The Third Dimension

3D video is an emerging technology that will improve outcomes and efficiencies in the coming years.

Imagine a future with ORs in which already talented surgeons are aided by 3D technology that produces spectacular images with such clarity and brilliance that they can confirm the precision of their work in real time.

Coming to an OR near you

The results of using this tech — which is already happening in some places right now and could be the norm in 10 to 15 years — will see OR teams performing minimally invasive procedures that cause less trauma to the body and ensure patients experience less postoperative pain.

That, in turn, shortens recovery times and allows for confident, safe discharges for patients who undergo an ever-increasing number of procedures just a few hours after they underwent their surgeries.

Smaller companies now offer products that are being used by some of the country’s top hospital systems, while other large providers are more hesitant. It’s just a matter of time, however, before the technology will win, according to Suraj S. Soudagar, MS, MBA, LEED AP, principal and project executive with IMEG Corp., a healthcare engineering, design and medical equipment planning firm in Naperville, Ill. Hints of this inevitability are seen when peeks behind the curtains of the major medical device manufacturers show they all have systems in some stage of pre-production that will allow them to introduce 3D visualization in ORs to accompany their line of laparoscopic surgical products.

Some companies, for example, have recently touted 3D planning tools for cath labs that include surgeons wearing ocular glasses or virtual reality headsets that allow them to perform surgical pre-planning in real time right at the operating table. “That is very cool,” says Mr. Soudagar. “Integrating what they are seeing on the table and overlaying it with their visualization tools is very powerful.”

After seeing the major medical device companies begin their journeys into this market, smaller companies touting themselves as being collaborators have followed suit. They crunch the numbers of big data for the big players in an effort to partner with them to help them advance.

Current success stories

Recent announcements from Hospital for Special Surgery (HSS) about what’s already taking place in its New York City locations show the promise of 3D — while simultaneously providing a glimpse into the future of the majority of ORs in, say, 2025.

In March, HHS announced results of a study that showed intraoperative 3D imaging was better than two-dimensional radiographs in confirming the accuracy of pedicle screw placement during spine surgery. The research was presented at the 2023 American Academy of Orthopaedic Surgeons (AAOS) annual meeting in Las Vegas.

“Even one misplaced screw can have a significant impact for a patient, a surgeon and a hospital system,” notes Darren Lebl, MD, the study’s lead investigator. “Therefore, based on these findings, we suggest that for intraoperative confirmation of screw position 3D imaging may soon represent a new standard of care.” In December, Chief Emeritus of HHS Spine Frank Cammisa, MD, performed the first augmented reality (AR) navigation-guided spine surgery in New York State by using an FDA-cleared system that superimposes 3D images of a patient’s anatomy onto the surgeon’s view of the operative field via an AR headset that can’t be seen with the naked eye. The spinal decompression and fusion procedure on a 28-year-old male patient was a success.

“The technology allows us to visualize the patient’s 3D spinal anatomy during surgery to accurately guide instruments and place surgical implants, such as pedicle screws, while looking directly at the patient rather than at a separate computer screen,” explains Dr. Cammisa. “Improved control and visualization of the patient’s anatomy and critical structures can lead to a more precise, efficient surgery and can enhance safety.”

Training will be crucial

SUPER ENHANCED 4K/3D imaging systems provide amazing clarity that allows physicians to increase their precision while making cuts.

Mr. Soudagar notes that the adoption of 4K imaging systems by the majority of facilities who still operate with 1K will be hastened by 3D imaging. Training physicians on 3D, however, will be the key to getting them on board. 4K/3D systems allow surgeons to see tissue, droplets and polyps that might have otherwise gone undetected at a rate of four times greater than non-3D-aided 4K systems. The ability to pre-plan procedures with this 3D-imaging assistance provides physicians with a de facto surgical GPS system. Previously they’ve essentially been engaging in educated guesswork, even with 4K guidance.

Without training, surgeons could be deluged with too much of a good thing. With so much information at their fingertips, could they be overwhelmed by an ability to navigate that’s better than what they’re used to by using their naked eyes? Training seasoned physicians will be crucial for the technology’s immediate adoption. Barring that, younger people who were raised on high-tech and wound up in medicine will take care of that barrier in the near future. To date, however, the mass marketing of 3D technology remains largely a futuristic reality.

Temporary trepidation remains

A challenge for companies will be getting hospitals, which Mr. Soudagar refers to as “traditionally closed systems,” to share intraoperative data with companies that need the information to function at optimal levels. “Health systems don’t like their mistakes to have the potential to be advertised,” he explains. “That’s why the Googles and Amazons of the world, while having achieved entry into health care, haven’t been able to get this data. Health systems don’t want these companies to know everything they know.”

This institutional pushback, predicts Mr. Soudagar, is temporary. Eventually, allowing Big Data companies in on the Big Data health systems possess is inevitable.

In 10 to 15 years, the surgeons that health systems and ASCs want to attract will have been raised on Google and will insist on 3D tech and beyond. “The kids who get Chromebooks in school now that enter medicine in 10 years will be more familiar with integration tools and will force administrators to adopt this technology because it’s all they will know what to work on,” says Mr. Soudegar.

He notes that while some health systems are receptive to new technologies and are early adopters, others are less willing to be pioneering in terms of clinical methods — unless the new product can help their companies improve financially. “Some health systems feel they already have the secret sauce with their methods, policies and procedures,” he explains. “New product manufacturers can’t simply make a pitch that surgeries will be made better. To get their would-be customers’ attention, they need to demonstrate that their product will reduce the time of procedures, which will allow them to add more procedures per day.”

The young residents who will be trained in imaging rooms with 3D at the major teaching hospitals will not only insist on that tech wherever they wind up attending, but might also need the system to be the same brand as the one they learned on.

As time goes on, 3D video will become the norm, price points will decrease, studies will be done, and, if the results of the research shows that outcomes are improved, patients will demand these products. “We’re almost at the point where if you’d hand a young laparoscopic surgeon a scalpel, they’d say, ‘Hey, where’s my robot?’” says Mr. Soudagar. “That’s the road we’re heading down with this as well. The new surgeons will drive the movement for systems with the many benefits of 3D visualization.” OSM