InAVator: Professor Christian Woiciechowsky

A spinal surgeon in Germany is using a mixed reality platform to improve the speed and precision of surgery. Paul Milligan finds out how it all works.

When asked what first drew him to using mixed reality in surgical procedures Professor Christian Woiciechowsky, chief of the Spinal Surgery Clinic at Vivantes Humboldt hospital in Berlin, is as precise as his profession so often demands. “A surgeon likes images, they always have images in their minds, to see where a tumour is, to see where the problem is, to see how to remove it. It’s good to have new possibilities in how you see things on a screen.”

Woiciechowsky has always been interested in technology because as he says, ‘it makes things easier and faster and better‘. So it’s no surprise that he has begun using the newly developed Holographic Navigation platform, which is the first mixed reality surgical holographic navigation platform using Microsoft HoloLens glasses.

Created by German company Scopis, a developer of surgical navigation and medical augmented and mixed reality technologies, the technology uses Microsoft HoloLens (which communicates wirelessly with the Scopis system) to let surgeons meticulously and accurately navigate through the human body. It tracks the movement of the patient and the integrated HoloLens precisely with a stereoscopic infrared camera. This data then gets processed in the Scopis Hybrid Navigation unit, a powerful medical computer. The 3D-tracking enhances the overlay’s precision, and shows planning structures at their real position inside the patient.

It enables surgeons to use gesture control to place virtual monitors into their visual field near the patient, so their eyes remain on the operative field. Woiciechowsky has a particular interest in the technology because it can provide a real benefi t to his specialism (spinal surgery) by aiding the positioning and alignment of pedicle screws during multiple vertebrae fixation surgeries.

Does he find surgeons are pro technology on the whole, or resistant to use something new? “Maybe some other surgeons don’t like technology because they find it complicated, but usually surgeons are interested in improving procedures, in making things safer for patients, and making things more accurate.

The main objective is to improve the outcome for the patient.” Like all industries, investment in equipment has to show ROI, “With new technology there is always a cost, and our administrators will ask us ‘do we need to spend money on this?’ With this system, we can show we can improve the outcome of the patient, by shortening surgical time or shortening the length of stay in the hospital, or by lowering the risk.”

So what is it about this technology that he feels could be of particular use to the surgical community? “As I said before, surgeons always focus on images, we now have a lot of screens to look at during surgery. With this new technique, we only need one pair of eye glasses because we can have images in the air, so we don’t need to rotate our heads to look at the screens, it’s more convenient for the surgeon. It is also possible to overlay the images directly over the patient, so we can have a direct view of the patient’s anatomy and can see where the problem is, for example where the tumour is. This new technology can be revolutionary.”

Aside from helping the speed and precision of surgery, the technology could also benefi t patients and medical professionals by reducing the radiation exposure from fluoroscopy devices that are currently used to determine the optimal position for screw placement during surgery.

Although Woiciechowsky is a spinal surgeon, he sees uses for the technology across the board, “All surgeries need navigation, I can see uses for neurosurgeons, orthopedic surgeons, all different specialties will be able to use it.”

He also sees the technology playing a key part in bringing along the next generation of surgeons, “For training surgeons sometimes you have the images in your brain, we have an idea of how to reach the tumour, but with training it’s diffi cult as there is lots of blood, you have vessels, nerves. When you have the possibility to overlay with the real images you can have a better training session. It helps to lower the risk and likelihood of complications.”

When we spoke to Woiciechowsky he was four weeks into a year-long evaluation program of the technology. He is the only surgeon using the system at the moment but he sees that changing over the next 12 months.

“In evaluation time it is usually one surgeon that mainly drives the development and helps to improve the system. We want to get to the level of having a very good system, then it can be used worldwide easily by every spinal surgeon.”

To help improve the system Woiciechowsky is in regular contact with Scopis to develop the system over the course of a year to fi ne tune it, because as he puts it, “it has the potential to make spine surgery more effective, safe, and precise.”

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