Vacit Arat, the CEO of LA-based Vantage Surgical Systems, presents the work and future vision for AR in live surgery. Vantage Surgical Systems is a medical technology company commercializing novel surgical visualization techniques in collaboration with Total Immersion. Its mission is to improve patient outcomes through superior visualization during live surgery, which is achieved by overlaying and tracking diagnostic data over the live surgical field of a surgeon. Vantage termed this technology Computed Surgical Visualization (CSV™). Vantage believes CSV will be applied in the future to all types of surgery conducted using endoscopes or visual aids such as microscopes.
CSV aims to eliminate surgeons’ cognitive memory load. Currently, surgeons study and analyze diagnostic images prior to surgery, mentally create a plan of action, commit everything to memory, and then translate them into action in the OR while reconstructing everything from memory in 3D and real-time. Surgeons may also bring their diagnostic images into the OR such that they can refer to them during surgery, but only by having to looking away from the surgical area from time to time. CSV will greatly relieve the surgeons from this burden and by accurately overlaying such diagnostic images over a live, moving camera feed, effectively allowing them to “see through organs” while performing the surgery.
There is currently a strong wave of conservatism at the FDA where decision makers are more risk-averse than ever in adopting new technologies. Arat opines that “the pendulum is on the wrong side, and it may stay there for a while before it comes back.” He projects that, depending on the application, many CSV techniques may take 5-20 years to bring to market, considering that the more-stringent FDA regulations may require lengthy clinical trials before any commercialization can begin.
Opportunities in Ophthalmology
One of the most promising areas of adoption is in ophthalmology. It involves a microscope as surgeon’s visual aid which is where the previously acquired images such as x-rays (florescein angiograms) can be inserted into the view of the surgeon. Currently during eye surgery, while the eye is continuously moving, surgeons must manually aim lasers, leaving a lot of room for inaccurate executions. Arat demonstrated a simulation of an automated retinal laser surgery procedure which eliminates human error in targeting while greatly accelerating the time it takes to perform the surgery. The UI of the system displays 3 visual layers: real time footage, an x-ray overlay, and an OCT-image overlay. The UI shows the several steps in the process. First the surgeon completes the planning segment by selecting multiple target points for the laser. The system tracks movement of the eye to maintain accurate location of target points in real time. In the treatment step, the surgeon simply presses “run” and the laser automatically hits the target points in a quick sequence. Finally the UI generates a report while keeping a digital record of the treatment for future reference.
Arat believes that an Ophthalmology AR System could be in the market in 1-2 years in contract to the other applications in surgery. Although it will be years, even decades until full-scale adoption of CSV systems, he believes that Vantage Surgical Systems is at the forefront of an AR revolution in medical technologies.