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3D virtual reality revolutionizes complex operations

Just two years after Houston Methodist invested in state-of-the-art technology to create the Virtual Surgical Theater environment for surgeons and patients to “fly through” a patient’s brain and see the specific tumor that needs to be removed, Dr. Mas Takashima and Dr. David Baskin agree the investment was well worth it for patients, surgeons and for training of future surgeons. “I’m a believer,” said Takashima, MD, FACS, Professor and Chairman, Department of Otolaryngology — Head & Neck Surgery, Houston Methodist Academic Institute. “As we do more complex cases, I’m realizing the value of having the Surgical Theater’s 360° XR visualization platform.” “Patients appreciate it; it definitely wows them, but it is far more than that. Patients really understand better. They can see the relationship between the skull base tumor and surrounding important structures such as the optic nerve and carotid artery,” Takashima said. He adds that the technology allows surgeons to identify new treatment options and continue to push the boundaries of improved surgical treatments. Baskin, Vice Chairman of Neurosurgery for Houston Methodist and Director of the Kenneth R. Peak Brain & Pituitary Treatment Center, goes so far as to call the Surgical Theater’s 360° XR visualization as “truly disruptive technology.”

There may be very critical structures in the back of the tumor, but you can’t see them because the tumor is blocking it. Behind the tumor could be the main artery of the brain, important nerves, optic nerve, and you can’t really see it,” Baskin said. “We’ve been through various versions and it keeps getting better and better. You’re putting on a VR helmet, and it’s literally like you’re walking inside your patient’s brain.

David Baskin, MD

“This is so out of the box, you can’t even conceive of it,” Baskin said. “We’re training the surgeons of the future using this disruptive technology, and, guess what, they’re as good at it or better at it than we are because they’re the video game generation.” Katherine “Katie” Mattingly, XR Program Lead for Surgical Theater, works with Houston Methodist to turn imaging from patients into a 360-degree model that surgeons and patients can walk or fly through to see exactly where the tumor is in relation to the inside of the skull. She says the Surgical Theater can improve surgical planning, patient engagement and enhance surgical precision. “I can see firsthand how helpful this is to the patients; they feel a lot more comfortable after they see exactly what everything looks like in their own cases,” Mattingly said. Typically, Mattingly builds the cases the night before or morning of the patient’s surgery. Then, she sets up in the operating room where the surgery team can view their specific cases. She also works with Omar Ahmed, MD, and Gavin Britz, MD, on endoscopic skull base tumors. Dr. Ahmed is assistant professor of Otolaryngology – Head and Neck Surgery at the Houston Methodist Academic Institute. Dr. Britz is the Candy and Tom Knudson Distinguished Centennial Chair in Neurosurgery at Houston Methodist.

The 360° XR Visualization gives surgeons the breadth of information that increases their situational awareness from every angle and every approach.

“When I first heard about this and saw it, I was skeptical,” said Takashima. “I’ve been doing all these surgeries without it; why am I going to need it now? We have become pretty good at visualizing the 3D spatial aspects of the tumor in our heads.” But now Takashima may even stop a procedure, tell the team to take off their gloves and gowns, put on the special virtual reality (VR) goggles and get a better appreciation of where vital structures are in relation to the tumor. Baskin added, “These are areas that traditionally are very difficult to reach because you have to remove large areas of bone.” Before the purchase of Virtual Theater’s visualization software, surgeons had angled mirrors so they could look around the corner, but it was a tiny window that the team had to make into three-dimensional sense. “There may be very critical structures in the back of the tumor, but you can’t see them because the tumor is blocking it. Behind the tumor could be the main artery of the brain, important nerves, optic nerve, and you can’t really see it,” Baskin said. “We’ve been through various versions and it keeps getting better and better. You’re putting on a VR helmet, and it’s literally like you’re walking inside your patient’s brain,” said Baskin. “It shows you where the vessels are, where the critical structures are. Are they thinned out, are they pushed up, are they pushed down, are they pushed sideways. What is the exact anatomy there; that’s what you want to know when you’re doing surgery,” Baskin said. “As good as we all are at looking at images and making them into 3D surgery, nobody can literally, in their brain, perfectly see in 3D from 2D. We make inferences. You can put the VR goggles on and literally start at the nose, peel away the bone and fly through the brain. “We can show the patient the tumors, show them the arteries and nerves, you can fly them through and get a better understanding of what the real problem is and what the challenges are. In the end, they get a tremendous amount of reassurance. It gives them comfort knowing we are using the latest technology to help them,” said Baskin. Takashima and Baskin point out that Surgical Theater’s visualization platform also facilitates multidisciplinary collaboration among surgeons because everybody gets a chance to look in 3D and practice different trajectories. “It allows us to do the surgery virtually a hundred times if we want to do it,” Baskin said, adding that he puts the VR goggles on before every surgery and walks through the patient’s specific case. The 360° XR Visualization gives surgeons the breadth of information that increases their situational awareness from every angle and every approach. This information optimizes the surgical experience from clinic to planning to post op for a specific patient. It also allows residents a place to refine and practice their skills with a system of surgical simulators. Finally, it gives patients transparency throughout the surgical experience, so they feel comfortable, prepared and confident about their customized care. “Houston Methodist is really willing to invest in this — and it’s very expensive — and next year it will be out of date, like all technology. But they are willing to continue upgrading and investing, understanding that if we really want to lead medicine, we must invest in technology. Technology is revolutionizing surgery every day, and this is a great example,” Baskin said.