Computer-assisted tools and interventional technologies

PRESENT

AND

FUTURE

IIBm Computer-assisted tools and interventional technologies

urrent surgical practice beyond new hardware and is a relatively loosely software. One of the most connected and someimportant enabling features times uncoupled sequence of of these technologies is the events: diagnosis and planning, Anthony M DiGioia III, Branislav Jaramaz ability to tightly couple and surgical execution of the plan, integrate preoperative planning and postoperative measurement of the surgical action. We and imaging, quanitfy surgical techniques, and directly cannot directly integrate these three phases because we lack relate patient's outcome to surgical practice--"closing sensitive and accurate devices to accurately gauge surgical the loop" in the treatment of patients (figure).These practice. We ~lso lack functional modelling of the technologies will provide clinical researchers with the ability patient's anatomy and physiology to examine cause and to quantify, characterise, and validate surgical practice. effect of surgery or to optimise our actions before the Our clinical and surgical tasks will no doubt evolve and patient presents to the adapt to the changing operating room. During world and the needs of surgery, we cannot our patients. New tools access or link precise and technologies will preoperative plans directly enable us to monitor with the execution patients almost at any of the surgical task. time, anywhere, and on an Our current tools do outpatient basis in doctors' not provide accurate inforoffices, and will allow mation to the surgeon to earlier interventions, better be acted on during monitoring, and more the actual procedure. continuous care. These The next generation technologies will also of surgical tools and validate surgical techinterventional information niques in a more efficient manner, providing informtechnologies will include Closing the loop in surgical practice preoperative planners that ation that can be passed on allow fully functional, three-dimensional modelling of to a larger surgical audience. Surgeons worldwide could patients' anatomy and physiology. Surgeons will simulate then benefit from the improvements in surgical practice the cause and effect of their surgery before it actually takes without necessarily having used the actual systems themselves. place. Most importantly, these preoperative simulators will permit the surgeon to optimise a surgical plan that will be Information technologies and tools will not replace anatomically and physiologically patient-specific. surgeons or the care that they provide. As stated by The surgical toolbox of the future will include robotic Bruce Burlington, Director of the US Food and assistive devices, navigational and image-guided surgical Drug Administration's Center for Devices and tools, and microelectro-mechanical systems (MEMS), Radiological Health, "Medicine isn't an encounter with micromanipulators, and implantable sensors. Smart tools technology. It's a human encounter, supported by will help to optimise preoperative plans or adjust the plan technology". during surgery as needed. These computer-assisted tools There is great potential for the application of this new will enable surgeons to develop the next generation of approach and interventional information technologies in minimally invasive surgical procedures. many subspeciahies within orthopaedic surgery, and in These technologies will allow us to directly link surgical the entire field of surgery. Orthopaedic surgeons can practice to outcomes. Navigation systems and MEMS be proud to have led the way sensors and actuators will give continuous and updated in the last part of the 20th information during surgery. Implantable sensors and century in the development actuators will permit the measurement of biological, phyof the clinical use of siological, and mechanical factors, and will allow recomputer-assisted technoadjustment of the implanted system by delivering biological logies. These new technomaterials or by readjusting the fit and alignment of an logies and tools are not an implant. Computer-assisted technologies will also enable end in themselves but a means to permit surgeons development of a new concept of vision, allowing direct to explore and create the viewing of the patient's full three-dimensional anatomy next generation of surgical without the need for ionising radiation during surgery. techniques. As we open the The development of these technologies and tools will not new millennium, we have no only complement the current efforts in genetic and doubt that these enabling biological therapies, but also will be absolutely necessary to technologies will influence their success. For example, treatment plans using gene or the way surgeons plan, simubiological therapies such as growth factors will depend on late, execute, and measure developing accurate, responsive delivery systems to apply surgical practice to benefit therapeutic agents to specific pathological areas without our patients, closing the loop disrupting soft tissues or blood supply to the area. in surgical practice. The promise of these computer-assisted tools extends

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The Lancet • 2000 • 354 • December

• 1999

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