Scientists from the University of Nottingham's Schools of Mechanical Engineering, Computer Science and Human Development working with medical staff have created the prototype of a simulator that combines three dimensional computer graphics with technology that allows surgeons to feel as though they're actually touching a human brain as they operate. "The simulator is a device, a method of obtaining a response to a device, which you hold by the fingers, and the force in the device feeds back from the computer to allow you to feel an object that is not really there; it's virtually there and you can feel the response of that object wherever you actually poke it in space.?" Traditionally surgeons working on such advanced operating techniques have relied on training based on observing practising surgeons and conducting operations under supervision. Pressure on resources, staff shortages and new E.U. directives on working hours make this means of "on the job" learning increasingly difficult to accommodate.

Previously we trained neuro surgeons on the job - there are problems with that; first of all risk to the patient, risk for infection, MRSAs is very high on the cards these days in publicity. There's also the restriction of working times; our trainees have to obey working time directives and there's less exposure to big and complex operations. Training on the job is good but it can only go so far and I would hope that we could come to a form of accreditation of simulator operating much as you do in civil aviation.

This simulation of surgical cutting in real-time computing is particularly difficult to achieve. Cutting creates new surfaces that did not exist before the cut was made. Nottingham's researchers have devised new computational methods that allow the software to respond to the cut in real-time.

The line between simulation and reality may blur further: "If you project maybe four or five years from now it may be possible, indeed it's quite feasible, for a surgeon to operate on a patient totally remotely. So the surgeon would be located somewhere else in the world and can communicate through the internet possibly, with some robotic assistance, can actually feel the operation as they are seeing it on the screen."

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