At the Intersection of Science, Health Care, and Technology: The Center for Surgical Innovation at Dartmouth-Hitchcock
LEBANON, N.H., Dec. 1, 2014 /PRNewswire/ -- In many ways, Amanda Shadowens is a typical teenager: hanging out with friends, attending school dances, playing her trumpet. But Amanda also suffers from chondrodysplasia punctata: a rare form of dwarfism that impacts the curvature of Amanda's spine and can cause a dangerous compression of her spinal cord. Amanda was forced to wear a collar to keep her neck straight, to prevent that compression. But a revolutionary surgery at Dartmouth-Hitchcock promises to change Amanda's life, allowing her to be an even more normal teenager.
On August 7, Amanda underwent a complex fusion of the upper cervical spine through the mid-thoracic spine. The surgery took place in the Center for Surgical Innovation (CSI) at Dartmouth-Hitchcock, a new, state-of-the-art facility at the intersection of science, health care and technology.
Pediatric Neurosurgeon Dr. David F. Bauer of the Children's Hospital at Dartmouth-Hitchcock performed Amanda's 20-hour surgery, assisted by a team of more than a dozen doctors, nurses, aids and engineers in a procedure involving a variety of fixation devices, screws, and rods to hold Amanda's spine together in the most-secure, safest manner. As Amanda recovers, four months after the surgery, the results are promising.
(VIDEO – Watch Amanda's story: Part One | Part Two | Part Three)
"Our goal is for Amanda to have full activity, without any restrictions, and do the things we want children to do," says Dr. Sohail K. Mirza, Medical Director of CSI and Chair of Orthopaedics at Dartmouth-Hitchcock, and who assisted on Amanda's surgery, "which is to run around and play without worrying about damaging her neck or spinal cord."
In the beginning: a dream
CSI combines, in one facility, interoperative imaging capabilities that give surgeons unprecedented ability to see, in real time, the tissue and organs involved in procedures. Designed and built by the Minnesota-based technology firm IMRIS, the CSI configuration combines computed-tomography (CT), magnetic resonance imaging (MRI) and traditional fluoroscopy (x-ray) technology, and, according to IMRIS, is the only hybrid operating suite in the world where both CT and MRI can scan a patient on the OR table with either or both modalities – without moving the patient. The advantages in operating efficiency and patient safety are immense, says Mirza.
"CSI began as an idea – a dream, really – about a facility that could dramatically accelerate and improve surgery. CSI allows us to perform procedures in ways that are significantly better than conventional surgery. We're looking very carefully at how the technology we use and the procedures we develop will improve the lives of patients."
In 2010, the National Institutes of Health awarded a $9.3 million grant to support development of the $19 million CSI. The project leverages the research strengths and interests of Dartmouth-Hitchcock and Dartmouth College, including the Geisel School of Medicine and Thayer School of Engineering, in a multi-disciplinary approach to advancing population health. Construction began in June, 2011; the first surgeries in CSI were neurosurgery procedures performed by Dartmouth-Hitchcock Chief of Neurosurgery Dr. David Roberts in the spring of 2014.
(VIDEO – Improving brain cancer treatment with fluorescence-guided surgery)
"We offer services for very complex, high-risk cases like pediatric spine surgery, like Amanda's, as well as certain types of brain tumor surgery and spine cancer surgery, that we wouldn't be able to offer without the technology in the CSI," says Mirza, who is also a professor of orthopedic surgery at Geisel. "This will allow us to directly contribute to improving the health of local patients and the population we serve in Northern New England."
Seeing below the surface
Surgeons are too often limited by what they cannot see, including anatomy that is difficult to reach or medical conditions that are not visible to the naked eye. "While advances in imaging such as real-time x-rays during surgery and MRI and CT scans prior to surgery have helped to advance many surgical procedures, further innovation is needed," Mirza explains. "An example would be the fractures of the second vertebrae in older adults, where a millimeter too long or too much to one side can mean catastrophe if a blood vessel is injured. But with 3D imaging during procedures and things like robotic surgery, we'll be able to be much more precise and overcome a lot of human limitations."
