A surgeon's view on CIS, presentation at SPIE
The annual SPIE Medical Imaging conference was held in Orlando this February. It featured a good amount of technical talks, lectures and poster presentations. One of the highlights of the conference week was Duke Herrell’s (Vanderbilt University) keynote titled “Engineering solutions in the operating room: a surgeon’s perspective”. The abstract did not reveal too much: “While the promise of genomic biology and “personalized” medicine may revolutionize disease care and diagnosis in the coming decades, the operating room continues to offer a fertile ground for innovation.
Engineering solutions such as image-guided surgery (IGS), robotics, functional and tumor targeted imaging, and tissue ablation hold promise to potentially revolutionize surgery and improve patient outcomes. Key to the development of successful solutions is a close collaboration between development engineers and surgeons. Utilizing a trans-institutional collaboration of engineers and surgeons, solutions such as incorporation of IGS into robotic and kidney surgery, advanced robotic and ablative technologies, and new imaging modalities are being explored at our institution and will be reviewed.”, but in fact, the talk gave a good overview of the emerging technologies (pros and cons), such as:
He summarized the future needs of the field, innovations deriving from the close cooperation of surgeons and engineers:
Engineering solutions such as image-guided surgery (IGS), robotics, functional and tumor targeted imaging, and tissue ablation hold promise to potentially revolutionize surgery and improve patient outcomes. Key to the development of successful solutions is a close collaboration between development engineers and surgeons. Utilizing a trans-institutional collaboration of engineers and surgeons, solutions such as incorporation of IGS into robotic and kidney surgery, advanced robotic and ablative technologies, and new imaging modalities are being explored at our institution and will be reviewed.”, but in fact, the talk gave a good overview of the emerging technologies (pros and cons), such as:
- Registration and tissue deformation models
- Tracked robotic instruments
- Laser Range scanners in open surgery for model generation
- LESS/single incision (e.g. with magnetic anchoring, NOTES robots)
- Image-guided ablation techniques (Cyroablation, RFA, Microvawe, HIFU, Histotripsy (high intensity pulsed US) )
- Robotic radiation-therapy (CyberKnife)
He summarized the future needs of the field, innovations deriving from the close cooperation of surgeons and engineers:
- Smart instrumentation (e.g. tissue-specific markers)
- Patient specific simulation and education
- Miniaturization of instruments with autonomous functions
- Imaging integration (augmented reality).
Probably the best part was how he talked about surgeons’ adaptation to new technologies. He compared it to adaptation to defeat or death, described with the U-shaped curve by psychology. According to [Wilson 2006], the characteristics of newly adopted surgical technologies are:
- Compatibility of current practice, support by available facilities
- Surgeons can observe procedure
- Modification of an existing procedure, or easy to learn
- Offered for trial period before fully embraced
- Case volume and expected demand justify learning required
- Procedure will appeal to patients.
He compared advanced surgical technology to drones for the military, and concluded with the wish to have the very best “pilot and plain” duet for surgery.
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