Virtually Awake: Discussing a New and Improved Alternative to Sedation with Dr. James Clarkson, MD

by | Sep 9, 2022 | Issue 155, Issues | 0 comments

You find yourself in need of minor surgery. Right away, images of a hospital, operating room, fasting before the procedure, being placed under anesthesia, recovery time and a hefty bill...

You find yourself in need of minor surgery. Right away, images of a hospital, operating room, fasting before the procedure, being placed under anesthesia, recovery time and a hefty bill flash through your mind. 

But what if you could have your surgery in your doctor’s office with only local anesthesia? It would undoubtedly save you significant time and money. But you hesitate because, even if it’s pain-free, you don’t want to be awake to see that! 

What if there were something that so distracted you that you stopped worrying about the procedure? Dr. James Clarkson and his team have developed a way to use virtual reality to distract patients from the anxieties associated with being awake during surgery.


Dr. James Clarkson, MD

Dr. James Clarkson, MD (MBBS, MSc, FRCS (Plast), FRCSC) was the Chief of Plastic Surgery at Sparrow Hospital in Lansing, Michigan, from 2016 to the end of 2021, specializing in hand surgery. He recently passed on the title to his colleague. He is now focusing his talents on being the Chief Medical Officer and co-founder of Wide Awake Virtual Reality, Inc.

“I reconstruct wounds from major injuries—leg, upper limb, body and facial wounds. I also manage hand trauma,” Dr. Clarkson said.


Inspiration from Family Tradition

Dr. Clarkson patterned his career after his grandfather, a World War II plastic and hand surgeon.

“I’ve always been inspired by my grandfather. I pretty much do the same work that he did. I have these pictures of injured soldiers from 1943 and the amazing reconstructive work that he did,” Dr. Clarkson shared.

Dr. Clarkson published some of his grandfather’s work based on the available photographs, data and written records. At that time, this work would be considered beyond the accepted medical care.  

“He advocated for early closure of wounds and pioneered the early removal of burns and application of skin grafting. He looked at how people were doing things and realized it was people copying people. They weren’t thinking for themselves. And he thought for himself,” Dr. Clarkson explained.

Dr. Clarkson inherited his grandfather’s forward-thinking and willingness to question the status quo. So, when faced with a string of complications that seemed to be centered around general anesthesia, Dr. Clarkson first started questioning. Then, he started innovating. 


The Question of General Anesthesia

A Problem Revealed

Over the years, some of Dr. Clarkson’s patients encountered serious complications after minor procedures. 

“One patient had a small stroke. Another had a major heart attack. An elderly man developed such bad pneumonia that he nearly died in intensive care,” he said.

Dr. Clarkson concluded that the unnecessary use of general anesthesia contributed to these complications. Yet when he spoke to others, it was considered business as usual.

“That inspired me to make a simple observation that nobody wanted to make—we’re overusing general anesthesia,” he explained. “It’s not that it should never be done. But it should only be done judiciously and when it’s necessary with the minimum required intervention. General anesthesia isn’t always required.”


About General Anesthesia

General anesthesia is a combination of medication and gas that render patients unconscious. For most patients, it is a safe, effective method of avoiding pain. 

Yet, as with any medical procedure, there are associated side effects and risks, such as nausea and vomiting, confusion and dizziness and muscle aches. In addition, it  can be hazardous for patients with conditions such as diabetes, sleep apnea and heart disease. As the population grows older and more frail, these risks, in addition to post operative confusion, are set to grow.


A Local Alternative

While general anesthesia is a must for major surgery, the profession is interested in moving minor surgery to the doctor’s office and using local anesthesia only. 

But Dr. Clarkson finds that patients often have no desire to be awake, even for minor surgery. The fear of surgery is a significant fear to overcome, and Dr. Clarkson realized that the solution is not in a haze of unconsciousness. 

“What they need is something we haven’t been using—a form of distraction,” he explained.

He found a solution outside of traditional medicine.


A Virtual Reality Solution

From an idea inspired by his children, Dr. Clarkson pioneered the use of virtual reality for his patients.

“We were playing with a virtual reality headset, surrounded by visual and audio sensations. I was entranced by it. Then, it occurred to me that this was synergistic with distracting my patients,” Dr. Clarkson shared.

Virtual reality has become valuable beyond gaming in the past few years, with applications in entertainment, space exploration, museums, manufacturing, education, law, mental health, shopping and the military. In addition, it has helped advance diagnosis, treatment, education and surgery in healthcare as a profound distraction. 

“The object,” Dr. Clarkson said, “isn’t to create a meditative experience. Instead, we want to engage the mind, where our patients are intensely interested in what they’re looking at.”


Wide Awake Virtual Reality (WAVR)

With intellectual property developed by partners David Wheeler and Joseph Gough, Dr. Clarkson founded Wide Awake Virtual Reality, Inc. and developed a VR device. Patients are immersed in original content and kept anxiety-free while undergoing minor surgery with local anesthesia in the doctor’s office. 

“Content includes visually stunning, beautiful documentaries and fascinating material that fills your mind with activity. There’s lots going on. It’s stuff that patients have never seen before,” Dr. Clarkson explained.


A VR Study

Dr. Clarkson conducted a study on VR instead of general anesthesia, and the results point toward an improved patient experience. VR patients reported lower anxiety and described the experience as fun. In addition, the procedure conducted with local anesthesia decreased costs and shortened the hospital stay. Patients are more likely to choose this safer, more accessible procedure when their anxiety is eliminated. 


The Success of the Solution

“I’m very pleased with the results,” Dr. Clarkson said. “A day’s surgery is now just a little visit to the office. They have breakfast, and they can drive home after the surgery. And there’s absolutely no risk from anesthesia.”

Of Dr. Clarkson’s hand surgeries, he performs about 60% in his office with a local anesthetic and a VR headset. 

“VR makes their surgical experience a neutral or even pleasurable experience,” he said. “We even give them post-operative educational information directly into the headset.”

Dr. Clarkson has followed his grandfather’s path of medical innovation and created a way to keep patients safe and happy. 

“Remember,” he said, “It’s always safer to be awake!”

Gaye Newton

Gaye Newton