Push The Frontiers Of Surgery Forward
When you get in your car to travel, you no longer have to depend on two-dimensional maps that may have been printed years ago. You can switch on your GPS to keep you on course and give you precise updates on your position along the way.
Similar advances in technology are guiding the hands of surgeons in high-precision procedures and helping those in remote locations overcome the barriers of distance while working hand-in-hand with experts when they venture into unfamiliar territory.
O-ArmR Surgical Imaging System
“Our eyes see only surfaces. With the O-Arm, we can see where we are working with precision, while we are operating,” said William C. Woodall, III, MD, of Birmingham Neurosurgery & Spine Group, P.C. “It makes surgery safer and helps us do our work better for better outcomes.”
The O-Arm surgical imaging system from Medtronic provides quick access to real-time multidimensional images. It completely encircles the bed, taking images that are assembled to show the surgery team what’s happening on three different planes.
“It’s almost 3-D. We can look at positioning from three different orientations,” Woodall said. “There’s a camera and detectors on instruments so we can see where we are in relation to the patient. It’s an excellent tool for stereotactic surgery, and helpful in cranial surgery. For example, in dealing with brain tumors, we can use it to confirm that all questionable tissue has been removed.
“The big advantage, however, is in spinal surgery, particularly in spinal fusions and the placement of hardware. The skull is more fixed in one position, but the spine moves and even a small movement as we take the patient into the OR can throw the positioning off. With the O-Arm, we can see how we’re placing the screws during surgery to make sure we have them in the best position,” Woodall said.
“Our neurosurgeons use the O-Arm at St. Vincent’s, and it’s also popular with the orthopedic surgeons working here, particularly in traumas to make sure fractured bones are properly realigned.”
The system helps to minimize radiation doses for both the patient and the staff. Surgeons can quickly choose simple, low-radiation 2D fluoroscopic images to check details, or get a full 3D reconstruction in standard or high definition with a large field of view.
Before patients leave the operating room, repairs can be confirmed, giving patients the best opportunity for good outcomes from their procedure while reducing the need for followup surgery.
Shared Virtual Reality
When you pick up a scalpel to perform a complicated surgical procedure for the first time, it helps to have experienced hands guiding your own.
But what do you do if the nearest expert is half a state away? How do you deal with emergencies that simply can’t wait for help to arrive?
With Virtual Interactive Presence, you have an expert working with you anywhere you can establish an Internet link. In field hospitals, distant medical schools and remote areas where the patient can’t come to the surgeon, the surgeon can come to the patient.
The technology combines local and distant video elements, laying a pair of hands in one location over another pair of hands in a different location while both people see the same image. The expert can point to what needs to be done and place the image of his hands to guide the hands of the person on the scene.
The technology is the brainchild of UAB neurosurgeon Barton Guthrie, MD, who wanted to find a way to meet the need for more trained surgeons at a time when an economic downturn was stretching budgets.
Guthrie called on the Enabling Technology Laboratory in the Department of Mechanical Engineering at the UAB School of Engineering for help in developing the idea. For three years he worked with Bharat Soni, PhD, Douglas Ross, PhD, and programmers Corey Shum and Marcus Dillavou to create a software capability that is the first of its kind.
"Much of what is needed for a connection - Internet access, monitors and Web cameras - will be available wherever it's needed," Guthrie said. "What the virtual technology provides is a way to bring it all together."
Recently Virtual Interactive Presence was used in training law enforcement officers to deal with bomb disposal situations. The Department of Defense is looking at applications, and VIPAAR LLC of Birmingham has licensed the technology for commercial development.
Soon, experts at Alabama automotive plants could be offering hands-on help to trainees doing engine repairs in another state. When you’re assembling a new bike for Christmas morning, you could ask the online help desk to lend a hand.
And when golden hour is running out for an accident victim in rural Alabama who can’t make it to a trauma center, the specialists of the trauma center will be able to come to him, working hand in hand with the medical team on the scene to give him a second chance at life.