Mixed Reality and AI to aid surgeons with keyhole heart valve surgeryCardiac surgeons could in the future beconducting procedures virtually before evenstepping into an operating theatre thanksto researchers from the University of Westof England who are working with cardiacsurgeons from the University of Bristol on newtechnology that will allow surgeons to betterpredict risks and help prevent the conversionof a keyhole heart valve operation to openheart surgery.The research team from UWE Bristol’s BigData lab and Faculty of Health and AppliedSciences (HAS) is developing technology thatuses artificial intelligence (AI), augmentedreality (AR) and virtual reality (VR) to assistcardiac surgeons in planning and preparing forcomplex keyhole heart valve surgery.The team is initially collaborating with theBristol Heart Institute (BHI), a SpecialistResearch Institute at the University of Bristol,whose surgeons will test the system whenpreparing for minimally invasive cardiac valvesurgery (MICVS).Compared to conventional open-heart surgeryinvolving cutting through the breastbone toreach the heart, MICVS is less intrusive as theheart is accessed through smaller incisionsusing endoscopic instruments. And patientrecovery time is generally quicker after thiskeyhole surgery.However, MICVS is complex and requires hoursof pre-operative planning and preparation.Dr Hunaid Vohra, Consultant Cardiac Surgeonand Honorary Senior Lecturer and Researcherat the BHI, who is collaborating with UWEBristol, said:“In the operating room, despite pre-planning,it is currently very common to find unexpectedchallenges, as every patient’s height, weightand heart-lung anatomy is different. Andpatients’ frailty varies.“Mixed Reality and AI will enhance our abilityto prevent the conversion of a keyhole heartvalve operation to an open heart surgery,avoiding two sets of scars, and delay inrecovery.”Surgeons will initially be able to use thesystem’s AI to tap into the patient’s medicaldata to predict the risks associated with theprocedure. The likelihood of adverse events isthen presented to the surgeon on a HoloLensusing AR.Next, the surgeon will have access to ARtechnology to show a patient a 3D version oftheir heart and explain the procedure to themvia headsets.Dr Muhammad Bilal, Associate Professor of BigData and Artificial Intelligence at UWE Bristoland leading the research team, said: “Mostterms surgeons use to describe heart surgeryduring consultation draw a blank from patientsand this system makes the explanation taskmuch clearer and easier.”Incorporated in the system is also a preoperativelogistics element that optimisesoperation planning. This will assist medicalteams in preparing the right instrumentsand materials, and booking the appropriateoperating theatre and hospital beds, amongother tasks.Crucially, the software’s virtual planningfeature will provide surgeons with accessto a complete digital version of the patient,enabling them to perform the entire operationbeforehand on a replica of the patient’sthoracic cavity. This will include ‘what-if’scenarios to determine the most optimal andpersonalised surgical strategies.Finally, in collaboration with UWE Bristol’sCentre for Print Research, surgeons performingvery complex cases will be allowed to ordera bespoke 3D printed model of the patient’sthoracic cavity mimicking organs, veins, andblood flow to simulate the procedure on asynthetic body.“This will enable us to practise before theactual operation and minimise the potentialfor things to go wrong on the day,” said DrVohra. “Overall, we are excited to be involvedin this technology, which could spell thefuture for highly successful minimally invasiveprocedures of this type in adults and babies.”Dr Bilal added: “Currently, the practice ofMICVS is limited to a small group of surgeons inthe world. This technology-enabled guidancepromises to increase the number of doctorsable to perform these operations, providingwider access to the general population.“There are significant engineering challengesto be resolved before this technology can berolled out into the NHS but our collaborationwith the BHI provides a perfect testingground.”When responding to articles please quote ‘OTJ’The next issue copy deadline, Friday 25th February 2022All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YYTel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.comThe Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.comand in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors.All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editorat the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2022Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD4 THE OPERATING THEATRE JOURNAL www.otjonline.com
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