Integration of 3D imaging and optimized 3D robotic control set to be ‘important’ part of vascular surgery future

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Alan Lumsden

NEW YORK—The marriage of 3D imaging and robotics in hybrid operating suites promises to be a pivotal aspect of the future in vascular surgery—part of advances in the field that down the road will see surgeons look back on the static image era with a sense of puzzlement.

Those were among the sentiments delivered by Alan Lumsden, MD, the medical director of Houston Methodist DeBakey Heart & Vascular Center in Houston, during a presentation at VEITHsymposium in New York (Nov. 19–23, 2019) entitled, “Future advances in hybrid operating suites: What is on the horizon and beyond.”

“Robotics—we think—are going to be a very important part of this future,” he told delegates. “We are very excited that robotics [here at Houston Methodist], through the catheter platform, will start to be integrated into the imaging system.

“There is no point in having great 3D imaging if you don’t have great 3D control, or optimized 3D control if you don’t have 3D imaging. It’s the integration of these two things that are very important that you utilize,” he said, adding, “I think you’re going to see increasingly these remote control capabilities.”

Lumsden opened with what he called a significant disclosure, drawing attention to his institution’s imaging partner, Siemens, with which it formed a partnership to create its translational imaging research center, and Corindus Vascular, partner on its catheter robot.

Moving on to the subject at hand, he spoke of the importance to Houston Methodist of the capabilities these advances bring. “In an academic center like ours, it is important to be able to record, it’s important to be able to broadcast, and that’s something you need to consider at the time you’re actually planning these,” Lumsden explained.

Recalling his stint at Emory University Health Center in Atlanta, he described how proud he and the team there were of the operating room at that point in time.

But with the passage of time, the prospect of great leaps forward emerges. “What really formed vascular surgery was real-time angiographic imaging,” Lumsden went on. “With an operating room that allowed surgeons to get the imaging, the platform was formed for the next generation of advances.”

He advised his colleagues in the audience who may be starting to build such suites that planning for procedures now starts with pre-procedure acquisition of imaging, such as optimizing CT (computerized tomography) scans.

Lumsden went on: “Understanding how these images are acquired is going to be very important. Because no longer is it just the CT scan you look up on the wall and you figure out how you’re going to do an open aortic aneurysm. We are actively engaging and fusing these images. So if the preoperative imaging is not of a high quality, you can’t get these nice holograms that you’ve seen, and you can’t get optimal fusion.

“And so getting involved in optimizing the preoperative imaging is very important. And one of the things we’ve been very interested in is dynamic MR [magnetic resonance]. The idea that we take such a dynamic structure as the vascular system and use static images when we look at aortic dissection: We’ll look back on this and think that it’s crazy. We work on the most dynamic structures that exist in the cardiovascular system. I urge you to start pushing whoever is controlling the preoperative imaging into acquiring dynamic images.”

Before finishing, Lumsden spoke briefly of another development in the imaging arena arousing his team’s interest. “The other thing that’s happened in the imaging revolution that we’re really interested in is so- called cinematic rendering,” he said. “Forgive me for this but ultrasound, CT scans—they were designed basically to help magicians try to interpret them,” adding, “What’s happened now is you’ve started to create anatomical rendering of these images.”

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