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by Cat Vasko
· Poster Shows How Viking 3D Vision Complements Robotic Laparoscopic Surgeries
· A Software Package Helps Orthopedic Surgeons Plan Procedures
· Case Study: Children’s Healthcare of Atlanta Goes Digital with IR
Poster Shows How Viking 3D Vision Complements Robotic Laparoscopic Surgeries
A poster given at the 2007 meeting of the American Urological Association, Linthicum, Md, in Anaheim, Calif, highlighted the advantages of using 3D visualization in conjunction with da Vinci robotic technology.
“During the last 5 years, the da Vinci robot has increasingly been used in performing the radical prostatectomy,” said the poster’s author, Vincent Lanteri, MD, of Hackensack University Medical Center, Hackensack, NJ. “One of the benefits of the robot is the surgeon’s ability to perform the operation in three dimensions. A concurrent realization has been the limitations placed on the assistant surgeon who is viewing the procedure and simultaneously assisting in two dimensions.”
In the poster, entitled “Perspectives in 3D Assisting for Robotic Laparoscopic Prostatectomy,” Lanteri concluded, “Having both Intuitive Surgical’s da Vinci system and Viking Systems’ Endosite Digital Vision system is the ultimate combination and allows the surgeon and the assistant to finally operate on the same surgical field. Additionally, the advantage of both systems may translate into improved operative times, shortened learning curves, and greater surgeon-assistant comfort. This might allow the beginning robotic surgeons and assistants to become experts quicker and without limitations.”
Medical Imaging asked Stephen Song, product director at Viking Systems Inc, San Diego, a few questions about the Viking 3Di HD Vision system for robotic laparoscopy.
MI: What makes the 3Di system unique?
Song: We use a laparoscope and a 3D camera, and we actually have two 3-chip cameras in our camera head, one for each eye. We display a real-time stereoscopic image through a head monitor display that the surgeon wears throughout the procedure. We can also bring in secondary information, such as video sources, radiologic images, that they might want to see during the procedure.
MI: How does this abet the process?
Song: It allows you to visualize in real time what you’re doing throughout the procedure, as opposed to having to break scrub to go look at the MRI or CT, or having to move your head around to look at different monitors. He has it all there by voice command in his field of view.
MI: And it complements robotic laparoscopy?
Song: Yes. We can also interface our system with the da Vinci robot so that everyone who’s working on the procedure can see the 3D as well. The surgeon sits away from the patient at a console and views a 3D camera image and uses that to navigate the robot inside the patient. It gives the surgeon more precision. By allowing everyone involved in the procedure to see in 3D, it reduces the learning curve. It helps progress the procedure along as well.
MI: What happened before the system was used in conjunction with the robot?
Song: The only person who was seeing in 3D was the surgeon sitting at the console. No one else was able to have the 3D view.
A Software Package Helps Orthopedic Surgeons Plan Procedures
Not long ago, orthopedic surgeons had to keep a grease pencil handy to mark up x-ray films when planning for corrective surgery using prosthetic implants. But as digital imaging becomes more prevalent in health care, physicians look to software to assist in their planning processes. Cedara Software, Toronto, a Merge Healthcare company, recently launched the OrthoWorks ProPlanner, designed to offer orthopedic surgeons the tools they need for surgical planning, templating, archiving, and distribution.
ProPlanner, which can be integrated into an existing PACS system, incorporates several automated features. For example, for procedures such as total knee replacements and spine surgeries, the software automatically stitches multiple images into one, using Cedara’s ImageSnap Technology. Other features are designed to help surgeons produce the results they want without having to input all of the information on their own. “Mouse-clicking is frowned upon by a lot of users, so if you can do something in one mouse-click rather than two or three, that’s definitely preferred,” said Haniel Croitoru, MSc, product manager for orthopedics at Cedara Software.
During processes such as hip-surgery planning, ProPlanner overlays a suggested hip implant over the image based on common measurements for hip templating. “The software analyzes the image, finds certain anatomical points, and based on those points, it makes an educated guess as to where the implant should be placed and what the size should be,” Croitoru said.
Surgeons can then accept, reject, or change these measurements. “The goal of this is not to replace the surgeon’s work,” Croitoru said. “It’s trying to get the surgeon much closer to the end stage. There will be cases where the surgeon will decide that they want to use a different position for the implant or a different size, but at least they’re much closer to the end phase.”
ProPlanner supports digital CAD-based templates from all major implant manufacturers and features a library of 15,000 templates.
ProPlanner’s Custom Measurements feature allows users to define macros for complex measurements, such as distances, angles, and parallel lines that a surgeon routinely uses. Other tools include AutoPlan, which saves combined template sets; Study List Filters, which allows users to sort patient studies by criteria such as anatomy, date, and patient name; and Advanced Measurements & Tools, which provides parameters such as line-angle ratios and differences. The software also gives users several reporting options, including the use of key images, measurements, templated implants, patient demographics, and technical notes. Cedara Software plans to release a Web-enabled version in the near future.
?Ann H. Carlson
Case Study: Children’s Healthcare of Atlanta Goes Digital with IR
In May, Children’s Healthcare of Atlanta (CHOA) acquired a new digital interventional radiology (IR) system from Philips Medical Systems, Andover, Mass. The Allura Xper FD20, housed at Children’s at Scottish Rite, facilitates fast and more accurate diagnosis and treatment of disease; treatment is less invasive, and dosage is reduced, a critical factor when imaging children.
Raymond Woodall, an interventional technologist at CHOA, noted, “This new system has allowed us to improve our workflow tremendously. It’s got this redundancy built in that allows the staff to make changes either bedside or in the control area, and that makes our ability to work with the patients so much better because we’re not having to run back and forth between the systems.”
Installation took around a month, Woodall said, and training consisted of 5 days off-site for the supervising technologist and 5 days on-site with the rest of the staff.
The Philips digital IR system has countless features that make it exciting to Woodall and his colleagues, particularly after working with an analog system for so many years.
“It has what’s called a 3D-RA capability, so it allows you to be able to do a 3D image of vascular studies,” Woodall explained. “That way you’re able to see a 3D image in different rotations. The system also has the capability to give a cross-sectional image in the interventional suite without having to move the patient to a CT suite to see if there’s something going on inside, any complications. That’s a great thing because there’s less patient transfer. It gives the physicians an immediate view inside the body without having to do an invasive procedure.”
The system is particularly well suited for children, Woodall noted. “It’s great because of the radiation exposure it reduces,” he said. Though MI spoke to Woodall in the Allura’s first week of operation, the new system was already making waves. “We did a very invasive case yesterday looking at blood vessels in the brain, and to be able to see those in a 3D image, to be able to rotate it to where I can see anything that’s going on?it’s just an amazing capability. And the 3D imaging gives you the ability to fly through the vessel, so you can see what’s going on inside as well as out.
“The possibilities are endless with this thing,” he said. “It’s like going from an abacus to a computer.”
