For Surgeons

“Case Medical Center is using the Surgical Rehearsal Platform (SRP) for preparation for intracranial procedures, including aneurysm clipping. Before this case, we had used the SRP only for elective procedures, and had not used it for emergency procedures or ruptured cerebral aneurysm.  This case highlights the benefits of SRP in allowing for optimal clipping of ruptured cerebral aneurysms, even in an emergent setting. The segmentation capabilities and detail obtained with the patient-specific, interactive 3D model makes the SRP a valuable tool for pre-surgical planning and preparation”

“Furthermore, this case demonstrates how the SRP can facilitate an extensive patient specific “hands on” experience for residents, providing a ‘virtual OR experience’, in a “safe environment” outside of the actual operating room.”

~  Warren R. Selman, Harvey Huntington Brown Jr., Professor & Chairman Department of Neurological Surgery Neurosurgeon-in-Chief, University Hospitals Director, UH Neurological Institute

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“At Mount Sinai we’re committed to using the most advanced technology, science and engineering for the benefit of our patients. Using tools like the Surgical Rehearsal Platform in our patient care helps us keep that commitment.”

“We anticipate using this technology will support our mission to provide outstanding quality of care to our patients and will provide long-term risk reduction and efficiency improvement, both key in helping hospitals provide high quality and cost-effective care.”

~ Dr. Joshua B. Bederson, Professor and Chair, Department of Neurosurgery at The Mount Sinai Hospital.

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“Most of my friends if we have a big case coming up the next day at night you sort of can’t sleep because you’re putting together exactly what move you’re going to make and what it’s going to look like,” Selman said. “But wouldn’t it be nice if you could actually do that on a computer screen? That’s what’s really unique about this.”

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Acquisition Justification

Surgical Theater’s Surgery Rehearsal Platform (SRP) provides institutions and their respective surgeons with the opportunity to reduce surgical errors, decrease the amount of surgical waste and related costs, and minimize the high risk nature of the procedures.  How do we do this? The SRP platform allows our surgeons to gain currently unobtainable insights before surgery, in a manner that refines perioperative performance.

  • Reduce Errors: A U.S. Army Medical Research, Telemedicine and Advanced Technology Research Center (TATRC) study, compared surgeons’ performance when they utilized general virtual reality (VR) simulation for their training versus standard training[i]. This study demonstrated that the “virtual reality” training group made six times fewer, objectively assessed, intra-operative errors than the standard training group.
  • Decrease Surgical Waste: Additional cost reduction opportunity, specific to cerebral clipping surgery: During the clipping process, a surgeon may try and evaluate the use of multiple clips in order to match the most suitable clip for the specific case. Once a clip is placed inside a patient, it cannot be reused in another case. Given that the average cost of each clip is approximately $500, the economic impact of knowing which clip to use beforehand, can be substantial.
  • Reduce OR Time: Furthermore, the above TATRAC study found that the “virtual reality” group performed procedures 30% faster. VR simulators have also been adapted for preoperative warm-up immediately before a procedure. Kahol and colleagues have demonstrated, in the laboratory, a decrease in operating time and errors by warming up for 15 minutes before performing a procedure. This is an example of a priori knowledge that has been implemented in many other professions (symphony, baseball, basketball, dance, etc), and demonstrates how warming up before a demanding activity can dramatically enhance performance. This improvement effect persists for about 30 minutes, and enhances performance of novices and experts alike [ii]
  • Surgical Rehearsal Platform provides for an opportunity to maintain high quality in neurosurgery training, and for taking the Education outside of the OR: Halstedian training for surgery skills depends on a large volume, a wide variety of cases, and almost endless resident’s time in the hospital[iii]. Recent developments have forced a rethinking of the Halstedian system. The recent constellation of pressures on Halstedian system includes; restricted work hours, increased public scrutiny, and reduction in operative experience[iv].
  • Reduce Procedure Risk: Rehearsal can reduce the need for adjusting or replacing a clip.  Adjustments and replacement of the clip can typically result in extended temporary occlusion and overall longer procedure time.  This may increase overall procedure risk.
  • Impact Malpractice Insurance: Doctors and hospitals see a reduction in malpractice insurance premiums[v]; “Information provided in June 2010 indicates that CRICO/RMF (the patient safety and medical malpractice company owned by and serving Harvard-affiliated health care organizations) offers a 10 percent premium discount to each insured physician and nurse midwife who completes the program.”

[i] Importance of Validation in Simulation. Anthony Gallagher, PhD, Emory University School of Medicine, Presented at: Telemedicine and Advanced Technology Research Center (TATRC), U.S. Army Medical Research and Materiel Command July 30 2004.
[ii] Kahol K, Satava RM, Ferrara J, et al. J Am CollSurg 2009;208(2):255–68
[iii] Andreas H. Meier, MD: SurgClin N Am 90 (2010) 491–504
[iv] Andreas H. Meier, MD: SurgClin N Am 90 (2010) 491–504
[v] AHRQ Healthcare Innovations Exchange. Accessed at: http://innovations.ahrq.gov/content.aspx?id=265.

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