Surgical Rehearsal Platform, Navigation Advanced Platform, Collaborative Theater

Alon GeriRecently showcased on CNN, Fox News, and Extra, Surgical Theater, LLC combines the science of flight simulation with advanced CT/MRI imaging technology (DICOM) to reconstruct dynamic and interactive 3D models with life-like tissue reaction and accurate modeling of surgery tools. Surgical Theater utilizes flight simulation technology to offer a suite of products based on 3D imaging technology and augmented reality that allows a surgeon to perform a real-life "fly through" of a “patient-specific” surgery; the Surgical Rehearsal Platform (SRP), the Collaborative Theater, and the newly launched Surgical Navigation Advanced Platform (SNAP - pending FDA clearance).

In understanding of the need for highly realistic visual representations whether a simulator is being utilized for military or medical practice, Surgical Theater initially creating algorithms and appropriate haptic feedback for accurate 3D modeling. “In military situations we were creating algorithms that allowed a pilot to experience the difference visually between approaching a building or tank, for example, but in a medical setting we had to figure out how to allow a surgeon to experience the differences between bone, tissue and skin,” President and Co-Founder, Moty Avisar said.

Click image for a larger size.VP for Engineering and Co-Founder Alon Geri explains that determining how best to allow for this realistic experience led to the SRP using volume rendering technique for the anatomical structure models based on CT/MRI scans. In addition, the SRP’s collision detection algorithm supports collision between surgery instruments (polygon models) and other polygon models and does not support collision between surgery instruments and tissue (volume models). Interaction between instrument and tissue is done by force simulation.

Along with visual feedback, how to provide haptic or “sensory” feedback was another key component of developing the SRP, which had to be experimented and tested before getting it right. In neurosurgery because the cerebral tissue, in particular the damaged tissue in an aneurysm, is extremely delicate the surgeon must apply the appropriate amount of force. Both too much and too little force could result in negative outcomes. As a result, providing realistic haptic feedback was vital to creating a product beneficial for surgeons.

The SRP allows for pre-living surgeries while preparing outside the operating room and the SNAP will be utilized to take the pre-planned pathway into the operating room to be used during a procedure. Surgical Theater’s unique software utilizes flight simulator technology to permit the remote connection through The Collaborative Theater’s multiple platforms; participants anywhere in the world can simultaneously work together and practice the same case with real-time feedback and collaboration.

“The SRP’s ability to provide this needed haptic feedback is in the controller that comes with the unit,” said Avisar. “The controller was modified to include the grip of the surgery instrument so the surgeon can hold what he is familiar with and what he will hold in the OR.”

Another key issue in development was ensuring that regardless of the scanner being utilized to create the CT/MRI images, the SRP would still create an accurate 3D image. To do this, a series of validation studies and testing was done with images from various scanners during development.

“The comparability of the SRP to various CT/MRI scanners was important to ensuring a neurosurgeon can trust the accuracy of the 3D practice and that the experience they are having with the SRP will provide them with an accurate clinical insight that will enhance the clinical outcome,” said Avisar.

The new (SNAP), which is currently being considered for Food and Drug Administration (FDA) clearance, is a product that integrates with operating room technology to provide advanced 3D capabilities and augmented reality, allowing surgeons to enhance their surgery performance. The SNAP provides neurosurgeons unique virtual-reality guidance to determine the safest and most efficient pathway to remove cerebral tumors and treat vascular anomalies. With the SNAP surgeons can execute their surgery plan while in the operating room utilizing a patient’s CT/MRI scans, allowing enhanced accuracy and efficiency. It also provides innovative features that allow surgeons to see behind arteries and other critical structures, something not possible until now.

"Surgical Theater has been providing neurosurgeons the ability to ‘Pre-Live the Future’ with our planning platform, the SRP. Soon, with the SNAP, surgeons will be able to re-live their surgery plan in the operating room,” said Moty Avisar, Surgical Theater CEO and Co-Founder. “Using our technology supports every neurosurgeon's goal of providing their patients with the best possible outcome of what can often be delicate and complicated brain surgery."

Since the SRP obtained FDA clearance in February 2013, Surgical Theater has installed SRPs in leading research and teaching hospitals across the United States. Hospitals include: The Ronald Reagan UCLA Medical Center, The Mount Sinai Hospital, Mayo Clinic, University Hospitals Case Medical Center, University Hospitals Rainbow Babies and Children’s Hospital, NYU Langone Medical Center, and others. The company estimates that to-date, the SRP has been utilized in preparing for more than 500 surgeries.

Surgeons are reporting that the images, as well as the dynamic and interactive modeling of the patients' cerebral tumor and vascular cases, provided by the SRP, are unique in their precision.

This precision is enabling surgeons to gain clinical insight that was previously unavailable and which now allows them to perform enhanced planning and navigation of complex cases.