A panel of distinguished experts discussed the current state of personalized surgery, robotics, 3D printing, medical simulation, and the ongoing potential for it. Moderator Andy Christensen, University of Cincinnati was joined by Dr. Pravin Patel, Chief of Plastic and Reconstructive Surgery, University of Illinois, Sean Curry, Senior VP, Onkos Surgical, and Riddhit Mitra, Smith and Nephew, to discuss the current state of personalized surgery, robotics, 3D printing, medical simulation and where it is all headed.
The three panelists represent new approaches in precision surgery for orthopedics, pediatric cosmetic and craniofacial surgery, and invention of new solutions for ‘intelligent’ digitally-integrated surgery.
What Does ‘Personalization’ in surgery deliver?
“We don’t have a mission or a vision, but really a commitment.” Says Curry of Onko Surgical. “That commitment is that we believe that patients who require surgery deserve solutions that are designed specifically for them, their caregivers and their support network.”
Curry goes on to describe how a personalized approach to surgery supports improved patient outcomes and experiences, and includes tools such as virtual surgical planning, 3D anatomical modeling, 3D printing, implant design, and workflow optimization.
As part of that, the ability to conduct better joint preservation during the operation is just one of the growing benefits of personalized surgery.
“The options for some of those patients [used to be] a replacement perhaps of a joint that didn’t need to be replaced. The worst-case scenario, perhaps an amputation.” Says Curry. “With the advancements in technology … we now have the capability to help surgeons really preserve that native structure and native tissue of removing the diseased bone more precisely.”
Part of the process of developing surgical solutions that are specific to the patient is the integration of the patient’s 3D data supported by 3D printing, which in turn not just enables the production of patient-specific implants and guides but also the ability to practice and simulate the operation on 3D printed anatomical models prior to it starting, giving what these experts called ‘A roadmap’.
“I think that any technology that reduces the learning curve and allows rehearsing the surgery prior to the operating room significantly benefits the patients,” says Patel. “The operating theater has become the experimental lab but really you ought to do all the experiments and figure out all those technical skills and actually rehearse the operation outside the operating room.”
Patel recalls when he started using 3D printed, patient-specific anatomical models for pre-surgical preparation. “That model really turned out to be useful for the surgeon in the operating room if you’re doing complicated cases. For the first time I actually had a roadmap.”
Where Do Robotics Fit In?
Personalized surgery has improved in leaps and bounds over the last twenty years and the addition of robotic tools is also offering new levels of accuracy and precision in surgery.
“When we think about personalization, a surgeon can virtually plan, [put the] implant slightly higher, slightly deeper and slightly extend it to fit this bone surface perfectly.” Says Riddhit Mitra. “That’s where robotics really come in. Once we have a plan made in the virtual space, the surgeon picks up a rigid body tool, and the robot tracks where the tool is in relation to this space. Then it precisely mills out the specific geometry required for the implant that you have in hand. When you start combining additive manufacturing, you can now have specific shapes that you could print out.”
Dr Patel shares a situation of reconstruction of a common sports injury – a collapsed orbital floor from a baseball hit in the face. “You put the plate in there, then you get the x-ray and the plate is just simply off,” he says. “You need to go back, take out the plate and redo the plate or you accept a lower tolerance. The only way to get that plate in the perfect position is with the robot.”
Can All These Technology Advancements Reduce Medical Costs?
According to this expert panel, Precision Surgery can improve efficiency and effectiveness, that in turn reduces cost. Riddhit Mitra explained one cost savings through the development of minimized toolkits. But the larger impact would appear to be through improved surgical outcomes.
“In the literature, [results] vary where some have great results with less than 5% revision rates, where in some instances you may be hovering in the low two digits to 20, 30%,” Says Mitra. “Those readmissions are expensive and those reconstructions are expensive. If you can optimize those and narrow the bell curve with robotics, I think it helps in that shift of economic lowering the cost of care.”
Patel brings a surgeon’s point of view that for him it is less about the cost and far more about successful outcomes. “All this technology is really for the benefit of the patient in the end,” says Patel. “Imagine if it were your own child or a family member, would you want the surgeon walking to the room prepared, know the topography, travel the route before? Or would you prefer me to fly without instruments? Have no idea where I’m going to land, fly in a fog or crash?”
What Will it Look Like Ten Years from Now?
Where does this all lead? Our experts have a very positive view of the possibilities that will affect precision surgical processes going forward. “Through the applications around big data and AI and this convergence between data and software capabilities are becoming more predictive,” Says Curry. “I think that surgeons will become more fluent in the technology. I think the fluency in that technology is going to really help implant design considerations, and I see that convergence happening quickly.”
Mitra agrees and foresees new applications that will be predictive on bone structures and each potential outcome. “There’ll be optimized plans that’ll be recommended and you’ll have precision tools to carve out exactly what you need to,” he says. “We’d probably be even looking at an optimized operating theater where robotics are ubiquitous, it’s in the background, with all the things you need to visualize right in front of your eyes with augmented reality or mixed reality [tools]”
Patel is already doing research on the next, new tools for precision surgery. “I think the future is being able to, again, simulate the environment, but with a higher fidelity in terms of that simulation,” he says. “This is something I’ve been focusing on, especially for the last several years. [I have] surgeons working with engineers and computer programmers to develop a platform where it’s very intuitive, so I don’t need mice or keyboards, but actually I have all the cutting tools I have in virtual reality.”
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Watch the full discussion.