New and experienced orthopedic surgeons can improve their surgical skills with an innovative software surveillance system that tracks their instruments during surgery performed in a computerized operating room.
"Right now, doctors sit in a classroom and look at pictures, diagrams and movies to see how surgeries are performed. Then they spend years watching surgeries before they work on cadavers, then eventually patients," says Dr. Kenneth Mathis, chairman of the Department of Orthopedic Surgery at The Methodist Hospital in Houston. "The goal with this system is to set up experiments where they will watch the surgery and then go do it. We believe this will shorten the learning curve for surgeons."
Prior to surgery, biomedical engineers prepare CT scans of cadavers and reconstruct the data into computer models that look like real patients. The surgeon then simulates a joint replacement operation on the computer by manipulating models of surgical instruments and the knee or hip joint. Once the surgeon is satisfied with the placement of each component, he or she defines the result they are striving to achieve and then performs the actual surgery on a cadaver.
This procedure is performed in a special operating room where 12 infra-red strobe cameras track the position of the bones, implants, and instruments during the procedure. This allows researchers to see what the surgeon is doing at every point of the surgery and see if the surgeon is hitting the landmarks set for themselves.
"At the end of the operation, we will be able to superimpose what the surgeon did on the screen and show them how closely they reached the targets set before the operation," says Dr. Phillip Noble, the John S. Dunn Professor of Orthopedic Research who invented the computer training system in partnership with Dr. Michael Conditt in the Institute of Orthopedic Research and Education (IORE). "Using this system, we can zoom in and show surgeons each key step in their surgical technique and the magnitude of any deviations from their original plan. Advanced routines also allow us to estimate the impact of changes in technique on the function of each joint after the procedure."
This system has been developed for widespread use outside IORE and is now under evaluation at the Methodist Institute for Technology, Innovation and Education (MITIE) through funding provided by the U.S. Department of Defense.
"Every 10 years doctors have to be re-certified in their specialty," Mathis said. "How do we know someone is still a good surgeon by giving them a written exam? This computer system will help us better determine if surgeons are performing at the level of skill that is good for patients."