Lecture 4: Pre-op & Intra-op Technologies PDF

HSS 4109A – COMPUTER ASSISTED HEALTH APPLICATIONS 25-Jan-22 CONFIDENTIAL Lecture #4: Pre-op & Intra-op technologies 1 STUDENT GROUPS (~5 MINS) 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Finalizing……. 2 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL WE FINALIZE GROUPS TODAY 3 Group Pr...

HSS 4109A – COMPUTER ASSISTED HEALTH APPLICATIONS 25-Jan-22 CONFIDENTIAL Lecture #4: Pre-op & Intra-op technologies 1 STUDENT GROUPS (~5 MINS) 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Finalizing……. 2 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL WE FINALIZE GROUPS TODAY 3 Group Projects (70%) 70% grade CONFIDENTIAL 7 minute presentations PPT on April 3 & 10. 1-2 people max/group will present in front of class. 2 pages WORD doc. – a summary of your research article. The 1st page is your own summary. The 2nd page is a chatgpt4 summary. Group Projects (70%) 70% grade CONFIDENTIAL 1. Find a journal publication on any Medical Technology in any capacity (diagnosis, pre-op, intra-op, post-op, aging, cancer, biology, hospital, Health Canada, WHO, etc.) 2. Not a systematic review, not a literature review, not a state of the art, a pure research article that has a clear methodology and experimentation protocol with results. 3. Published 2022-onward 4. PubMed, MedLine, Google Scholar 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL THE SURGICAL TEAM 6 Copyright: SIU SOM Assists doctor in prepping patient for surgery Nurses unionized in Ottawa problem - can’t enter hospital before 7:30 can’t have surgeries at 7:30 if they cannot enter the room before this time Usually young resident surgeon present - to learn and observe A team of highly trained professionals with a wide range of specialties who is present to offer comprehensive patient care. 25-Jan-22 CONFIDENTIAL Who’s who in the OR Video click me complex environment - must be kept sterile (masks and caps), lots of moving parts Lecture #4: Pre-op & Intra-op 7 Surgeon The surgeon is responsible for performing the surgical procedure. CONFIDENTIAL Communicates exact procedure, operative side and any special needs prior to surgical case. minimize complications 25-Jan-22 Lecture #4: Pre-op & Intra-op 8 Anesthesiologist Assesses need for appropriate anesthetic during the surgical procedure The physician that puts the patient to sleep and watches their vital signs to ensure they are stable during the surgery. 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Assesses patient’s risk for receiving anesthesia 9 Circulating Nurse looking around, making sure everything is okay Boss of the unsterile environment, the “Watch dog” of surgery The nurse is also there should the surgical team need anything further to complete the surgery (e.g. medical equipment, imaging technology). 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL The individual that keeps track of time and gets the patient ready for the surgical team. 10 Scrub Nurse Sets up sterile supplies and instrumentation cleaning CONFIDENTIAL Is gowned and gloved and able to handle and pass sterile items into the sterile surgical area. Boss of the sterile environment 25-Jan-22 Lecture #4: Pre-op & Intra-op 11 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL 20TH CENTURY IS THE ERA OF THE SURGEON 12 The “infection controlled” hospital CONFIDENTIAL Pennsylvania Hospital, 1911 Windows - fresh air and ventilation Emphasis on sunlight, high ceilings to facilitate cross ventilation. 25-Jan-22 minimize germ theory Rooms are bigger and beds are farther apart Lecture #4: Pre-op & Intra-op 13 A lot of major surgeries + transplants completed The “Century of the Surgeon” also medical imaging was developed by physicists, etc. (ex. X-rays, ultrasounds (discovered bc of world wars - submarines)), later on CT scans…. CONFIDENTIAL Explosion in surgical techniques surgeons can operate on head, chest, and abdomen  1st successful appendectomy  Massachusets General Hospital (MGH) abdominal surgery ward Physiological Surgery  Conserved tissues, preserved anatomy, careful dissection 25-Jan-22 Lecture #4: Pre-op & Intra-op 14 Heart surgery 1923 – CUTLER OPERATED MITRAL STENOSIS 1938 - GROSS SUCCESSFULLY TIED OFF A PERSISTENT DUCTUS ARTERIOSUS 1953 – JOHN GIBBON USED THE HEART- LUNG MACHINE TO SUPPLY OXYGEN WHILE HE CLOSED A HOLE IN THE SEPTUM BETWEEN THE ATRIA 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL 1912 – OPERATION ON THE AORTIC VALVE ( TUFFIER) 15 