Updated: Apr 28
Winston Churchill said: he who fails to plan is planning to fail. This is true in most tasks, but in complex tasks it becomes even more important. One of the most complex tasks a human can perform is a surgery on another living human being. We would expect a whole lot of planning to be happening before each surgery. And a lot of practice does go on, a significant amount of resources goes into training and honing the skills of a surgeon to the highest extent possible. But practice does not necessarily equate to planning. Each patient is different and the pathologies affect the patients in changieren ways. The tools the surgeons use for the planning are usually limited, in most cases it consists on a piece of tracing paper that is positioned on top of an x-ray and the planning is performed manually. This planning technique has worked with good results for more than 50 years and it has allowed for an incredible number of people to be rehabilitated, but certainly in the midst of the 4th industrial revolution we can do better.
After a CT Scan of the patient is obtained, a segmenting software can be used to create a 3D model of the tissue to be studied. This 3D model can the be manipulated via CAD (Computer Aided Design) software to virtually operate in the patient, as many times a necessary without putting the patient at risk. This process can be aided by 3D printing and Augmented Reality to give the surgeon an accurate 3D perspective of both the pathology and the surgery to perform. This in itself is an exponentially better planning tool than what is commonly available.
Nonetheless it doesn’t stop there, 3D printing can be used to create custom implants and instruments that can be used to ensure the surgical plan is precisely followed. This is also a much better than the traditional method of analyzing intraoperative fluoroscopy and adjusting by eye. Thousands of surgical mistakes are made every year around the globe and these don’t necessarily account for sub-par surgical results of good surgeries.
We decided to take the challenge of evaluating in a surgical workshop, whether the 3D planning tools would actually improve the anatomic reconstruction of a Distal Radius osteotomy as performed by a highly capable hand surgeon. The results show that the average result, based on the different aspects of the surgery that are measured increase from an average accuracy of 82% to an average accuracy of 99.3% when compared to the ideal anatomic reconstruction. This work was published as a poster in the International Society for Fracture Repair biennial meeting in 2016. Attached is a copy of the poster that was presented.
Its time we change our chip and understand that the tools available in this time can significantly increase the results of the thousands of people that require reconstructive surgeries around the world. Let’s start using, publishing and inventing new uses of these technologies to improve patient outcomes, and make custom the new standard.