In an exceptional example of the use of virtual reality (VR) coupled with a 3D-printed preoperative model, a surgical team from Israel has reported succes in a procedure removing part of a lung from a 7-year-old girl.
In this exclusive interview, 3DMedNet spoke to Ruth Shaylor from the Division of Anesthesia, Pain and Intensive Care at Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) about the details behind the case as well as what the team hopes to gain from the tandem use of virtual and physical 3D models for surgical planning.
I am a Cardiothoracic and Liver Transplant Anesthesiologist working in the Division of Anesthesia, Pain and Intensive Care at Tel Aviv Sourasky Medical Center in the cultural capital of Israel, Tel Aviv. While on fellowship in Australia I worked with an anesthesiologist who was setting up a 3D printing lab and was inspired to develop different ways to apply 3D printing in anesthesia education. I have had a long-standing interest in medical education and simulation starting from using bananas to teach epidural techniques to trainees. Outside of my clinical work I enjoy road cycling, diving and singing in my local choir.
Could you please tell us a little about the background for this case covered in the recent 3DMedNet news piece?
Recently my hospital’s thoracic surgery service has been expandng, providing the anesthesia team with almost weekly challenges. Whilst we have an experienced team, all of us are primarily adult anesthesiologists. We are experienced with conventional anesthesia in pediatric patients but had not performed one lung ventilation (where we only ventilate one lung whilst the surgeons operate on the other lung) in pediatric patients before.
Children between 7–10 years fall into a grey area. Below this age the commercially available equipment for one lung ventilation is too large for their anatomy. Above this age it will fit. But without testing on the patient, there is no way of knowing.
Obviously, trial and error on the patient during anesthesia is less than ideal, so we decided to build a model from the CT data instead.
What challenges did you face in preparing the patient in this case for surgery?
Our biggest challenge was timing. We knew this case was coming but did not know the exact day the surgery was scheduled for or specific patient details – including the CT scan data – until the Thursday before. The surgery was scheduled for Monday morning.
Fortunately, because we were handling a pediatric patient and the airways are quite small the modelling did not take very long, then our colleagues at Synergy3DMed (Netanya, Israel) pulled out all the stops to get it 3D printed over the weekend and back to us on time.
How did 3D printing and VR help to overcome these challenges?
The 3D-printed model revolutionized our airway plan. We knew exactly what equipment worked – and more importantly – what equipment did not. The virtual reality model helped us to familiarize ourselves with the distances and structures involved, which were smaller than we were used to.
Most importantly, instead of walking into the case with a lot of unknowns, we were much more relaxed and confident our plan would work.
How were the virtual and physical 3D models regarded by the wider surgical team?
Initially, I think they were a bit bemused. They were happy to indulge us but did not really understand why we needed it. Then they saw us working on the model trialing all the equipment and I think they finally understood the challenge facing us.
At the end of the day, the whole team were glad that the operation went smoothly and according to plan. The 3D model certainly played a part in that.
Following the success of this case, how do you envision the tandem use of 3D printing and VR being used for future surgical procedures?
We currently make 3D-printed models of all pediatric cases requiring one lung variation. Unlike the textbooks, we have found that the equipment we use is related more to the height and weight of the patient rather than their age. In every case it has been hugely important in forming our airway plan.
VR is used for adult patients’ procedures we expect to be difficult, whether it’s due to unusual anatomy on the CT scan or having a tracheostomy in place. We find that measurements taken off the VR simulations are much more accurate than those taken from the CT.
What’s next for you and your team? Do you have any other projects or uses for technologies such as these in mind for the future?
We are currently looking at additional ways to use 3D printing and VR in education. I have already built an epidural simulator in my kitchen (to the chagrin of my husband) which is made from a 3D-printed spine in a gel to simulate the soft tissues.
We are hoping to make VR bronchoscopy training routine for helping anesthesiologists who had completed their thoracic rotation maintain their skills as well as providing an immersive experience to trainees who are learning the skills.
Where do you see the use of 3D printing and/or VR in anesthesia in 5–10 years’ time?
We envisage that VR modeling will become routine for all thoracic patients. Even for those with relatively ‘normal’ anatomy, there are still individual variations that are important for the anesthesiologists to be aware of.
For those where the VR modeling shows it will be particularly challenging or for patients with a known difficult airway, we would then go on to print the model so we can practice with the equipment available prior to starting the case.
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The opinions expressed in this feature are those of the interviewee and do not necessarily reflect the views of 3DMedNet or Future Science Group.