Augmented Reality System Boosts Performance in Spine Surgery

By Christopher Cheney

A spine surgeon at AdventHealth has developed an augmented reality system to boost the efficiency and outcomes of spine surgery.

Augmented reality systems have been developed for operating rooms and other healthcare settings. For example, Google Glass has been adopted for several healthcare applications.

Chetan Patel, MD, medical director for spine surgery at the AdventHealth Neuroscience Institute has patented the iSight augmented reality system, and it has been used for spine surgery at the Altamonte Springs, Florida-based health system.

“The goal of iSight is to take any screen in the operating room regardless of what technology it is on and bring it to the surgeon within the surgical field. The way this system works is that we have a box that attaches to whatever it is you want to see. The box will be different depending on what technology you are using. The box takes information, digitizes the information if it has to, then encrypts and compresses the information. The surgeon wears glasses to see the information on the screen. The glasses are a controller, which gets a wireless signal that is decrypted so the surgeon can see the information on the screen,” he says.

The iSight system is designed to address three problems during spine surgery, Patel says.

“The first problem is we have to look back and forth away from the patient to the screen to do our job. The second problem is the ideal place to put a screen is in front of the surgeon; but in surgery, my assistant is in front of me. Usually, the screens are between 20 and 30 inches, and they are off to the side. The screens are also quite a distance away to maintain sterility. It’s difficult because I have to twist my neck to see the screen. The third problem is that errors can occur because you are looking at the screen and you are not able to look at the patient at the same time,” he says.

The iSight system can display critical information from several screens in the operating room, Patel says.

“For screw placement, we are looking at the screen that allows us to accurately place the screw. For other procedures, there is other types of displayed data. For example, in tumor surgery the information that I care about is the pre-operative MRI and the CT scan that shows me where the tumor is located. So, that is the image that I would choose to display. If there is a herniated disc and I am just removing part of it, I would want the X-ray displayed. If I am taking pressure off the spinal cord from arthritis or bone spurs, blood pressure is critical. If the blood pressure gets too high, there is too much bleeding. If the blood pressure gets too low, the spinal cord can be in danger. So, in those cases, I want to see the anesthesia monitor,” he says.

Boosting efficiency and outcomes

The iSight system increases surgery efficiency because the surgeon does not have to look back and forth between display screens and the patient, Patel says. “I have done a prospective study to see what happens when I don’t use iSight versus when I do use iSight. For example, when placing a screw, there is about 10 minutes of time saved. That’s less anesthesia time, less blood loss, and it is just easier and more comfortable for the surgeon.”

Surgeons do not need to climb a steep learning curve to use iSight, he says. “With iSight, you can deliver a better result from Day One. The result is better than what you can deliver in the operating room today without having to learn anything new because this system is simple. All you have to do is plug in power, put on the glasses, and click on what you want to view.”

Reducing the time of a spine surgery procedure is likely to improve clinical outcomes, Patel says. “Boosting outcomes is related to the time saving from iSight. With the reduction in the time to do a surgery, it results in a better outcome because there is less anesthetic, less blood loss, and improved accuracy. All of that leads to better outcomes.”

Learning opportunity

The iSight system can record surgical procedures, creating a learning opportunity for surgeons and operating room staff, he says.

“If you look at elite athletes, they usually record themselves and analyze what they are doing to get better. But in surgery, we do not typically do that, partly because we do not have an easy way to record a surgery. With iSight, you can record operations. What I have found is that the improvement in time did not just come from me. It also came from my operating team. We watched our surgeries and looked for opportunities to do it better. So, there is the opportunity to share the footage with others, then teach and learn.”

Potential for new applications

The iSight system has the potential to improve any medical procedure that involves a clinician looking back and forth from the patient to a screen, Patel says.

“This is just the tip of the iceberg. Once we have the opportunity to launch iSight outside of spine surgery, I can imagine the implications. Any surgeon who must look at a screen can benefit from this technology. For example, you can think of orthopedic surgery in general. Orthopedic surgeons fix fractures while looking at a screen. They are having to do the same thing—looking at the patient, looking at a screen, then having to put a screw in place. Using iSight completely eliminates looking back and forth.”

The iSight system also has potential outside of orthopedic surgery, he says. “I am excited about what iSight can do for other specialties and getting it in the hands of others to see what benefits we can gain for physicians in other fields. That is the next immediate stage.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.