What is virtual surgical planning in Orthopedics for PSIs?

Virtual Surgical Planning involves using medical images, like X-rays or CT scans, to generate digital 3D anatomic models. The technology is also used to generate implants and surgical guides and help size and place them accurately on a patient’s anatomy for a better fit.

Virtual surgical planning is also known as preoperative planning for 3D printed implants and surgical solutions. 3D printed solutions are also known as patient specific solutions or personalized solutions.

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What is the Virtual Surgical Planning process?

Virtual Surgical Planning (VSP) in Orthopedics refers to the use of virtual tools and three-dimensional (3D) imaging technology to plan and simulate surgical procedures before they are performed. 

This approach allows orthopedic surgeons and medical device companies to create detailed preoperative plans that are unique to the anatomy of each patient. This is particularly relevant in the context of patient-specific implants, where the goal is to create personalized implants tailor-made to fit the specific anatomy of each individual patient.

The process typically involves the following steps:

Medical imaging

VSP starts with the upload of high-resolution medical imaging, like X-rays, CT scans, or MRI scans. These images provide information about the patient’s anatomy in 2D.

Image segmentation

Surgical planning technology slices the 2D medical scans and isolates relevant anatomical structures from the images. This process is called segmentation, and it involves identifying and delineating bones, joints, and other anatomical features necessary for the surgical planning process.

While in the past, this process took time and manual resources, we now have artificial intelligence or AI-driven segmentation that is faster and more efficient.

Creating 3D models

After segmentation, the 3D modeling software generates detailed 3D anatomic models based on segmented images. Depending on the technology, this process can be fully automated or partially automated.

These 3D models represent the patient’s anatomy in a digital format and serve as the foundation for the virtual surgical planning process.

Custom-fit 3D implants or instruments

Once the patient's anatomy is available in 3D, medical device companies can find the best-fit solution for implants and surgical instruments. 

Surgeon review and approval

The 3D models are shared with the operating surgeon and their surgical team for review and approval. At this stage, surgeons can request changes, including the angle of placement, fit, size of implant or guide, or other.

Surgeons can also use the 3D anatomic model to discuss surgical approaches or other preparatory steps with their teams ahead of the surgery.

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What happens after Virtual Surgical Planning?

After virtual surgical planning is finalized, the digital files for each case are sent for 3D printing to an additive manufacturer to create 3D printed implants or surgical solutions. Once they are produced, they are sterilized, packaged, and shipped for surgery.  

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Integration with Robotic-Assisted Surgery

Virtual Surgical Planning can also play a pivotal role in enhancing the capabilities of robotic-assisted surgery in orthopedics. By leveraging the detailed 3D models and plans generated during the VSP process, robotic systems can execute surgical procedures with unprecedented precision and consistency.

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How Virtual Surgical Planning Enhances Robotic Surgery

Precision in Execution

The detailed 3D models and surgical plans created through VSP allow robotic systems to understand the patient’s unique anatomy intricately. This understanding enables robots to perform precise cuts and placements that would be challenging even for highly skilled surgeons.

Customization of Surgical Robots

VSP data can be used to program surgical robots for each specific operation, tailoring their movements to the individual's anatomy and the surgical plan. This customization ensures that patient-specific implants are positioned with optimal alignment and fit, minimizing the risk of post-surgical complications.

Reduced Operative Time and Improved Outcomes

By integrating VSP with robotic-assisted surgery, the overall time spent in surgery can be significantly reduced. This efficiency not only benefits the patient by reducing their time under anesthesia but also improves surgical outcomes by minimizing tissue trauma and potential for human error.

Enhanced Surgical Collaboration

VSP enables surgeons to plan and simulate the surgery in a virtual environment and then execute that plan with the help of robotic assistance. This collaboration between human expertise and robotic precision ensures the best possible outcomes for patients. 

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Benefits of Virtual Surgical Planning

Virtual Surgical Planning (VSP) in orthopedics, especially when integrated with patient-specific implants and robotic-assisted surgery, offers several distinctive advantages that go beyond improving surgical accuracy and efficiency. These benefits include:

Enhanced Communication and Collaboration

VSP serves as a vital tool for enhancing communication among surgical teams, medical device companies, and patients. The ability to visualize and discuss detailed 3D models of patient anatomy facilitates a more comprehensive preoperative dialogue, ensuring all parties are aligned with the surgical plan. This collaborative approach helps in identifying potential challenges and planning the most effective surgical strategies.

Customization and Patient-Specific Solutions

Beyond the precision and efficiency benefits shared with robotic-assisted surgery, VSP stands out for its ability to produce highly personalized surgical solutions. Each patient's unique anatomical details are considered, leading to the design of custom-fit implants and instruments. This level of customization is critical for optimizing surgical outcomes and ensuring that implants integrate seamlessly with the patient's anatomy, potentially improving recovery times and reducing the likelihood of post-operative issues. 

Additionally, personalized implants, designed through VSP, are tailored to each patient’s unique anatomy and designed to offer a better fit.

Educational Value

Virtual surgical planning also serves an educational purpose for both surgical teams and patients. Surgeons can use these detailed models to explore different surgical options and outcomes, enhancing their skills and knowledge. For patients, it provides a clearer understanding of their condition and the planned procedure, which can help in reducing anxiety and increasing satisfaction with the surgical process.

Streamlined Workflow and Efficiency

While the integration with robotic-assisted surgery significantly reduces operative time, VSP itself streamlines the entire surgical planning process. From initial imaging to final approval, VSP technologies reduce the time needed for surgical teams to prepare for procedures. This efficiency not only benefits patients by reducing their wait times but also allows hospitals and surgical centers to optimize their schedules, potentially increasing the number of surgeries that can be performed.