台北內湖三軍總醫院一樓大廳有個很特別的診間，這是三總與宏達電DeepQ部門合作打造的亞洲第一個智慧外科診間。
今年5月底開診，結合3D列印中心，服務顱顏骨需要修復再生的病患，內有一台電競級的電腦，以及搭配數據搖桿器、動作偵測器，掃描電腦斷層（CT）、核磁共振（MRI）等醫療影像資訊，進行三維重建組合而成的酷炫虛擬影像軟體。
22歲的張先生，才體驗過「智慧外科虛擬實境診間」，43歲的神經外科部科主任湯其暾幫他戴上VR頭戴式顯示器後，張先生眼前就是一個好像在玩人體結構拼圖的逼真世界，從腦、頸椎、脊椎到骨盆的每一塊骨頭、複雜的血管（黃色）和肌肉，都看得清清楚楚。
「會從脊椎開始，是因為脊椎部位可以容許稍微大一點點的誤差。」但令湯其暾驕傲的是，團隊於2013~2015三年間，共在322位病患植入1788根骨釘，精準度達99.1％，成果超過美國、德國。現在頸椎手術已開了100多例，最難的腦部手術開了20多例。
湯其暾清楚記得去年一位56歲男病患，他在院子鋸樹時不小心摔下來，導致頸椎6、7節錯位又斷裂，下半身也失去知覺。第一次植入骨釘手術開了6小時，但患者血壓一直往下掉，擔心手術中可能發生嚴重休克，只好縫合後送進加護病房。三天後患者血壓正常，又進行第二次手術，開了10小時。二個星期後，患者慢慢恢復力氣，一個月後已經可站起來，病患深深感激，醫師也覺得很有成就感。
如今VR科技可幫助外科醫師更容易找到病灶位置。
湯其暾指出，現在的手術室至少有四台螢幕，包括內視鏡螢幕、麻醉監測螢幕、mri/ct螢幕、導航螢幕，醫師常覺得眼花撩亂，VR可以把所有螢幕疊合在一起、隨時切換，讓醫師的目光不用再轉來轉去。
自從6年前，湯其暾從美國進修回國後，就積極向院方爭取經費研究AR、VR在外科的應用。但他不諱言，當時有些大老級醫師以為VR就是遊戲，完全不瞭解。
直到2016年，東京醫學大學首先把Sony研發的VR軟體用於臨床教學上，三總以教學名義邀請東京醫大團隊來三總示範，開啟新契機。因此三總在成立智慧外科門診之前，也是將VR科技首先應用於臨床教學的醫學中心。
湯其暾說，外科醫師的手術技巧訓練多靠教科書圖譜或大體老師，但捐贈的大體老師都是優先讓醫學系學生使用；臨床要用的大體多由美國進口，一具台幣18萬元，使用時間也僅有半年就毀壞。現在透過VR模擬手術和解剖部位，可以讓外科醫師反覆練習，鍛鍊手感，增強外科醫師功力，讓手術百分之百成功。
「手術就好比太空飛行，每次能安然抵達目的地，都是靠無數次的練習，」湯其暾說，如同太空梭飛行模擬器，訓練在地球的太空人，體驗登月後的真實狀況；VR實境也有擴大手術視角及警示死角危險的功能，並預測潛藏的出血處，可協助制訂術前計畫，增加醫師臨場實戰的應變力。
不過，VR實境操作訓練雖可讓醫師精準掌握手術位置和距離，但VR缺少回饋機制，例如操作者就無法確切知道手感、觸感，也就是下刀時的力道究竟有多大，因此大體老師和VR手術訓練仍必須相輔相成。
目前VR實境已經可以做到「看透透虛擬的腦部神經」，成為醫師對患者解說病情的最佳利器。
幾天前，湯其暾完成一個難度達八級（共分十級）的腦部手術，患者是一位懷胎34周的孕婦，在孕期中，醫師發現她的腦垂體腫瘤愈長愈大，已壓迫到視神經，導致一眼看不到。
孕婦剖腹安全生下嬰兒後，湯其暾為她解說將要切除的腫瘤手術，第一次他拿著MRI影像，但患者一臉霧煞煞；第二次他把腦部切片影像合組成立體影像，拿iPad給病人看，並解說病灶位置，旁邊是運動神經、視神經，下刀會從側面進去，患者也清楚瞭解手術過程和難度。
目前三總的智慧外科診間，先用於神經外科教學門診，患者必須簽署願意分享醫療個資的同意書，至今約有5位病患體驗過，一個月只有一次門診時間。
VR旋風尚未全面衝擊醫學界，但已逐漸改變醫學人才的培養方式，在可見的未來，也可能將醫學教學與病患體驗提升到一個新高度！
There is a very special clinic in the lobby of the First Hospital of the Inner Mongolian Three Army General Hospital. This is the first intelligent surgical clinic in Asia created by the three chiefs and the HTC DeepQ department.
