Medicine is continuously learning from other fields, perhaps the best example being aviation. It is from aviation that we gained the benefits of checklists, integrated ICUs and ORs, and – most recently – simulators. The first computer-based flight simulators came out 50 years ago and only now are we getting up to speed in terms of developing systems that enable surgeons to rehearse operations in advance.
This past June Medgadget met up with the Surgical Theater team at The White House and discussed how they are turning this vision into a reality – or, rather, the other way around. Their flagship product, the Selman Surgical Rehearsal Platform (SRP), allows surgeons to “pre-live the future” by practicing procedures on their actual patients’ anatomies using pre-operative MRI and CT images. We heard from them recently because the SRP has reached a few milestones in the past six months, including its first purchase by University Hospitals (UH) Case Medical Center in Cleveland and submission for FDA approval.
We had the opportunity to catch up with Surgical Theater‘s President, Moty Avisar, and Medical Director, Dr. Warren Selman, who is neurosurgeon-in-chief at the UH Case Medical Center.
Shiv Gaglani, Medgadget: What are the various use cases for the SRP (education, pre-surgical rehearsal, etc)?
Dr. Warren Selman: Right now, surgeons look at CT scans before an operation and have to translate the flat, black-and-white image into a realistic picture in their heads. Even with the planning, it takes extra time in the operating room. Even for experienced surgeons, if we know ahead of time what an aneurysm is going to look like, we could choose a way to optimize the procedure. Shaving just 20 to 30 minutes in an operation could improve the patient’s outcome.
Moty Avisar: Prior to receiving FDA clearance the SRP is restricted to educational purposes, meaning that only historical patient case studies will be used. Subsequent to FDA clearance, we will be able to use pre-surgery patient specific studies (CT/MRI) so that surgeons can practice operations virtually.
Medgadget: When do you expect to hear back from the FDA? How would that change how the Selman Surgical Rehearsal Platform is used?
Avisar: We are anticipating that we will hear back from the FDA by the end of Spring 2013. Subsequent to FDA clearance, we project that the SRP will be widely adopted by the neurosurgeons. We believe that the positive impact of the SRP on safety, outcome improvement and cost reduction will be recognized very fast by the neurosurgery community, and that once surgeons experience the immersive and realist pre-op insight they gain by “pre-living the future” with the SRP, they will not want to go back to use old pre-op images.
Once we obtain FDA clearance we plan to clear our “Hands-Free OR Viewer”, our next generation platform which will provide the surgeons with all the standard imaging visual capabilities and the SRP’s capabilities without touching anything (not even a mouse) and without leaving the surgery table. We are developing this cutting-edge platform which will allow the surgeon to “warm up” (just like golf and baseball players swinging the club/bat once, twice before hitting the ball…) just before they apply the clip on the aneurysm or start to remove the tumor. The establishment of this muscle memory has been shown to be highly beneficial for athletes and surgeons alike.
Medgadget: Approximately how much does the SRP cost? Have other institutions expressed an interest?
Avisar: The SRP price ranges from $250k to $350k depending on the configuration that the institution selects (number of modules and number of portable stations). Surgical Theater has established an Early Adopters Program that we are making available to a limited number of trailblazing institutions in the US. This program includes attractive terms and a significant discount. The Early Adopters group currently includes Case Medical Center in Cleveland Ohio that has already acquired SRP. We are expecting that the Mayo Clinic, UCLA and a few additional trailblazing institutions will join this program very soon.
As part of the Early Adopters Program, the Surgery Rehearsal Platform (SRP) will be delivered with modules for cerebral aneurysm, pituitary tumor and meningioma. We plan to release additional modules during 2013, including microvascular decompression and acoustic neuroma.
Each module includes preloaded cases (CT/MRI) that have been converted into a 3D dynamic and interactive model. The modules include accurate modeling of the surgery instruments and realistic interaction between the instruments and the tissue. Our technology and granted patent in the field of image reconstruction into a dynamic and interactive model allows us to provide a unique solution to the surgeons and we are very encouraged by the clinical utility that the surgeons see in our platform.
As part of the Early Adopters Program, Surgical Theater will collaborate with the Early Adopter group in studies to provide evidences for the SRP’s clinical and educational value proposition. We have already developed the first study protocol that we are submitting to the IRB at Case UH. Finally, we are offering to the Early Adopters group rapid, free of charge software upgrades and added capabilities.
Here’s our interview with Surgical Theater at The White House:
Flashback: Surgical Theater: A Surgeon’s Simulator (Video Interview at The White House)