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A new surgical robot is making medical undergraduates three
times more accurate during practice hip operations, according to
pilot study to be discussed at a conference this week (8 February
2008).
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Delegates at the British Society for
Computer Aided Orthopaedic Surgery
Conference will hear that results from a
pilot study saw graduates 95 per cent more
confident using this robotic technique than
when using conventional surgical methods in
training.
Professor Justin Cobb, Head of the
Biosurgery and Surgical Technology Group at
Imperial College London, conducted the trial
on 32 undergraduate medical students at
Imperial College London from December 2006
to December 2007. The pilot study tested
whether planning before an operation,
combined with the latest robotic navigation
equipment could increase the success rates
of students practising hip resurfacing
arthroplasty procedures – a method for
correcting painful hip bone deformities by
coating the femoral head with a cast of
chrome alloy.
Up to 5,000 hip resurfacing operations
happen each year. These operations are
technically demanding and require precision
and accuracy. Surgeons rely on years of
experience and on different cameras, lasers
and hand held tools to help them navigate
during an operation.
Inexperienced surgeons often face a steep
learning curve to gain the experience
necessary to carry out hip resurfacing
operations. Until now, this has only been
gained through repeatedly performing the
operations. This can cause problems because
if hip bones are repaired incorrectly wear
and tear occurs, requiring patients to
undergo further painful and expensive
corrective operations. Imperial researchers
believe their method will address the issue
at the undergraduate level.
Third year medical undergraduates were
asked to trial a state-of-the-art robot
called the Navigation Wayfinder - a new
navigation tool never before used in the UK.
The Wayfinder is similar to a GPS
tracking system. It helps the user to
navigate during surgery by plotting correct
surgical incisions. It also calculates the
correct angles for inserting chrome alloy
parts needed to repair hip bones.
It has twin digital arms protruding from
a console. One senses the movement of
surgical tools as they slice through a
patient’s hip area. The other takes detailed
images of the bones. This information is fed
into software which generates a virtual
model of a patient’s hip as it is being
operated on. Similar to a 3D roadmap, it
allows the user to plot the progress of an
operation as they are performing it – a
vital technique for ensuring that it is
being carried out correctly.
Professor Cobb saw the benefits of
incorporating the Wayfinder into
undergraduate training and developed a three
step training programme.
Students used model replicas of deformed
hip bones for the trial, scanned by the
Wayfinder’s digital arm. This information
was used to create a 3D virtual model of the
bone area.
The Wayfinder’s computer programme
developed an operation plan setting out the
actions required for undergraduates to
correct the hip deformity.
Students were asked to carry out a
virtual operation on the 3D model of the
hip. Using the tool tracking arm, they
practised techniques for fastening chrome
alloy on virtual deformed hip bones. This
built up their confidence, technique and
skill.
They were asked to perform surgery on
model casts of real hip bones. By using the
Wayfinder to help them navigate,
undergraduates were able to attach a post to
the centre of the femoral head and thread
it, via a guide wire, to the femur.
Professor Cobb then asked students to
perform the same operation using
conventional navigation tools. One method
involved the use of jigs and alignments.
Similar to geometry sets, they are metal
surgical guides which helped undergraduates
to manually align the femoral head as they
attached it to the femur.
The second method required students to
operate using an optical navigation device.
A camera and pinpoint lights were used to
create an image of the hip on a computer
screen. This was used by undergraduates for
visual navigation during the procedure.
Professor Cobb compared how
undergraduates performed with each different
method. He found that they were three times
more accurate and precise using the
Wayfinder than if they used the two other
conventional methods.
Clinical trials using the Wayfinder are
currently being carried out at Warwick
Hospital, Bath Hospital, Truro Hospital and
the London Clinic. Professor Cobb believes
his training method could be applied
throughout the UK to improve outcomes for
patients. He said:
“Our research proves that we can take
untrained surgeons and make them an expert
in a new technique rapidly. More
importantly, we’ve also demonstrated that no
patient has to be on an inexperienced
surgeon’s learning curve. This could
significantly improve a patient’s health and
wellbeing and ensure they do not have to
undergo repeat operations.”
The British Society for Computer Aided
Orthopaedic Surgery Conference will be held
at the Beardmore Conference Centre, Glasgow,
from 7th to 9th February 2008. For further
conference details go to:
http://www.caosuk.org/.
Notes to editors:
1. About Imperial College London
Imperial College London - rated the
world’s fifth best university in the 2007
Times Higher Education Supplement University
Rankings - is a science-based institution
with a reputation for excellence in teaching
and research that attracts 12,000 students
and 6,000 staff of the highest international
quality.
Innovative research at the College
explores the interface between science,
medicine, engineering and business,
delivering practical solutions that improve
quality of life and the environment -
underpinned by a dynamic enterprise culture.
Website:
www.imperial.ac.uk
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