Organ transplants 1954: First successful kidney transplant by J. Hartwell Harrison and Joseph Murray 1967: First successful liver transplant 1967: First successful heart transplant by Christian Barnard 1986: First successful double-lung transplant 1998: First successful hand transplant 25-Jan-22 CONFIDENTIAL 1905: First successful cornea transplant by Eduard Zirm https://en.ppt-online.org/105096 Lecture #4: Pre-op & Intra-op 16 PAST: Cut, then see CONFIDENTIAL Philosophy of surgery before 20th century no prior information from the patient (ex. ECG, CT, etc.) wouldn’t know how to approach the activity of the surgery to cure the person 25-Jan-22 Modern day: dissect cadavers or be present during operation to educate students Lecture #4: Pre-op & Intra-op 17 PRESENT: See, then cut can see what’s inside patient — based on what were seeing, can decide best course of action can look at medical records, past history, blood work, health status, etc. — provide cues if doctor should be prudent during surgery Ex. Fluorescence imaging to resect tumours accurately whatever is green = cancerous = resect w scalpel can combine optical imaging and fluorescne imaging to fuse information between those images 25-Jan-22 CONFIDENTIAL Pre-operative planning CT, MRI, X-ray, etc. Image-guided surgery Computer-assisted interventions) Combine all this info — planning of surgery — what instruments are needed, workflow, etc. Lecture #4: Pre-op & Intra-op endoscopy, radiographic, optical, and ultrasound images Intra-operative navigation 18 Laparoscopic Surgery 1980s CONFIDENTIAL 1. Also termed Minimally Invasive Surgery. 2. Operations in the abdomen are performed through small incisions. 3. In 1982, introduction of the computer chip TV camera provided the means to project operating view on a monitor. tube w/ camera at end of instrument looking directly inside the body — also have ressectors at the end to cut tissue, etc. — bimodal instruments these surgeries cannot happen w/o optical imaging (video camera) 25-Jan-22 Lecture #4: Pre-op & Intra-op Slide1919 Examples: Gall-bladder surgery Laparoscopic gallbladder surgery has led to shorter hospital stay, faster return to work, and less incision pain and scarring 25-Jan-22 Hospital Stay* Avg return to work** Incision length* Open 3-7 days 6 weeks 5-8" Laparoscopic 0-1 day 2 weeks 4 tiny incisions *Healthcommunities.com, Surgery Channel, “Cholecystectomy”. http://www.surgerychannel.com/cholecystectomy/preop.shtml#post **Glavic Z, Begic L, Simlesa D, Rukavina A. Treatment of acute cholecystitis: A comparison of open vs laparoscopic cholecystectomy. Surg Endosc 2001 Apr; 15(4):398-401 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Improved Outcomes: 20 Examples: Knee Replacement Minimally invasive partial knee replacement has a shorter hospital stay, faster return to walking, and less incision pain and scarring 25-Jan-22 Hospital Stay Avg return to walking Incision length Total Knee Replacement 3-5 days 4-12 wks 7-8" Minimally Invasive Partial 1-2 days 1-2 wks 3-3.5" Source: University of Washington Department of Orthopaedics and Sports Medicine. “MinimallyInvasive Knee Replacement” Edited by Seth S. Leopold, M.D. http://www.orthop.washington.edu/faculty/Leopold/miniknee/print Lecture #4: Pre-op & Intra-op CONFIDENTIAL Improved Outcomes: 21 A preview of the next lectures CONFIDENTIAL Personalized medicine 25-Jan-22 digital twin — hologram — representation of entire body analysis has to be done to tailor medicine to your own personal being can predict when/ what age disease is going to occur and slow down its progression Lecture #4:aPre-op & Intra-op lot of work — imaging, body scan, physiology and compile all the data 22 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL IMAGE-GUIDED SURGERY 23 Image Guided Surgery (IGS) – Definition CONFIDENTIAL General term used for any surgical procedure where surgeons employs tracked surgical instruments in conjunction with preoperative or intraoperative images in order to indirectly guide the procedure. The camera tracks in real time the medical instruments - where are they located and positioned in real time w/ respect to the patient  IGS was originally developed for treatment of brain tumors.  