Innovation

Virtual platforms help surgeons plan ahead

More thorough preparation means better post-operative results


By Cindy George | June 5, 2019

Innovation allows surgeons to virtually step inside the human body and prepare for complex procedures, from plotting the precise location of a brain tumor to exploring the intricacies of a child’s malformed heart.

Before neurosurgery at Houston Methodist Hospital, physician Gavin Britz dons black wraparound goggles to strategize amid virtual reconstructions that combine CT scans, MRIs and surgical navigation into one 3D visualization platform.

He can start outside the patient’s skull, pan inside an eye socket into the brain’s soft tissue and locate a tumor amid the tangles of vasculature. Thanks to technology, the tumor appears fluorescent, which makes it easier to find.

The visualization platform, Surgical Theater, is used in about 50 medical centers and academic institutions around the world. Houston Methodist has the only system in Texas, according to Brady Culbreth, the company’s Houston-based program lead. Houston Methodist paid about $800,000 for the technology, a hospital system spokeswoman said.

Britz, a brain and tumor neurosurgery specialist who is chair of Houston Methodist’s neurosurgery department, said his field is steeped in tech out of necessity.

“Fifty years ago, a patient presents with headaches. You know they have a tumor. You have to inject into the head or into the spine. You think the tumor is there. You have to operate on the patient not knowing. You think the tumor is on the left-hand side based on the examination. That’s guesswork,” he explained. “You go in the head and you’re probably a couple of centimeters wrong. You can imagine the disaster. So, technology in neurosurgery has really made things safer and is a great equalizer.”

For Britz and other neurosurgeons, 3D visualization is a major breakthrough.

“I can get within a few millimeters of where the tumor is,” Britz said. “Just because I’m in Texas doesn’t mean I’m a cowboy. You have to be a thoughtful surgeon. The more I plan pre-operatively, the better your results are post-operatively. Technology has allowed us to really understand the disease process—where it is and how you can approach it surgically.”

The technology also transforms the patient experience.

According to the Ohio-based Surgical Theater, the visualization platform “allows patients and their surgeons to step into the patient’s complex diagnosis and to walk together in a 360-degree, virtual reality reconstruction of the page36image28955024patient’s anatomy.”

Britz, who has been using the immersion experience with patient anatomy scans for less than a year, said the technology has calmed the fears of patients while offering clarity about surgeries for them and their families.

“A patient terrified of the tumor puts on these goggles and sees what you’re going to do,” he said. “You can explain that something is going to be a problem because their motor fibers are right here and the tumor is completely engrossed and they can put the goggles on and they can see the problem. They understand what you have to do.”

Step inside the heart

For some of the smallest patients, the complex issue is their hearts.

At Children’s Memorial Hermann Hospital, pediatric cardiothoracic surgeon Jorge Salazar, M.D., can walk into a room-sized hologram of a young patient’s heart prior to surgery and consult a 3D-printed, handheld replica of the child’s organ.

Salazar, co-director of the Children’s Heart Center at Children’s Memorial Hermann Hospital, uses 3D patient-specific models and holograms for biven- tricular repair and conversions on youngsters whose families are often told that surgery isn’t an option and that their children will need transplants when they go into heart failure.

“It’s tricky to work inside the heart and to understand the three-dimensional relationships that are necessary to provide normal heart repairs for kids who essentially have a scrambled heart,” Salazar said.

The surgeon combines the 3D information from CT, MRI and echocardiogram scans to formulate his surgical plans.

“We use all of those modalities to give us a comprehensive understanding of the heart’s internal structures and their relationships to one another, and we are able to pre-plan and pre-map out the actual repair,” he said. “With the 3D imaging, we can create 3D models that are both virtual and printed. Now, with the latest technology, we are able to create 3D models with the heart beating—so I guess that’s 4D.”

Sometimes, when a congenital condition has been complicated by previous surgery, Salazar and his team face additional challenges.

“We have to essentially take the whole heart apart, undo everything that had been done before and convert [it] to normal heart physiology and connections,” said Salazar, who also serves as professor and chief of pediatric cardiovascular surgery at UTHealth’s McGovern Medical School.

The technology is helping surgeons repair and rewrite young futures.

“We’ve done 14 conversions of children who were thought to be single ventricles, meaning ‘half heart,’ and they were thought to be locked into this future of having half a heart with not only restricted quality of life but with restricted longevity of life,” Salazar said. “Many of these kids died or had a heart transplant before they got into their 20s. We’ve had 100 percent success in converting 14 of those children into normal hearts.”




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