Next-Generation Technology Adds New Precision to the Operating Room
When a child needs brain surgery, clarity is a must.
Michael Levy, MD, PhD, chief of pediatric neurosurgery at Rady Children’s Hospital San Diego and UC San Diego School of Medicine, and a professor at UC San Diego School of Medicine, and his team are integrating new technologies into the operating room and the preoperative planning process to assist with some of the most complex surgeries performed on children.
None of this replaces the extensive 30-year expertise of an experienced surgeon. What it does is provide clarity: high level information that’s more precise, resulting in enhanced preparedness before the first incision is made.
Navigating One of the Most Complex Regions in the Body
Some of the most challenging neurosurgical problems involve the skull base, the space below the brain and behind the eyes, nose and ears. Accessing an abnormality here often involves navigating through tight tunnels while avoiding healthy nerves and blood vessels. In children, smaller anatomy and changes due to growth make surgery even more difficult.
Rady Children’s is one of California’s top children’s hospitals, with its neurology and neurosurgery programs consistently ranked among the nation’s best by U.S. News & World Report. It also operates the only designated pediatric skull base center on the West Coast. Specialists from multiple pediatric disciplines come together to treat children with complex brain tumors, blood vessel abnormalities, congenital conditions and other disorders.
Vijay Patel, MD, is an essential member of the care team, and is the only physician on the West Coast with fellowship training in both pediatric ear, nose and throat care and rhinology, the medical specialty dedicated to the nose and sinuses. His unique skill set is incredibly beneficial when treating conditions where the brain, skull, nose and sinuses meet the skull base.
Robotic Assistance in the Operating Room
To treat skull base conditions, the care team turns to both extensive research — over the past decade they have identified the most important anatomic landmarks in the developing pediatric skull base — and modern technologies that help them visualize and understand this anatomy better.
The newest addition to the team is a pioneering neurosurgical robot that resembles R2-D2 from Star Wars. Rady Children’s was the first in the world to introduce this technology into pediatric skull base surgery, using it in the operating room as a guidance system.
Unlike the large robots used in other types of surgery, this robot interfaces directly with the operating table and assists the surgeon by guiding instruments. The robot acts as a highly precise positioning and navigation system, helping the surgeon to remain on course, akin to a pilot flying an airplane.
The robot acts as a highly precise positioning and navigation system, helping the team to remain on course, akin to a pilot flying an airplane.
Intraoperative Displays
Neurosurgeons use surgical microscopes to visualize structures that aren’t visible to the naked eye combined with specialty 3D monitors and head mounted displays that provide additional visual context.
When used in conjunction with the microscope, these displays provide detailed 3D visualization in addition to allowing for picture-in-picture overlays, which contribute other significant information.
With this important imaging, surgeons are better able to maintain focus on the operative field as they navigate.
Preparing Before Ever Entering the Operating Room
A lot of the work happens before the child enters the operating room.
Using medical imaging and solid or augmented 3D, models are created that match the child’s anatomy so the team can prepare for what they’ll encounter during surgery. The augmented imagery can be superimposed on the patient during surgery, allowing the surgeons to see through the walls of the skull.
When a case is particularly complex, these models help surgeons to consider different approaches, identify potential challenges and anticipate how nearby nerves and blood vessels could influence the surgical plan.
Since each 3D model is tailored to an individual child, it also serves as a planning, educational and rehearsal tool to help the team be prepared and have a plan in place when they arrive in the operating room.
Technology With a Purpose
Advanced technology can be awe-inspiring, but it is only successful if it’s benefiting patients and families. At Rady Children’s, technologies are implemented only when they can provide meaningful guidance or additional insight.
Pediatric surgeons’ expertise is ultimately the foundation of every procedure.