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.

For Residents

“The SRP was used to rehearse and to obtain the proper orientation and approach for optimal visualization of the aneurysm, including the bilateral superior cerebellar and posterior cerebral arteries. Additionally rehearsal facilitated selection and placement of the ideal permanent clip.  Given the patient’s anatomy and projection of the aneurysm, the 3D rehearsal enabled the team to visualize the aneurysm via the view from the surgeon’s perspective and from the reverse position to better appreciate the positioning of the distal vessels and their relationship to the clip tines. “

“When the clip was applied to the ruptured aneurysm during surgery, we used the exact clip that was pre-selected with the SRP and I successfully placed the clip with a single attempt. The “mental picture” and “muscle memory” gained from the brief SRP rehearsal allowed for safe and effective clip placement without need for further adjustment.

~  Justin Singer M.D. (PGY5), Department of Neurosurgery, University Hospitals Case Medical Center

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“The SRP allowed the resident who participated in the surgery to rehearse obtaining the proper orientation and approach for optimal visualization of the aneurysm and proximal M1 and M2 branches to facilitate application of the temporary clip, and selection and placement of the ideal permanent clip.  All of those actions were done on the SRP (Figure 1 & 2 –SRP snapshots) before proceeding with the actual dissection of the Sylvian fissure, allowing the resident to have a ‘mental picture’ of what would be seen in the microscope as the dissection proceeded.   Furthermore, this case demonstrates how the SRP can facilitate an extensive patient specific “hands on” experience for residents, in a “safe environment” outside of the actual operating room.”

“This case highlights the benefits of SRP in allowing for optimal clipping of cerebral aneurysms, even in an emergent setting. The segmentation capabilities and detailed insight 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, 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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Aside from its potential direct impacts on patient care, the rehearsal platform is an invaluable tool for training, senior neurosurgery resident,” Dr. Justin Singer said.

“For a younger generation of surgeons training, there are so many constraints on the number of hours that we’re allowed to train in the hospital,” he said, referring to recent rules limiting the number of hours interns and residents can spend working consecutively. “Any tool that we have at our disposal to enhance our perception and visualization ahead of time, so that when we get in the operating room we can say ‘I’ve seen this before’ is a degree of comfort that we’ve not had before. It’s a very powerful tool for the future.”

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For Patients

“Surgery is a frightening prospect for a patient. The risks can be high, but so can the dangers of not operating. What if you knew the surgeon had had an opportunity to practice the surgery you needed, on a model based on your own anatomy?

That is the concept behind Surgical Theater’s Surgical Rehearsal Platform (SRP), an FDA-approved, patented surgery simulator. Says Moty Avisar, president and co-founder of Surgical Theater, “We used to develop flight simulation for the Israeli Air Force, and felt that we needed to transfer our knowledge of building F-16 simulations to doing good for others by curing and saving lives.”

Israel News

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“The public trust is that I am competent to do this surgery,” said Dr. Warren Selman, Neurosurgeon-in-Chief of University Hospitals.  “Well yes, I’m competent, but you want somebody more than competent. You want someone who is the best there can be. This allows an experienced surgeon to achieve those improved outcomes. It just makes sense.”

“How are you going to train and keep up your skills and make sure you’re at the top of your game on these cases,” Selman asked. “This is the ideal way to do that, because you are going to need surgeons who are capable of doing open surgery, and they should have a rehearsal navigation platform just as the endovascular surgeons do.”

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“We are excited to partner with Surgical Theater to bring their Surgery Rehearsal Platform to our institution,” said John G. Golfinos, MD, chair of the Department of Neurosurgery at NYU Langone Medical Center and associate professor of neurosurgery at NYU School of Medicine. “The reaction of tissue in these 3D images is incredibly life-like and modeling of surgical tools is equally impressive. The SRP also will enhance the training of medical students, residents and fellows and help them hone their skills in new and more meaningful ways.”

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“Neurosurgery today is one of the most technologically involved surgical specialties with many contributions from computer-based neuronavigational technology.”

American College of Surgeons:
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“If medicine is to achieve major gains in quality, it must be transformed, and information technology will play a key part…Multiple studies now demonstrate that computer-based decision support can improve physicians’ performance and, in some instances, patient outcomes.”

The New England Journal of Medicine, Improving Safety with Information Technology:

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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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“Surgical Theater’s Surgical Rehearsal Platform (SRP) allows surgeons to rehearse for optimal clipping of ruptured cerebral aneurysms, even in an emergent setting.  The segmentation capabilities and detailed insight obtained with the patient-specific, interactive 3D model makes the SRP a valuable tool for pre-surgical planning and preparation. “ ~  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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“The SRP is going to be the best way for a surgeon to master one of the most complicated surgical tasks.  Using standard scanned images from any patient, the SRP generates 3D patient specific and accurate models of interactions between life-like tissue and surgical instruments. The tissue responds “realistically” to actions taken by the surgeon, thus allowing accurate pre-surgery planning and rehearsal. The unique software utilizes flight simulator technology to permit remote connection of multiple SRPs; participants anywhere in the world can work together simultaneously and practice the same case with real-time feedback and collaborate on the planning of a specific surgery case.” ~ Dr. Sagi Harnof, Chief, Vascular Service and Deputy Chairman, Department of Neurosurgery at Sheba Medical Center, Israel

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Please contact us to find out which hospitals is your area are using the Surgical Rehearsal Platform.

Surgical Theater’s Surgical Rehearsal Platform in the CNN Spotlight.

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