Digital Surgery and the Triple Aim part 2

Updated: Apr 28

On the past blog entry, we discussed how Digital tools can improve patient experience by providing better surgical tools. On this entry we will advance in the care workflow and move into the surgical planning aspect. Most surgeons spend a significant amount of time planning their cases but to this possess only rudimentary tools. Most planning is carried out on x-rays with either tracing paper or a transparency some implant manufacturers provide that can be superimposed on the negatoscope.

Surgical planning with patient X-ray
Surgical planning using patient X-ray, negatoscope and acetate

This planning, even if useful is very limited and does not provide enough insight into how the surgery will take place. Especially since its only taking place in two dimensions. Most surgical mistakes can be prevented with thorough pre-operative planning, and these mistakes cost the US healthcare system more than 17 Billion USD per year. A report by Saleh et al in November 2015 claims that 50% of orthopedic surgeons claim seeing a preventable error in the past 6 months and 13% of surgeons claim having performed a wrong site surgery at least once in their lifetime. It seems then that whatever we can do to reduce these mistakes is a sound investment.

Using digital tools like AR and 3D printing the surgeon can perform a detailed surgical plan but can take that a step further. He can 3D print custom instruments, like cutting guides and splints, that ensure the surgical plan is kept and that can raise early alarms if everything is not to plan. A detailed surgical plan can also be created that if followed carefully and taken in writing into the OR the risk of mistakes can be greatly reduced. Questions like Implant Selection, and design if nothing available will work, tumor resection margins, joint alignment, etc. can be planned with great accuracy as described in our past blog post.



3D planning of mandible reconstruction with Fibula Free Flap
3D planning of mandible reconstruction with Fibula Free Flap

3D surgical plan and surgical templates for resection of mandibular tumor and reconstruction with a free fibula flap. The plate used for fixation of the flap was custom made to ensure stable fixation and condyle preservation.


Naysayers always talk about cost, and this being more expensive, but several studies and many more on the pipeline more than demonstrate the improved cost-effectiveness in these surgeries a very good work on this subject was carried out in the UK by Attard et al and can be downloaded at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542447/.


In the next installment we will talk about how analytics and AI can further help the triple aim.

Digital Technologies are taking over osteomuscular surgery, its starting slow but it will pick up speed. If you want to be up to date don’t miss out 5th Annual Digital Surgery Meeting in Orlando in October 11th and 12th 2019. www.dsmeeting.com

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