By Vinod K. Goel
Minimally-invasive surgery (MIS) promised faster recoveries, less pain, less ‘collateral’ damage to healthy parts of the body, and fewer complications, thus reducing costs and improving outcomes.
In many cases these benefits haven’t been realized as quickly as promised as various factors have limited the effectiveness of MIS.
For example, due to the small size of the incision and remote manipulation tools, surgeons have much less room to operate, requiring additional training and experience to speed up surgery times and reduce complications.
Another major limitation is imaging. In an open surgery the anatomy is laid bare; surgeons can gain familiarity with the patient’s anatomy simply by looking at it. In MIS, the anatomical information and tool placement is only visible via medical imaging.
New medical imaging techniques, like fluoroscopy, made MIS a possibility in the first place. Yet, fluoroscopy relies on contrast dyes and x-rays to create grainy, black and white, two-dimensional images.
Fortunately, researchers around the world have been working on improving MIS to help realize the full benefits of the concept. Additionally, these improvements may unlock the future of healthcare by integrating with surgical robots and AI, further improving the quality and speed of surgeries.
There are three key technologies that will help us revolutionize minimally invasive surgery:
a. Robotic-Assisted Surgeries
b. Enhanced, real-time imaging
c. Predictive modeling and AI using big data
To understand how and why these technologies will revolutionize healthcare, let’s look at them in more detail.
Leading the field is Intuitive Surgical with their da Vinci robot, which originally gained FDA approval back in 2000.
Using a control panel and screen, surgeons can direct da Vinci’s robotic arms attached with surgical tools to conduct several procedures. The main benefit of the system is its ability to offer enhanced control and precision.
In the future, robots will do the ‘mechanical’ setup for the surgery autonomously – getting the right tools into the correct position in the patient’s body. It will also be possible to use robotic surgery devices remotely from anywhere in the world. This could give access to high-quality surgeries to millions of people across the world.
The major downside of surgical robots has been the cost. A single da Vinci robot costs about $2 million upfront while a single surgery generally costs anywhere from $3-6,000 more than traditional laparoscopic surgery; making the system unaffordable for most patients and hospitals.
However, new challengers in the space have been working to reduce cost without compromising on the benefits.
Enhanced, real-time imaging
As mentioned earlier, the current imaging ‘gold standard’ for MIS is fluoroscopy, which uses toxic contrast dyes and harmful x-ray radiation. The other option is using tiny cameras mounted on the end of tube devices that can be inserted by hand along with the surgical tools, (provided the surgery is not inside a vessel full of blood).
Both imaging solutions have poor-quality images. The human eyes and brain can’t intuitively interpret these kinds of poor images, requiring additional concentration from the surgeon. Not only can this be incredibly tiring, it can increase surgery time and lead to mistakes. What surgeons need is imaging that works with the natural human perception rather than against it.
Fortunately, several companies have been working to reduce or remove reliance on dyes and radiation while producing a superior image quality.
Centerline Biomedical, a Cleveland Clinic spinoff, of which I am President, has developed the proprietary Intra-Operative Positioning System (IOPS), which uses mathematical algorithms and a safe electromagnetic field to provide 3D color visualization and real-time tracking of devices in minimally invasive vascular surgeries.
IOPS utilizes the latest in graphics and augmented reality – technologies originally developed for gaming — to provide a clear image for more intuitive operation. Surgeons can apply all their skills, intuition and experience to the patent, rather than dedicating a lot of time and attention to interpreting the image.
Other imaging systems are focusing on different specific surgical regions or applications. ChemImage’s Molecular Chemical Imaging (MCI), for example, uses a combination of spectroscopy – the detection of specific matter based on electromagnetism – and digital imaging to help surgeons identify and remove tumorous tissue.
The Novorad AR headset helps surgeons to plan before operating as well as allowing them to appreciate the patient’s anatomy by seeing it as an overlaid image in advance of the surgery.
Johnson & Johnson’s CARTO System specializes in heart navigation, producing images that are revolutionizing treatment of arrythmias while minimizing patient trauma.
As we improve signal processing and continue to develop new imaging technologies, other options for seeing into a patient will be found. Images will become increasingly intuitive to use and offer currently unimaginable detail.
Predictive modeling and AI using big data
Intuition, as mentioned, is an important tool for surgeons. Intuition is our brain’s way of managing massive amounts of data. The more experienced the surgeon, the greater their training and experience, and therefore the better their surgical intuition.
However, in the age of informatics we can now collect, analyze and share that data, that experience, to help surgeons make better decisions in real time.
In hospitals one of the biggest areas for data capture and analysis is surgical workflows. Smooth workflows mean OR staff have what they need in the right place at the right time, leading to fewer errors and less wasted time. Efficient workflows also improve communication between staff members, even when they’re from different teams, helping foster an instinctive understanding of what to do when.
Overall, a smooth workflow reduces the chance of complications, reduces the time a patient spends under anesthesia and, therefore, the risk to the patient, as well as minimizing staff fatigue to make for a more alert and capable workforce.
For example, ExplORer Surgical are using tablets in OR to create balanced workloads and offer learning from experience of previous cases. This approach could quickly develop optimal surgical workflows and refine them in real-time, continuously providing the very best workflow management.
When it comes to surgery, data could also offer useful insights, particularly when formed into predictive models. New technology can, with a high degree of accuracy, predict what will happen if, for example, a surgeon inserts a blood vessel stent.
When combined with artificial intelligence (AI), the applications for big data and predictive modeling become astounding. In the OR of the future, surgeons will be able to ask their AI assistant the most likely outcome of a particular action or procedure and get a highly-accurate, real-time response. It will be like asking Siri the quickest way to the airport, except it may save your life!
Developments in these technologies will lead to surgery that is quick, efficient, relatively painless, and reduces complications and follow-up procedures. This will reduce costs and time, averting the potential crisis faced by healthcare administrations and importantly allowing minimally-invasive surgery to become a more realistic option for many more patients.
ABOUT THE AUTHOR
Vinod K. Goel, Ph.D. is President of Centerline Biomedical, Inc. Centerline is