Opened at the end of May this year, combined with the 3D printing center, the patient needs to repair and regenerate the skull and bones. There is an e-sports computer, as well as a data rocker, motion detector, and computerized tomography (CT). Medical imaging information such as magnetic resonance imaging (MRI), a three-dimensional reconstruction of cool virtual image software.
The 22-year-old Mr. Zhang had experienced the "virtual surgery virtual reality clinic". After the 43-year-old neurosurgery department director Tang Qichen helped him wear a VR head-mounted display, Mr. Zhang was in front of him as if he was playing a human body structure puzzle. The realistic world, from the brain, cervical vertebrae, spine to every bone in the pelvis, complex blood vessels (yellow) and muscles, can be seen clearly.
"It will start from the spine because the spine can tolerate a slightly larger error." But what makes Tommy proud is that the team implanted 1788 bone nails in 322 patients during the three years from 2013 to 2015. Up to 99.1%, the results exceeded the United States, Germany. At present, more than 100 cases have been opened for cervical surgery, and the most difficult brain surgery has been opened more than 20 cases.
Tang Qichen clearly remembered a 56-year-old male patient last year. He accidentally fell down when he saw the tree in the yard, causing the cervical vertebrae to break in the 6th and 7th sections, and the lower body was also unconscious. The first implant was performed for 6 hours, but the patient's blood pressure had been falling down. I was worried that severe shock may occur during the operation and I had to suture it and then sent it to the intensive care unit. Three days later, the patient's blood pressure was normal, and a second operation was performed for 10 hours. Two weeks later, the patient slowly recovered, and after a month, he was able to stand up. The patient was deeply grateful and the doctor felt very fulfilled.
laennecToday VR technology can help surgeons find the location of the lesion more easily.
Tang Qichen pointed out that there are at least four screens in the operating room, including endoscope screens, anesthesia monitoring screens, mri/ct screens, navigation screens, and doctors often feel dazzled. VR can stack all the screens together and switch at any time. Let the doctor's eyes turn away and turn around.
Since 6 years ago, after Tang Qichen returned to China from the United States, he actively sought funding from the hospital to study the application of AR and VR in surgery. But he did not swear that some old doctors thought that VR was a game and didn't understand it at all.
Until 2016, the Tokyo Medical University first used the VR software developed by Sony for clinical teaching. In the name of teaching, the three general invited the Tokyo Medical University team to the three general demonstrations and opened up new opportunities. Therefore, before the establishment of the wisdom surgery clinic, the three generals also applied VR technology to the medical center of clinical teaching.
Tang Qichen said that surgeons' surgical skills training relies on textbook maps or general teachers, but the general teachers donated are given priority to medical students. Most of the clinical use is imported from the United States, with a Taiwanese currency of 180,000 yuan. It was also destroyed in only half a year. Now through VR simulation surgery and anatomical parts, surgeons can repeatedly practice, exercise the hand, enhance the surgeon's skill, and make the operation 100% successful.
"Surgery is like flying in space. Every time you can reach your destination safely, you have to practice countless times," said Tang Qichen. As a space shuttle flight simulator, train astronauts on Earth to experience the real situation after landing on the moon; VR The real world also has the function of expanding the surgical perspective and warning the danger of dead angles, and predicting the hidden bleeding, which can help to formulate preoperative plans and increase the strain of the doctors on the spot.
However, although VR real-world operation training allows doctors to accurately grasp the position and distance of the operation, VR lacks a feedback mechanism. For example, the operator cannot know exactly the feel and touch, that is, how strong the force is when the knife is cut, so the general teacher And VR surgery training must still complement each other.
At present, the VR reality has been able to "see through the virtual brain nerves" and become the best tool for doctors to explain the patient's condition.
A few days ago, Tang Qichen completed a brain surgery with a difficulty level of eight (a total of ten). The patient was a pregnant woman with 34 weeks of pregnancy. During pregnancy, the doctor found that her pituitary tumor grew longer and bigger and was oppressed. To the optic nerve, it can not be seen at a glance.
After the laparotomy safely gave birth to the baby, Tang Qichen explained to her the tumor surgery to be removed. The first time he took the MRI image, but the patient had a smog; the second time he combined the brain slice image into a stereo image. The iPad looks at the patient and explains the location of the lesion. Next to the motor nerve and optic nerve, the lower knife will enter from the side, and the patient also has a clear understanding of the surgical procedure and difficulty.
At present, the three general wisdom clinics are first used in neurosurgery teaching clinics. Patients must sign a consent form that is willing to share medical resources. Up to now, about 5 patients have experienced it, and only one outpatient time per month.
The VR whirlwind has not yet fully impacted the medical profession, but it has gradually changed the way medical talents are trained. In the foreseeable future, medical teaching and patient experience may also be elevated to a new level!
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