Various applications of navigations for neurosurgery have been widely used for almost two decades 25-Jan-22 Lecture #4: Pre-op & Intra-op 24 Image-Guided Surgery (early 2000s) CONFIDENTIAL let doctors look at pre and intra op images components 25-Jan-22 X-ray device - C arm fluoroscope Lecture #4: Pre-op & Intra-op 25 Example – How it works for Brain Tumor surgery Video Click me CONFIDENTIAL emits infrared light antennae is reference can point to parts on skull w/ a pointer which will be detected by camera and shown on computer Fusion/registeration: registering pre-op and intra-op info together 25-Jan-22 Lecture #4: Pre-op & Intra-op 26 Has two “eyeballs” tracks movement of instruments 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Spine surgery navigation setup 27 Industry players -Spine navigation camera inside light CONFIDENTIAL Malham, G. M., & Wells-Quinn, T. (2019). What should my hospital buy next?—guidelines for the acquisition and application of imaging, navigation, and robotics for spine surgery. Journal of Spine Surgery, 5(1), 155. 25-Jan-22 Lecture #4: Pre-op & Intra-op 28 It’s like your GPS If you dissect or resect healthy connectivites in brain — patient can be paralyzed use microscopes to recognize these 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL Example planning software using MRI scans Intraoperative guidance using optical imaging (i.e. microscope camera here) 29 2D image overlayed on MRI Example – Ultrasound in Brain Tumor surgery Video Click me CONFIDENTIAL 25-Jan-22 Lecture #4: Pre-op & Intra-op 30 Workflow of Image-guided surgery 1. 2. 3. 4. 5. X-ray CT MRI PET Ultrasound Registered = Precise overlay to the patient anatomy Usually 2D / 2D registration; 2D /3D registration; or 3D /3D registration 25-Jan-22 Lecture #4: Pre-op & Intra-op Intraoperative navigation 1. 2. 3. 4. X-ray CT Ultrasound Optical/Video CONFIDENTIAL Pre-operative planning 31 Example Intra-operative imaging 2D X-ray devices Most common intra-op device found in hospitals CONFIDENTIAL 3D x-ray image - can rotate around body Malham, G. M., & Wells-Quinn, T. (2019). What should my hospital buy next?—guidelines for the acquisition and application of imaging, navigation, and robotics for spine surgery. Journal of Spine Surgery, 5(1), 155. 25-Jan-22 Lecture #4: Pre-op & Intra-op 32 Example Intra-operative imaging 3D X-ray devices Malham, G. M., & Wells-Quinn, T. (2019). What should my hospital buy next?—guidelines for the acquisition and application of imaging, navigation, and robotics for spine surgery. Journal of Spine Surgery, 5(1), 155. 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL More sophisticated in hospitals that do intensive research 33 Image Guided Surgery Kazuhiro Yasufuku MD, PhD multiple functional imaging technologies in a single room Hybrid OR @ Toronto General Hospital Multifunctions: intra op imaging from X-ray, and can do pre-op — can do everything in real time Need to be luminary/rich hospital to have this CONFIDENTIAL 25-Jan-22 20 Lecture #4: Pre-op & Intra-op 34 Image Guided Surgery Kazuhiro Yasufuku MD, PhD Hybrid OR @ Toronto General Hospital CONFIDENTIAL Endoscopy CT scan 25-Jan-22 Lecture #4: Pre-op & Intra-op 35 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL MARKET PERSPECTIVE 36 ©2022 P&S Intelligence. All Rights Reserved. Market Click Me always positive in the sense that there is always going to be a great market older adults, and aging population 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL 37 ©2022 P&S Intelligence. All Rights Reserved. Market Click Me > - Corporate annual Good to prevent radiation - safe 25-Jan-22 CONFIDENTIAL 42 % growt rate Lecture #4: Pre-op & Intra-op 38 ©2022 P&S Intelligence. All Rights Reserved. Market Click Me 4.. - ear 2 , nose ,. 5. image quality, resolution, real-time/speed Y elderly throat CONFIDENTIAL 1. 3 25-Jan-22 Lecture #4: Pre-op & Intra-op 39 EXAMPLE SCENARIO IN ORTHOPEDICS 25-Jan-22 Lecture #4: Pre-op & Intra-op CONFIDENTIAL PREVIEW TO AUGMENTED REALITY 40 about us CONFIDENTIAL Klinikum Innenstadt , Munich, Germany Complexity of the OR patient CONFIDENTIAL C-arm fluoroscope = Xrays Mental mapping 2D/3D CONFIDENTIAL Patient view X-ray view The « mental mapping » of a surgeon How do we relate the 3D anatomy to 2D imaging, such as X-ray Superman = Augmented Reality CONFIDENTIAL « i can see inside/outside of patient » Augmented view of patient = fusion between X-ray image and view of patient = registration of the viewpoints = registration between optical imaging and X-ray imaging = Augmented Reality X-ray / optical imaging fusion/registration CONFIDENTIAL + = Patient elbow Vidéo CONFIDENTIAL The 1st medical augmented reality inside the OR Camera Augmented mobile C-arm