Clarkson is the chief of the Hand Management Unit at MSU Health Care. He's also an assistant professor in the College of Human Medicine at MSU.
“The largest number of people I see have peripheral nerve compression and carpal tunnel syndrome. The other thing I obviously treat is trauma. We see huge numbers of injuries. I've been on call for Sparrow and McLaren Hospitals for 12 years. We've had every type of imaginable injury from farm vehicle injuries to firework injuries to the most common injury in the world, which is getting your finger caught in your door.
“I'm a minimalist. The hand is like the mouth. It can be made numb. And if you think about it, dentists have forever done awake surgery on their patients. I don't go to the dentist to get a general anesthetic, except under very unusual cases. And in hand surgery, when I came to the states, I was really surprised to see how much general anesthetic we were using.
“Back in the British National Health, I could give someone a local anesthetic, and we'd be able to do a carpal tunnel release, or trigger finger release, or remove ganglions. And some of the simpler things around the hand, indeed, some of the complicated things around the hand, can be done just under local anesthetic. And it really brought up in my mind a sense that the patients needed a choice. They don't necessarily want to be put to sleep, although they often think they do.
“The phrase, ‘Just put me out, doc: I don't want to know anything about it,’ came up quite a lot when I started offering awake hand surgery to my patients. And one evening, I got home, and my kids and I were playing with a virtual reality headset. I realized, ‘Oh, this is an incredible way to change your experience, without having to go to sleep.’
“I started offering it to my most reluctant patients. And before I knew it, they all were very happy to have awake hand surgery. And the other good thing about that is that I was able to transfer their care out of the busy hospital in-day surgery centers and just do it in the office, which is a much simpler, cheaper, and very fast way of dealing with things on a full stomach.”
Can you talk a little bit more about the virtual reality process and how it differs from traditional surgery?
“I like to take my patients across Victoria Falls or around the White House. Why shouldn't you have fun? Let's break the myth that you shouldn't have fun.
“The patients come in. They've eaten lunch or breakfast. They might be carrying a cup of coffee. They don't have to bring a relative. They can drive themselves to and from the appointment, provided they feel they can control the car. It depends on the hand surgery. They might choose to have a driver.
“That's a very big difference. When you are asked to go to a treatment center or to a hospital system, you're asked to have nothing to eat from midnight. And that makes a big difference for our diabetics, who are taking medication and who need to take their insulin and eat the right levels of sugar and carbohydrate in the morning. It really introduces a simplification for the patient.
“When they arrive, they're given some local anesthetic in one of the rooms. Once the patient is numb, wearing VR is just fun. And we introduce some education in the VR as well. We give them their preoperative instructions, their postoperative instructions, and they end up at the end of their procedure having had a joyful, fun time. They've been talking to me throughout the show. We're often joking about what they're watching and they're mindful. They don't wake up in a haze. They wake up mindful, and they know what their post-operative instructions are. They don't have any confusion, which makes a big difference.
“We see fewer complications from our patients doing it that way and fewer infections in my office when compared to doing it in the main hospital with general anesthesia. As a result of the success that we found from treating the hand surgical patients using VR, we've also been able to get our vascular team to start using virtual reality on their vascular procedures in the office, which is going well.
“We are developing a center of excellence for the use of virtual reality in awake hand surgery. And we are doing several studies to validate this method. We have already shown that it decreases anxiety, increases joy, and for patients who have needle phobia, it decreases the pain of the injection.”
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