Pioneering new augmented-reality surgical navigation technology for precision surgery

News 2019-10-29

Dr. Adrian Elmi Terander, a neurosurgeon at Karolinska, says the joint innovation project holds great promise. "With the help of live images during an operation, it becomes much easier for us to safely and accurately insert spinal implants."

With the help of live images during an operation, it becomes much easier for us to safely and accurately insert spinal implants.

Real-time imaging and navigation support

Surgical navigation systems are not new – they have been used for the past 20 years. Traditionally, X-rays of a patient are taken before the operation. These scans are then used to plan and guide the operation. With the new navigation technology, the care team gets real-time imaging and real-time navigation support during the operation, both in one system. A flat detector with four integrated hi-resolution cameras captures external images of the patient on the operating table. These images are automatically combined with internal images of the bony anatomy captured by an X-ray system, generating 3D views with augmented reality to help guide the surgical procedure.

"This allows us to plan our procedures virtually," Dr. Elmi Terander says. "We can now insert implants with high precision to improve patient safety."

Indicating some of the benefits of the technology, a clinical study that was recently published in the journal Spine [1] has shown that the technology enables a high (94.1%) overall level of screw placement accuracy whilst virtually eliminating radiation exposure for the surgeon.

Instant post-surgery checks

An additional advantage of the new augmented reality technology is that the result of the surgical procedure can be checked – and if necessary, corrected – in the operating room, directly after the operation. "Traditionally, the patient would go back to the general ward after the operation, and undergo a CT scan the next day," Dr. Elmi Terander explains. "With this new technology, we can do a 3D check in the operating room, to see if all the implants have been inserted correctly. If we need to make adjustments, we can do this straight away, saving the patient a second operation."

With this new technology, we can do a 3D check in the operating room, to see if all the implants have been inserted correctly. If we need to make adjustments, we can do this straight away, saving the patient a second operation.

The whole surgical procedure is intended to minimize minimal radiation exposure for the patient and to avoid radiation exposure for the surgeon altogether. "This is also very important for us," says Dr. Elmi Terander. "Safety of patients and staff is obviously a top priority."

Breaking down boundaries

While working on this innovation project, Dr. Elmi Terander has seen specialists from different disciplines within Karolinska come together. "Over the last year, we have had a very fruitful collaboration with our colleagues in orthopedics, performing surgery together," he says.

"Neurosurgeons and orthopedic surgeons bring different strengths to the operating room: neurosurgeons excel in high-precision work, whereas orthopedics are highly visual 3D thinkers. With this new surgical navigation technology, we can combine these strengths to achieve better outcomes for patients. I am also very happy about the way we work together with our neuroradiologists. I think this project is a prime example of what Karolinksa is trying to achieve with its new operating model: breaking down internal boundaries to deliver the best possible care."

Looking forward

As a next step, Karolinska will be working closely with Philips to further develop the new augmented reality technology. Dr. Elmi Terander and his team will also start looking at other possible applications. "So far, we have focused on spinal surgery. But when you're operating on a brain tumor, for example, you also need to know exactly where you are with your instruments. It's still early days, but I envision a future in which this kind of technology will be used in all parts of the body that require high-precision navigation."

Read more about the Innovation Partnership