Clinical Solutions
Mixed reality system improves surgical outcomes
March 4, 2024
A surgical team at St. Joseph’s Health Care London, led by Dr. George Athwal, has advanced the use of mixed reality in the operating room using VR headsets and hologram-like images to dramatically improve the accuracy of shoulder implants.
Using cameras, a computerized headset and tracking technologies, Dr. Athwal is able to “project” the patient’s pre-surgical plan – using CT images – onto his or her anatomy during the operation.
While simultaneously watching the projection and conducting the surgery, the orthopedic surgeon can improve the accuracy of the procedure by a quantum leap – especially in more difficult cases.
“Even in normal surgeries, humans can be off by as much as 10 to 15 degrees [in placing the implant] or as much as 5 millimetres,” said Dr. Athwal. “Sometimes it’s as much as a centimetre. But using this mixed reality solution, we’re getting as close as 1.5 millimetres to where we want to be.”
Dr. Athwal said orthopedic surgeons are quite good at what they do but asserted that this technology can “make us even better surgeons.”
For several years, Dr. Athwal has been helping global medical technology giant Stryker to develop the mixed reality orthopedic surgery system, called the Stryker Blueprint MR Guidance solution. He and another orthopedic surgeon at the Mayo Clinic in the U.S., Dr. Joaquin Sanchez-Sotelo, were the first worldwide to deploy the latest system.
Three years ago, Dr. Athwal was the first in Canada to use the previous version of the solution, in which the pre-surgical CT images could be viewed as a reference for the surgeon.
In the latest iteration, the 3D computed tomography scans appear as an overlay on the patient and show the surgeon the underlying anatomy. They also guide the surgeon, showing him when he is off the mark and enabling him to get back on track.
“The operations are normally done through a small incision, and we can’t see all of the bones and underlying structures,” said Dr. Athwal. “Now we can see all of the bones. I can see when I’m off, and I can correct my positioning.”
Dr. Athwal, a surgeon with St. Joseph’s renowned Roth McFarlane Hand and Upper Limb Centre, said he has a passion for developing new solutions that apply mixed reality to surgery. He is also a professor at Western University’s School of Medicine, where he supervises engineering students working on novel biomedical technologies, along with medical students.
He said the Stryker solution, which he helped devise, could be adapted to other orthopedic surgeries, such as knee, hip and spine.
While it’s a new method of conducting surgeries, and one that has a futuristic appearance with surgeons wearing headsets as they work, Dr. Athwal said it’s likely to become “the standard of care in five to ten years.”
That’s because the improvements in accuracy that it enables are so profound.
Dr. Athwal was part of a team that worked with Stryker, a manufacturer of shoulder implants, and Microsoft Corporation, manufacturer of the HoloLens 2 – a holographic headset – to develop the mixed reality shoulder replacement technique.
He has since performed numerous surgeries using the initial version of the technology and is in demand to provide demonstrations worldwide.
Involved in the development of this software and technology for the past 10 years, the London surgeon says, “it feels like you’ve been watching your child grow and become increasingly successful at every stage.” He envisions this next generation of the system being particularly instrumental for more complex shoulder replacement patients – those with the greatest amount of bone deformity and disease.
“For the most challenging cases, where implant positioning is critical to successful patient outcome, this technology is a game changer.”