Surgeries of the future?

CSN Event Report

Only a few years ago, the ideas of 3D printing and regular use of robotics were something from a futuristic movie or television show. In 2018 Dr. Claudia Di Bella is using these techniques everyday to improve her surgeries and get better outcomes for patients. Claudia, an orthopaedic surgeon with a flair for innovative research, completed her medical training at the world’s oldest continuous medical school at the University of Bologna, Italy. She specialises in oncological orthopaedics, and operates on patients with cancers of the bone, cartilage, and musculoskeletal system. With her ‘other hat’, Claudia runs a bio-printing lab at the BioFab3D facility at St. Vincent’s hospital in Melbourne, which aims to use new technologies to regenerate cartilage and other musculoskeletal tissues.

New technology #1: Computer-navigated surgeries to increase accuracy and improve patient outcomes

Accuracy is undoubtedly the most important skill that a surgeon can have, and modern surgery has always simply relied on the surgeon’s technical skills – and what they can physically see. Successful surgeries are the result of a surgeon’s ability to “match what they plan, with what they do.” In orthopedics, surgery relies on landmarks – structures within the body such as bones and muscle groups that help guide surgeons to make cuts in the correct location. Using landmarks for navigation in surgery first emerged about 15 years ago, by physically placing markers on these landmarks and using computer navigation to determine more precise cutting locations. However, every patient’s body is different, and a landmark on one person may be a few centimetres misplaced in another. Likewise, we can’t expect all surgeons to have absolutely precise, flawless technical ability.

To remedy this, surgeons can now use navigation during surgery via CT scans to identify landmarks and plan the next steps while the patient is already in the operating theatre.  Even more advanced, intraoperative navigation can be used to completely plan a surgery from CT and MRI scans. These techniques not only give surgeons more confidence in their precision, but make each surgery a more personalised experience for the individual patient.

New technology #2: Could a robot replace a surgeon’s job altogether?

Are robots used in surgery? It sounds like something completely futuristic, however in 2018 robots are a reality in the operating room. Procedures can be completed with the assistance of robots, or a robot can actually act as the surgeon’s hands to cut and repair tissue! A surgeon can sit in a console with their head embedded in a virtual reality style headset, driving instruments with their hands that correspond to those on a surgical robot.

The robot has a camera, so the surgeon can see exactly what is happening in 3D around them without needing to be scrubbed into the sterile operating room. This idea of ‘hands-off’ surgery may sound absolutely terrifying to many, and there is one key downside to remote robotic surgery – the lack of human touch. Surgeons use their sense of touch to assess how soft, firm or spongy tissue might be, and robots are unable to give feedback to the surgeon in terms of how the surgery ‘feels’.

Robots are more commonly used alongside surgeons in the operating room. Claudia uses robots in conjunction with her own surgical techniques to pre-plan joint replacement surgeries from CT scans. She uses the robot to perform the planned surgery, and it is able to stop at any point if she is going off course, too fast, or taking a risk.

Although robots may sometimes be completing near entire surgeries, they won’t be taking surgeons out of a job anytime soon. Surgery is all about planning and decision making, and the surgeon is still the brains behind the procedure – robots are merely a tool to amplify this.

New technology #3: 3D printing – tumours, implants..and cells?

3D-printing has become a bit of a trend in the last five years, and as Claudia points out, you can even buy a small 3D-printer at Aldi! 3D printing can be used in a multitude of ways in general life, from building models, small plastic trinkets, jewellery, even some types of food can be 3D-printed! In surgery, it can be used both in planning and completing procedures. A surgeon may 3D print models of a heart with a defect, a tumour, or misshapen or fractured bones, and use these models to work out the best surgical procedure to perform.

In orthopedics, surgeons can design personalised cutting guides designed exclusively for each individual patient. These can be printed in a sterile environment, and put directly on the bone in surgery to make cuts that are perfect every time. Even further, metal implants can be 3D printed and are safe to place in the body (and much less expensive than traditional implants!). Claudia uses 3D printing to plan surgeries to remove difficult orthopaedic tumours; she designs guides to make the cuts, does the surgery, and uses 3D-printed implants that once fitted are “absolutely perfect”.

3D-printing for reconstruction in the orthopaedic field is “absolutely huge”- but can you 3D print biological material like cells? Claudia describes the Biopen, a mini 3D printer that uses ‘stem-cell ink’ to deposit cells when repairing knee injuries. The Biopen was developed at St Vincent’s Hospital in Melbourne, and is can be used like any other surgical instrument during a procedure. The pen is loaded with stem cells in a special material called Hydrogel, which keeps the cells alive and thriving during the stressful printing process. This allows surgeons to deliver stem cells into a damaged area during surgery, such as a pre-arthritic lesion. The cell material becomes hard, and over time the cells are able to regenerate cartilage into the damaged area. Trials to date using the Biopen in animal models have been very successful, with studies in humans hopefully in the not-too-distant future.

Future technologies in surgery, medicine and beyond:

With this age of robotics, 3D printing and computer navigation being routinely used in surgery, what more could the future hold? The possibilities are seemingly endless-with each new technological advance, there is a potential application for medicine and surgery. For example, ‘organ on a chip’ technologies are changing the way we investigate biology, and provide a great physiologically relevant alternative to using animal models. Virtual and augmented reality systems could be the future of medical training, as trainee surgeons can experience the ins-and-outs of surgical procedures without need for extensive use of cadavers, animal models and other forms of education. Each advance in technology provides new techniques for surgeons to explore, improves surgical outcomes for patients, and creates an entirely new way of thinking about modern surgery.

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This article was sourced from our proud Precinct Partner : The Convergence Science Network