Intraoperative 3D imaging reassures traumatologists at the University of Virginia Medical Center (UVA).
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Surgical standard procedures requiring treatment control utilizing postoperative CT scans can be enhanced regarding both procedural and ultimately economic outcome if possible complications can be disclosed while the patient is still on the table. Intraoperative real-time rotational imaging as provided in a hybrid operating room has already proven to be key to making this happen. This technological advance can result in a decrease in complications associated with limb malalignment and the ability to provide fracture treatment in a more individualized and cost-effective manner.
UVA medical center has been involved with computer-assisted orthopedic surgery since the early ‘90s. Orthopedic Traumatologist David Kahler is a pioneer in the field. Seth Yarboro specializes in pelvis and lower extremity trauma including bone non-unions and malalignment surgery. Bobby Chhabra is the Chair of Orthopedic Surgery at the University of Virginia Health System.
“Using the Artis zeego the 2D imaging is most helpful when we’re looking at long bones. It has a very large field of view, which gives us the ability to image the entire bone.”
“One of the goals of an institution like mine is to be an innovative leader in the newest technologies that will advance patient care.”
“Precision is what’s provided with the hybrid OR: you can place your implants exactly where you want them and be confident that they are there.”
And then how do you think this affects the patient outcome?
B. CHHABRA: You can obtain 3D images so that you know that your fractures are aligned well, that your implants are in the right position, with the goal of doing the perfect surgery with minimal incisions. It is really a phenomenal advance in treatment of these orthopedic trauma injuries.
D. KAHLER: It’s one-stop shopping. We try to get everything done in one trip to the operating room. There are no surprises when we get a post-op CT scan: when we see a screw that’s a little bit too long or perhaps one that’s malpositioned that has to be changed. Up to 20 percent of the time, we are going to make a change if we have that information in the operating room. So it’s a huge advantage to the patient.
We guess, some people have been against the 3D imaging …
S. YARBORO: I can certainly understand some resistance to the change that would be involved with adopting this new technology. But there are cases that present particular imaging difficulties and that’s where we found it to be most helpful. It’s not to be used necessarily routinely but for certain instances it can really make a dramatic difference in outcome.
B. CHHABRA: I think one of the goals of an institution like mine is to be an innovative leader in the newest technologies that will advance patient care. It will be a great benefit to any institution to learn how to use high-level technologies like this that have a major potential for improving the outcomes of surgical intervention and reducing complications.
What is your vision for orthopedic trauma surgery?
B. CHHABRA: There are so many opportunities to improve our patient outcomes, particularly in the trauma population. Having information is crucial in the treatment of any patient. I think the hybrid OR is a step in that direction that provides us the information we need to best treat complex injuries.
D. KAHLER: I think the real Holy Grail is the ability to do a fracture reduction in the operating room, confirm the position with 3D imaging, and once we’re satisfied with the result, to be able to actually navigate and place an implant and lock it in place with screws to hold the fracture in place while it heals. And we’re very close to achieving this level of precision in fracture care.
What advice can you give to a decision maker planning to integrate a hybrid OR at the hospital?
B. CHHABRA: Radiation safety is a very important issue that needs to be addressed. Everyone in the room has to be safe from excessive radiation exposure. Having the right equipment and having surgeons who are trained on this technology are both very critical in optimizing the use of a hybrid OR.
S. YARBORO: The main thing that I would recommend is from a very early point involving multiple disciplines – the vascular teams, the cardiothoracic team, neurosurgery, orthopedics – so that you can have multiple services that use the new technology.
D. KAHLER: Having an integrated hybrid OR in the operating room setting, I think is a real advantage. And I can’t say with any certainty at this time that the investment will pay for itself, but we are seeing benefits now for our patients.
B. CHHABRA: If these technologies are shown to result in better patient outcomes, then the surgeons who adopt them will be leaders in their fields.
Hospital Portrait
UVA Health System in Charlottesville, Virginia, includes a hospital, nationally recognized cancer and heart centers, and primary and specialty clinics throughout central Virginia. Its level-one trauma center has a large referral basis from all over the state and treats some of the more significant injuries in the area.