Surgeons See into Their Patients

Hospital operating rooms already brim with high-tech scopes, imaging machines and monitors. But surgeons still must draw largely on their knowledge of anatomy and their wits once they make the first incision into a patient.

Now, a new three-dimensional imaging and navigation system is beginning to change that, giving surgeons almost Superman-like vision into the human body. The goal is to perform operations that are less invasive, safer and less painful for the patient, and that lead to a quicker recovery.

The imaging and navigation system from Palo Alto, CA-based Cbyon Inc. (sea-bee-on) helps physicians see internal organs, bones and vessels layer by layer, so they can locate and remove tumors more accurately or drill into spinal bone and repair it without damaging the nerve.

Looking Deeper

The 3-D surgery system, called the Cbyon Suite, includes a personal computer, a high-resolution flat panel display, an optical tracking device and sophisticated software that helps guide a physician through neurosurgery, biopsies or other procedures.

“Surgeons usually look at images in 2-D and then imagine them in 3-D, which leaves it to the surgeon’s knowledge of anatomy. Our system lets them see the anatomy in 3-D, giving the surgeon an extra level of confidence,” says Ramin Shahidi, chief technology officer and founder of Cbyon. Shahidi is on leave from Stanford University, where he developed the Cbyon technology.

The Cbyon system has so far been used for ear, nose and throat operations, as well as brain and spinal surgeries. In the future, the company hopes new technologies like 3-D ultrasound will make the system useful for soft tissue operations, such as heart or breast procedures.

Peeling Back the Layers

The Cbyon system creates a virtual 3-D model of a patient using data from magnetic resonance images, X-rays, ultrasounds and other types of scans. Doctors can peel through the data layer by layer, as if certain tissues in the body were transparent and others opaque.

In addition, physicians can pinpoint the location of their surgical tools-in relation to a tumor, for example-by means of an attached infrared diode that’s tracked by two infrared cameras in the operating room. The precise location of the tool in the body is followed in real time and displayed in 3-D. This instrument-tracking capability is accurate to 1.5 millimeters at best, and 6 millimeters at worst, says Shahidi.

Previous medical imaging systems enabled a kind of surface imaging that was equivalent to visualizing the outside rind on a melon, comments Dr. J. Patrick Johnson, a neurosurgeon who is director of the Cedars-Sinai Institute for Spinal Disorders in Los Angeles.

The Cbyon system goes a step further, showing 3-D structures inside the melon. “This helps us see beyond the surface of the operation,” says Johnson. “We usually don’t know whether we are one millimeter or one centimeter away from the spinal cord when we are using a high-speed drill running at 20,000 revolutions per minute. So there’s a risk of paralyzing someone. The Cbyon system helps us see exactly where we are.”

Johnson recently used the Cbyon system to perform a thoracoscopic discectomy on a professional golfer in his mid-20s. The procedure aims to relieve pressure on the spinal cord by removing part of a damaged spinal disc through a small incision in the patient’s chest. Johnson said he was able to make a smaller-than-usual incision and remove less tissue because he could see exactly what he was doing.

“We didn’t have to do a major reconstruction of the spine,” he says, adding that the patient recovered quickly from the procedure.

Johnson has performed about 10 procedures with the Cbyon system so far. While it hasn’t yet saved him a lot of operating time, “it does increase accuracy, information and safety during the operation,” he says.

Pushing the Limits

Furthermore, the Cbyon system is inspiring Johnson and other doctors to consider procedures they were previously unable to perform because of inadequate guidance technology.

Dr. William Louden, a pediatric neurosurgeon at Children’s Hospital of Orange County in California, which recently acquired a Cbyon system, says he wouldn’t have performed a recent operation without an image-guided surgical system.

Louden operated on a 10-year-old boy with a brain tumor that caused awkward movements on the right side of his body. “I’m impressed with the accuracy,” says Louden. He also was heartened by the patient’s quick recovery. On his first post-surgical visit, the boy could write his name clearly.

“This isn’t future technology,” Louden says of computer-guided medical imaging. “It’s available now and should be a standard of care.”