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Cool New 3-D Computer Game? STORY BY

Darla Brown

What started off as a group of doctors “playing” with animation software has resulted in a 3-D virtual reality surgical planning software, and it’s opening the door to the operating room of the future.

Through the creation of this software, surgeons at the University of Texas Health Science Center at Houston can now perform certain surgeries completely within the computer, planning for the optimum surgical outcome.

Drs. James Xia and Jaime Gateno, both assistant professors in oral and maxillofacial surgery, together with Dr. John Teichgraeber, professor of pediatric surgery at the UT Medical School and Dental Branch are using the software they developed to plan out complex craniofacial surgeries that require distractors – devices implanted under the skin to restructure the face and grow bone.

The Turn of the Screw

When the distractor is installed on bone and buried underneath the skin, there is a pin accessible to surgeons, which they turn very slightly to separate the bones. This procedure results in new bone growth to fill the gap. Distractors are used in patients with cleft lip and palate, deformities that result from certain syndromes, severe small upper and lower jaws, and trauma to the face.

Through the creation of this software, surgeons at the University of Texas Health Science Center at Houston can now perform certain surgeries completely within the computer, planning for the optimum surgical outcome. “In the old days, you would make cuts in the bone, push the bones forward, wire the teeth together and insert bone grafts taken from other parts of the body into the gaps you created,” Teichgraeber explains. “It was a big surgery and sometimes it worked, sometimes it didn’t.

Currently, the UT physicians are the only ones in the city using the distractors and virtual surgical planning together.

“We use the computer simulation to determine how much to turn the distractors. The exact location and results desired by the distractors are mapped out prior to the surgery through the virtual reality surgical planning,” Teichgraeber explains, adding that he has 4-6 pediatric patients a year who require this type of treatment.

The physicians also are working on designing an absorbable distractor that only would require that the pin be removed.

The distractors replace the “halo,” a rigid external distractor that children find difficult to move, sleep, and play in. “The internal devices have fewer psychological effects on the patients than the external devices, and the results are more predictable using the computer planning,” Gateno said.

“Measure Twice, Cut Once”

Virtual surgical planning is an elaborately orchestrated rehearsal. After importing a CT scan of the patient’s face into the software, the doctors create a 3-D color model of the face. “We then perform a virtual surgery, calculating the movement necessary for the actual surgery. We can cut the bone in the computer and predict and plan outcomes,” Xia says.

“Even if I could simulate the surgery on the model, it doesn’t translate to the operating room as software does,” Gateno said.

Planning a surgery in 3-D using the virtual reality software allows the surgeons to achieve the most accurate and best results on even the most difficult of procedures before the surgery ever begins.

“In the past, we used X-rays to simulate the operation, but, deformities are in three dimensions, so a flat X-ray is inadequate,” Gateno says.

From the Laptop to the OR

Using the computer software also moves surgeons away from expensive plastic models, which are made for each patient to help in surgical planning. However, these models cannot be cut and re-cut, like the computer model, and they don’t account for any soft tissue – just bone. “Even if I could simulate the surgery on the model, it doesn’t translate to the operating room like this software does,” Gateno says.

Xia developed a computer-assisted surgery simulation system in Hong Kong, which was released for orthognathic surgery in 2000, and he has built upon this work, adding the ability to transfer the computerized plan to the operating room since coming to the UT Medical School at Houston.

Downloading Success

“In the surgery of the future, we’ll spend most of the time planning before the surgery in front of a computer, and the operation will take a shorter amount of time, be simpler, and have better results,” Gateno says. “We will be able to do things we couldn’t have dared do before because there was no road map.”

“It’s like a pilot with a flight simulator – I can see ahead of time what I am going to find and what to expect during each surgery. It makes the case smoother,” Gateno adds.

Last Updated: 7-17-2003