• Investment World
• eWorld
• Catalyst
• Mentor
• Life
• Canvas
• Praxis
• Urban Pulse
• Brand Quest

L.N. Revathy

Computer-aided surgery can help doctors perform procedures on the spine and knee with almost 100 per cent precision. It's a win-win deal for patient and doctor.

Picture shows images on a computer screen of a screw being fixed into the backbone during computer-aided surgery.

IT was a spacious, yet packed lift, that carried both patient and visitors, apart from the hospital staff, to the top floor of the six-storey building. While the patient wore a nervous look, the eWorld team chanced to inspect the place, which was like any other hospital in the city.

A couple of minutes later, Dr Rajasekaran, Director and Chief Orthopaedic surgeon of Ganga Hospital, came out of the operation theatre with his mask still in place, asked his staff to prepare the patient for surgery, and invited us over to his room. Besides the PC, there were demo models of various joints such as the knee, the spine and hip on his table.

Rotating the knee joint mock-up, the surgeon, who has over the years performed more than 100 joint replacement procedures of the knee, hip, shoulder and elbow, explains that the revolution in the surgical field could not change only one factor since the beginning — and that is the surgeon. "No doubt, we have better trained surgeons today than ever before, but our inability to be 100 per cent precise all the time has been the limiting factor," he says.

Spine disorder and knee replacement procedures have been on the rise in recent years. Patients are treated either conservatively or surgically, depending on the clinical presentation and neurological status.

Surgeries are performed to correct deformities and stabilise the unstable segment (of the spine) using screws and rods. However, the danger of the screws damaging the spinal cord or the large blood vessels, although very small, is ever present. The technique of biological percutaneous pedicle screw insertion and closed threading of rods is done, but cent per cent precision has always been a question.

Joint replacement surgery, on the other hand, involves removal of the bone from either end of the joint and replacing it with an artificial joint. Here, the chances of an error of judgement on the centring, the degree to which the (artificial) joint can be moved for a perfect alignment is as per the physician's perception - more appropriate than accurate.

"For that matter, even medical literature allows a known complication rate in every surgical procedure. But these rates are set to change for the better with computer-aided surgery. And the ultimate beneficiary of this technological advance is the patient," says Dr Rajasekaran.

And for the first time, says Dr Rajasekaran, it is truly the computer that is directing the doctor's moves in the course of the surgery. Until now, technology captured on the computer screen the surgery performed by a doctor as the process unfolded in the operation theatre, be it bypass surgery or any other. So the images one saw were those of the doctor going about his task. But in computer-aided surgery, the surgeon's moves are actually guided, in real time, by the computer, he says.

Ganga Hospital has invested around Rs 1.5 crore on this up-to-date machine, VectorVision, from the BrainLAB stable. The Munich-based BrainLAB manufactures, develops and markets software-driven medical equipment. The image-guided surgical procedure allows the physician to provide a treatment that improves medical outcome while being more accurate, less invasive, and less expensive than traditional surgery.

Clinically-proven, software-driven medical technology in the field of orthopaedics has revolutionised long-established techniques, says Dr Rajasekaran.

The machine's navigation system allows instant navigation and does not require complicated and expensive pre-operative CT scans or additional treatment planning time. The surgical navigation relies on sensors that accurately measure the three-dimensional position of the bone to be operated on, as well as the surgical tools. During surgery, a series of landmarks are collected to generate a 3-D model of the part and that is morphed to the patient's individual anatomy.

Based on this intra-operatively acquired data, the software recommends a treatment plan that can be optimised according to the surgeon's expertise. The movements of the surgeon's instruments are guided with high precision and are visualised in real-time throughout the procedure, thus helping to achieve optimal implementation of the treatment plan.

According to Dr Rajasekaran, in computer-aided surgery, the computer decides the position and size of the screws to achieve perfect placement of the screws.

The latest equipment available for knee replacement surgery can cut bone within 3 to 5 degrees of the desired range, and the error margin is brought down to a negligible zero to 0.5 degree, ensuring perfect alignment.

With the increasing number of joint replacement surgeries performed in this country, the need for revision replacements is also on the rise. Revision surgeries require greater skill, special instrumentation, and technique for cement removal. Cutting-edge-technology helps in maximising the life of the artificial joint.

Would robots eventually take over the surgical procedure considering the advances in technology? "Not really, remember you are performing surgery on human life. It is precious. The tool is only a guide, a supplement that helps us to be more precise," says Dr Rajasekaran.

lnr@thehindu.co.in

Article E-Mail :: Comment :: Syndication :: Printer Friendly Page

Stories in this Section
When minutes matter

Copyright © 2004, The Hindu Business Line. Republication or redissemination of the contents of this screen are expressly prohibited without the written consent of The Hindu Business Line