tablet or phone and it reacts, but it’s not a live patient. It’s perfectly safe. You can try things you never would.”