CSI enhances Dartmouth-Hitchcock's nationally-recognized research programs in neurosurgery and orthopedic surgery; leverages research in neuro-imaging and breast imaging to spawn innovative new programs in interventional psycho-therapeutics and intraoperative biomarkers for surgical resection guidance; and augments emerging research programs in prostate surgery, intraoperative oximetry imaging, and in vivo optical microscopy. CSI offers advanced imaging, image-guidance and data collection tools, which will be used to substantiate and/or validate medical discoveries, clinical hypotheses and procedural innovations.
"CSI consists of two operating rooms and two procedure rooms in a long, linear set of suites that will provide intraoperative CT and MRI scanning," explains Keith Paulsen, PhD, the Robert A. Pritzker Professor of Biomedical Engineering at Thayer School of Engineering and CSI Scientific Director. "The scanners are mounted on ceiling rails, allowing them to move in and out of the ORs. The MRI can go into either OR and the CT can go into one of the ORs, which we call OR 2. That makes OR 2 the only operating room in the world at this time that has both MRI and CT scanning."
Translating theory into practice
While other institutions have advanced surgical facilities, those spaces are usually reserved for a particular subspecialty area such as neurosurgery or cardiology. CSI is open to all disciplines. Dozens of research projects, led by Geisel and Dartmouth engineering faculty, are being planned and will include the fields of orthopaedics, neurosurgery, oncology, psychiatry, solid organ transplantation, and biomedical imaging.
"Translational research is essential to developing new clinical technologies and procedures as well as for evaluating clinical outcomes," says Paulsen, one of the recipients of the original NIH grant and whose research interests include medical imaging methodology and cancer therapeutics. "Yet, it has become increasingly difficult to conduct in the current health-care environment because it is highly disruptive to clinical workflow. CSI addresses a growing clinical need for additional surgical and imaging capability, creating more efficient and effective patient care."
"We anticipate immediate clinical benefit, as imaging modalities are used during the course of orthopaedic or neurosurgical procedures to assess the successful completion of the procedure," says Mirza. "In addition, we anticipate significant funded research opportunities, both for current faculty as well as for potential future faculty."
ABOUT DARTMOUTH-HITCHCOCK – Dartmouth-Hitchcock (D-H) is a nonprofit academic health system that serves a patient population of 1.2 million in New England. Anchored by Dartmouth-Hitchcock Medical Center in Lebanon, NH, the system includes the Norris Cotton Cancer Center, one of only 41 Comprehensive Cancer Centers in the nation; the Children's Hospital at Dartmouth-Hitchcock; affiliate hospitals in New London, NH, and Windsor, VT; and 24 Dartmouth-Hitchcock Clinics that provide ambulatory services across New Hampshire and Vermont. D-H provides access to more than 1,000 primary care doctors and specialists in almost every area of medicine. In partnership with the Audrey and Theodor Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT, it trains nearly 400 residents and fellows annually, and performs world-class research.
ABOUT GEISEL SCHOOL OF MEDICINE: Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, health care policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America's leading medical schools, Dartmouth's Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in health care.
ABOUT THAYER SCHOOL OF ENGINEERING: One of the oldest professional schools of engineering in the country, Dartmouth's Thayer School of Engineering features a single unified department of engineering sciences that fosters cross-disciplinary innovation in research and teaching. Graduate programs include the Master of Engineering Management (M.E.M.), M.S., Ph.D., dual degrees with Dartmouth Medical School, and the nation's first Ph.D. Innovation Program. Dartmouth undergraduates study engineering as part of a liberal arts education leading to the Bachelor of Arts degree; most majors take additional courses leading to the professional Bachelor of Engineering degree.
Video - http://youtu.be/qyt8KL1P-c0
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SOURCE Dartmouth-Hitchcock
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http://www.dartmouth-hitchcock.org
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