New applications with augmented reality and robotics in surgery are intended to improve precision and bring the operating room into the 21st century
Although many surgeries, including spinal procedures, have been much improved with robotics in recent years, the additional technology has created associated issues with its use in the space constraints of the operating room (OR). This is especially true with monitors and their small screen sizes, which make it difficult for surgeons to see details during procedures. Solving such problems and finding the optimal position for viewing as well as ensuring integration with current technology were primary objectives in the development of iSight, a wireless augmented reality (AR) system designed by Dr. Chetan K. Patel, MD, in collaboration with startup Altair Innovations . Patel is an orthopedic spine surgeon and executive medical director for spine surgery at AdventHealth Neuroscience Institute (Figure 1).
“The goal was to design AR that fits perfectly in the operating space—where you want it and as big as you want it, in an ideal position,” says Patel. “With iSight, you can look straight ahead and it’s easier to see, more comfortable, and more time-efficient.” Most monitors average 7–8 feet away from the operating table and are only 20–30 inches in size. In contrast, iSight wirelessly projects onto the top third of the glasses all, limiting the need for a surgeon to turn away from a patient during a procedure and offering improved ergonomics and sight lines.
Development of this new system began by considering how best to solve issues with surgical robotics that would benefit everyone—including patients. Work on versions of this technology actually began in 2009. “It was a really long journey from conception to market,” adds Patel, who also serves as the North American Spine Society’s section chair of robotics and navigation. “I had developed two solutions prior to this that worked but didn’t meet metrics for all parties.”
However, with recent advances in computer chips that exhibit higher capacity in a much smaller size, and improvements in displays and WiFi speed—all technologies stemming from growth in the smartphone and gaming industries—the tech requirements for an advanced surgical AR system were more easily met. iSight was first tested in Central Florida at AdventHealth Altamonte Springs in May 2020. Since then, almost 120 surgeries have been completed successfully using the system.
Overcoming Development Hurdles
“As a teacher and a surgeon, I had been seeing problems for many years,” Patel says, “including how difficult it is to use the current technology because of the steep learning curve.” This was a driving factor in designing an AR technology that would work with technology already available and in use. “Any new technology had to integrate seamlessly with existing tech. The intent was not to extend the learning curve or force surgeons to learn something new.”
The system design brings together three main physical components: the old screens used in surgery, hardware to send encrypted information over a WiFi network, and glasses that don’t obstruct the user view and are not too heavy—offering the freedom to move with no tether, and powered to last through the entirety of surgery. In addition, specialized software is required to recreate images on the display in realtime.
“Until recently, the hardware required for this type of system just wasn’t available,” Patel says. “There wasn’t the level of video compression technology needed, or fast enough WiFi to send data and encrypt it in realtime. There was not enough battery power, and the big batteries that were available were uncomfortable.” Also, the display options weren’t appropriate for the type of work being done. For example, the Hololens has an incredible display but is too heavy and large to wear for an extended time.
Now that technology on all fronts has improved enough to beat the current status quo, development of a viable AR system was possible. iSight encompasses ergonomic hardware with a cutting-edge Epson display, and the glasses themselves remain small and light. The system also includes several types of external display port plugs to connect to other technology used in the OR regardless of age (e.g., X-ray machines, RCA-level analog technology). Essentially, iSight is plug and play so any surgeon can use the system in an existing OR (Figure 2).
“As a doctor, I wanted to integrate with everything already in the OR,” Patel notes, “and I was passionate about creating something that adds value for an appropriate cost. The optimal path for development of this system was not about trying to create the most profitable technology but creating tech that had the most value added.” From an administrative standpoint, it meant asking where health care is headed, and which technology you would want to put in your OR. “The intent was to overwhelmingly beat expectations,” he says.
Increased Efficiency, Less Disruption
“From day one, we were achieving better results,” Patel says. Use of the system has shown increased efficiency, including a reduction in OR time—saving an average of 10 minutes per operation. That includes faster placement of spinal screws in spinal surgery, as well as improved comfort and ease for the surgeon. In fact, a study that was conducted measuring the amount of time that it took to place pedicle screws, noted a 51% reduction in time when utilizing iSight. For patients, a shorter time in the OR means less time under anesthesia—all positive indicators.
As noted, one of the major drawbacks of current surgical robotics technology is that it causes surgeons to look away—and shifting attention is not only inefficient when it comes to time and cost but presents a potential source of error. This is particularly true with spinal surgery, where precision is vital for placing screws. If the technology view is not perfectly aligned with the patient, although it may look acceptable on the screen, the angle of insertion might not be correct. iSight boasts a precision level within a 1–2 mm margin of error.
Ultimately, “this product was designed with the surgeon in mind,” Patel says. “My approach was not to change much of what I’m doing today in the OR.” With iSight, there is no need to relearn a new system, and it avoids a complete rebuild in the OR, which can add significant cost—both in capital cost and disposable of old equipment.
“iSight demonstrates how AR technologies in surgeries can positively benefit both patients and surgeons,” Patel states. Overall, iSight empowers surgeons to do their work, he adds, “not just differently but better.”
- [Online]. Available: https://www.altairinnovations.com/isight