Future of Personalized Medicine

Question 1

What can be done during the preoperative stage of surgery in regard to:
- Diagnostics
- Planning of surgery

Answer 1

Diagnostics:
- Compare with ‘normal’ population
- Compare with ‘normal’ self
- Determine desireable outcome

Planning of surgery:
- Determine surgeries
- Fabriate/choose tools
- Training (VR/AR/3D-print)
- Surgical navigation

Question 2

How does the future of the preoperative phase look like?

Answer 2

Towards a patient specific solution:
- Ideally based upon normal self
- Move away from statistics and towards AI

Backwards planning:
- AI driven
- Build upon history and experience (store all data in all steps of healthcare process and determine best practices)

Question 3

What happens currently during navigation visualization?

Answer 3

The feedback is only possible after positioning the implant, thus it is a process of trial and error positioning. And the interpretation of the placement of a 3D implant is still made by the surgeon.

Question 4

Optimal navigation visualization is direct, real-time and intuitive.
However, there are still some challenges before this can be realized. Name three challenges.

Answer 4

1. Medical device regulation
2. Utilization with patient specific implants (PSIs)
3. Costs

Question 5

Another challenge of the optimal navigation visualization process that should be direct, real-time and intuitive, is the fact that this would result in a lot of screens to look at and focus on. What is a solution to this problem and what are the advantages and challenges of this solution.

Answer 5

Augmented reality, with a heads-up display that is projected onto the patient.

Advantages:
- No information loss
- Surgical plan can be projected real-time
- Wide utilization possibilities

Challenges:
- Technical accuracy
- Information overload

Question 6

Robotics could also be used during surgery. There are 3 different types of robotics that can be used: active, passive and semi-active.
What is the difference between the three?

Answer 6

• Active → Robot is ‘in charge’ of surgery and handles most actions by itself. Surgeon can only stop the procedure and cannot modify the procedure.
• Passive → 3D simulation based on the real world and provides quantiative feedback to monitor the progress of the surgery. Conventional instruments are still used during the operation and recommendations given by the system can be rejected based on the judgement of the surgeon.
• Semi-active → a system that limits the range of movement of the surgical instruments controlled by the robotic arm through preoperative human-machine dialogue.

Question 7

Da Vinci, MAKO and Yomi are three types of robots that have been invented. Describe their characteristics.

Answer 7

• Da Vinci → no tracking and no feedback (surgeon still performs surgery → passive system(?))
• MAKO → optical tracking and motion control (semi-active?)
• Yomi → dental tracking, motion control (semi-active?)

Question 8

What are advantages and challenges of using robots during surgery?

Answer 8

Advantages:
- Accuracy
- Invasiveness
- Safety
- Telesurgery

Challenges:
- Feedback (positioning and tactile)
- Safety
- Costs

Question 9

Name an example of an intelligent instrument that can be used during surgery and also name its associated challenges.

Answer 9

Intelligent knife (iKnife) that has mass spectrometry in the tip and can determine whether it is cutting into cancerous tissue or healthy tissue.
Challenges are: handling and getting real-time feedback