A new medical device collaboration is giving surgeons “x-ray vision,” by fusing digitally enhanced images directly into the microscope of a surgical device.
The tech, called SyncAR, is a partnership between Los Angeles-based health tech innovators Surgical Theater, and Irish medical device company Medtronic.
While surgeons typically need to look up at screens in order to access patient data or enhanced visuals – adding time and hindering surgical flow – this system enables access to all that information in one place.
“When you have your hands on something delicate, such as the brain, every minute and second matters. Every small movement matters,” says Moty Avisar, CEO and co-founder of Surgical Theater. “If you have to pull your head away from the microscope to look at a display and then go backwards, it disturbs to continuity of the surgery.”
It was designed specifically for complex neurosurgeries and includes augmented – or digitally layered – 3D images that are created using Surgical Theater’s SyncAR technology. Each image shows a detailed visual of the specific body part that is being operated on, built using a patient’s anatomical scans such as an MRI or a CT scan.
Digital images are layered on the surgeon’s microscope display. (courtesy Surgical Theater)
These SyncAR images are inserted directly into a Medtronic’s StealthStation S8 surgical device, a navigation system that is fitted with both a microscope and a screen. The images are complete with color markings and precise 3D visuals of arteries, vessels, nerves and more.
The surgeon then uses this technology to shift back and forth between real human biological tissue and the augmented scan, which serves much like a map: highlighting crucial areas of a patient’s anatomy so a surgeon can consider the most efficient path to target a problem area, such as a brain tumor, and visualize its surroundings.
From augmented reality to x-ray vision
Avisar says the technology is already showing beneficial applications. In the case of tumor removal, he says the technology “allows the surgeon to not only direct the most efficient pathway, but also to see beyond the tumor itself.”
“By allowing them to see the dark side of tumor, they’re able to spot key nerves and vessels on the other side, and avoid them,” he says.
The technology has been FDA approved in the US and is currently being tested by surgeons there, with plans to expand to hospitals in Europe by the end of the year.
Dr. Thomas Steineke, a neurosurgeon and chairman of the JFK University Medical Center’s Neuroscience Institute in New Jersey, is one of those doctors testing the device. He says the technology may help surgeons to reduce the risk of human error and enhance efficiency.
“Imagine you’re conducting a minimally invasive neurosurgery, and you don’t have a great line of sight. You’re somewhat going in blind, and have to refer to your screen frequently,” Steineke says. “With this combination, you can fade in and out of real image and a virtual map, and use that to make your way towards the pathology.”
By having all the necessary information within the microscope display, he says the technology “improves our confidence” – ultimately better for surgeons as well as patients.
While many of us may be familiar with augmented reality in everyday applications – such as video games or social media filters – this technology is becoming increasingly common in medical practice.
A mixed reality headset was actively used in a real-time surgery for the first time by Dr. Rafael Grossmann, who used Google Glass to livestream a procedure in London in 2013.
By 2016, companies such as London-based Proximie had entered the market, developing an augmented reality software for use on laptops and tablets, which can connect surgeons around the world. In 2017, Microsoft demonstrated the potential of its mixed reality headset, HoloLens, as an operational assistant in Latin America.
Last June, Dr. Timothy Witham at John Hopkins Medicine in Baltimore, Maryland, conducted the first spinal neuro-navigation procedure guided by augmented reality.
Armed with an AR headset called “xvision” by startup Augmedics, Witham was able to tap in and out of digital augmented displays in real time, using only his headset, while inserting six screws into a patient’s spinal cord.
Witham has since conducted over 50 surgeries using the xvision augmented reality headset. He says that the device has maintained a 98% efficiency rate so far, and the next step will be scaling up surgeon fluency with this technology.
“Traditional systems require you to look away from the patient, towards a remote screen, which is not a natural or intuitive way to do things. The stakes are high with a procedure around the central nervous system, and any error can be catastrophic,” says Witham.
“What you want is to be able to look at and work on the patient’s procedure, simultaneously,” he adds.
A desire for this intuitive flow has inspired an entire network of health tech development, as doctors and innovators work to remove unnatural screens and devices from the operating theater – with SyncAR being the latest.
“What we’re seeing here is a marriage of these two technologies: surgical equipment and augmented realities,” Steineke says. “And its combination is greater than the separate parts.”