Have you ever gotten lost while travelling? In the old days, people had to carry paper maps in their cars to help with navigation on long trips to unknown locations. Today, GPS technology can guide us anywhere we want to go. This once new technology is becoming increasingly common. In addition to being a standard feature in most new car models, GPS can also be found on smart phones and smart watches.
Now there is GPS-like technology in surgery. Let me introduce you!
Providing the safest and most accurate surgery with the least amount of pain has always been a challenge. To help with this, surgical navigation systems are now used to assist surgeons. For example, in brain tumor surgery, a computerized navigation system allows a surgeon to locate and remove the tumor with a higher degree of accuracy and safety.
As with most new technologies, surgical navigation systems were cumbersome during their developmental stage. Subsequent advances in computer and medical imaging technology resulted in surgical navigation systems becoming not only easier to use, but also more precise. Today, the systems have a 90% accuracy rate.
What are the advantages of using a navigation system in spine surgery? In spine surgery, metal plates, rods, or screws are used to stabilize the spinal bones. In principle, the largest possible screw must be placed to create the strongest attachment. Any misplacement of the screw can injure the nerve. In addition, ensuring the screw is inserted at just the right angle can prevent the screw from becoming loose. When comparing the left (green screw) and right (red screw) illustrations, it is evident that it is more difficult for the green screw to be loosened.
The illustration on the left is a view from the top at the time of surgery. The cross-sectional views (above) enable the surgeon to have a better view when placing the screw in the cylinder-shaped bone. Without the assistance of a navigation system, the surgery relied solely on the surgeon’s skill and experience of anatomical structure, in precisely placing the screw.
With the latest advances in technology, the navigator enables the surgeon to visualize a 3-dimensional image of the operative region (as shown below). This allows the surgeon to use the largest possible screw, and choose the best angle of entry for the strongest attachment.
The main advantage of using the navigator is that it eliminates the need for a large incision. An incision of only 1-2 cm is required in order to insert the screw. The surgery is performed in a small tunnel with a microscope. The smaller incision results in less pain after surgery, faster recovery, and a shorter hospitalization period.
Comparison between a midline back scar and small incision
The only downside of the navigator system is more radiation exposure, compared to traditional surgery. However, the level of exposure is slightly less than from a CT scan, which is a commonly used medical investigation technique.
Advances in technology have already changed many surgical procedures by increasing safety and resulting in a faster recovery. However, technology is constantly advancing and surgery is expected to change dramatically within the next ten years. In the next issue, we will talk about the future of surgical technology that is currently being developed by researchers.
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Authors: Dr. Withawin Kesornsak and Dr. Verapan Kuansongtham - Spine Surgeons at Bumrungrad’s Spine Institute.
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