Neurosurgeons and Ex-Israeli Air Force Officers Design Brain Surgery Simulator

Neurosurgeons at University Hospitals (UH) Case Medical Center are working with ex-Israeli Air Force officers on a surgical simulator using the same technology as flight simulators to allow realistic, interactive run-throughs of brain surgeries prior to actual procedures.

The surgical simulator, called Surgery Rehearsal Platform (SRP) and developed by the Cleveland-based company Surgical Theater LLC, uploads and transforms medical images, such as CT and MRI scans of patients, into life-like, dynamic and interactive 3D models. SRP enables surgeons to view and interact with dynamic brain images of their patients, allowing surgeons to plan and rehearse surgeries by seeing and interacting with an accurate replica of what they would see and use when operating on the patient. The surgeons can work on virtual blood vessels or brain tissue with virtual tools prior to performing surgery on the patient.

The virtually operated tissues react realistically to actions taken by the surgeon, thereby providing a realistic environment and allowing the surgeon to make critical decisions before entering the operation room in a "risk free" environment. "The SRP developers understand the importance of making the scene as realistic as possible so that surgeons can rehearse exactly what they're going to do the next day," said Warren Selman, MD, Neurosurgeon-in-Chief at UH and Harvey Huntington Brown Jr. Professor and Chairman of the Department of Neurosurgery at Case Western Reserve University. "I believe neurosurgeons will embrace SRP, and it will emerge as an essential component of preparing for surgery to improve outcomes and provide the best care for our patients," he said.

Through a chance meeting in a coffee shop with the former Israeli Air Force officers, Dr. Selman became intrigued with the idea of applying to the realm of surgery the flight simulator technology that the officers had developed. The former officers, Moty Avisar and Alon Geri, developed advanced mission-specific and exceptionally realistic flight simulators that gave pilots the ability to "pre-live the future." At the time of their first informal meeting with Dr. Selman, they were working in Northeast Ohio with Lockheed Martin's office in Akron, Ohio.

"It took us more than a year to respond to Dr. Selman's challenge," said Avisar, President of Surgical Theater, "but we were able to create a realistic program that even the most experienced neurosurgeons could appreciate."

From that chance meeting in 2009, Surgical Theater LLC will launch its first product in the first half of this year. The first SRP simulates the environment of a cerebral aneurysm, which Dr. Selman describes as one of the most technically complex procedures a neurosurgeon does. A cerebral aneurysm is a ballooning of a blood vessel in the brain that is often treated by microsurgical techniques involving the placement of a small titanium clip across the neck of the aneurysm.

The new SRP is coined the Selman SRP after Dr. Selman. The aim is to begin by making it available to the residency programs of medical education institutions and to eventually equip neurosurgery departments with at least one SRP. "We believe that once a surgeon will experience the clinical benefits he or she can gain from 'pre-living the future' of their patient's case by rehearsing and planning the surgery with the SRP, they will not want to perform surgery without the SRP." said Avisar.

Through broadband connections, surgeons in different locations around the nation or globe could be connected to SRPs simultaneously in a collaborative surgical theater. Through this Collaborative Theater platform, surgeons could "step into" the patient's virtual model and work together on the patient's case, jointly performing a virtual surgery and making critical decisions before entering the operation room via real time interaction on an accurate model of a patient's anatomy.

The company also is looking to begin a clinical trial this year for the Selman SRP to provide evidence for improved clinical outcomes. UH Case Medical Center is Surgical Theater's clinical collaborator.

The founders of Surgical Theater (http://www.surgicaltheater.net/home.html) have more than 20 years of experience in research and development for the Israeli Air Force. Moty Avisar, President, and Alon Geri, Vice President of Engineering, were both leaders in advanced, large-scale flight simulator programs. Also engaged with the SRP development since its incubating phases is Andrew Sloan, MD, Associate Professor of Neurosurgery at Case Western Reserve University and the holder of the Peter D. Cristal Chair and Director of the Brain Tumor and Neuro-Oncology Center of the UH Neurological Institute. Dr. Sloan is developing models for simulating complex surgical procedures for the removal of benign and malignant tumors located in critical areas of the brain.