Dr. Gregory Gasbarro of Mercy Medical Center in Baltimore poses with a pair of goggles he uses to perform shoulder replacement surgery using the Blueprint Mixed Reality Guidance system. He is the sixth surgeon in the country to perform the surgery
using the new technology, which helps guide him with a holographic overlay.An orthopedic surgeon at Mercy Medical Center in Baltimore is taking shoulder replacement surgery "to the next level" by donning a pair of mixed reality goggles that overlay the patient with a holographic image to help guide the operation.
Dr. Gregory Gasbarro, of The Shoulder, Elbow, Wrist and Hand Center at Mercy, is the sixth surgeon in the United States to perform shoulder replacement surgery using the new technology, called the Blueprint Mixed Reality Guidance system.
"It just gives you confidence during the surgery that you're actually executing the (pre-operative) plan that you've created, which ultimately should hopefully improve the patient's outcomes," he explained during an online press conference about the surgery.
While virtual reality is like an immersive video game, Gasbarro said mixed reality is blend of that and real life.
He explained that 20 to 30 years ago surgeons used X-rays to figure out an orthopedic issue and how to fix it in the operating room. "So it's very qualitative, and you're really just sort of eyeballing things," he said.
Then, CT scans became more common, and those scans were eventually used to plan surgery virtually. Then, patient-specific instrumentation evolved, and 3D-printed guides were created that matched individual patients and helped surgeons place implants properly.
"But as we've evolved now from patient-specific instrumentation to this new realm of mixed reality, that 3D plan in the software program can now be uploaded into a set of goggles and projected via holograms into the real world," Gasbarro explained.
An image from a video created by Stryker, maker of the Blueprint Mixed Reality Guidance system, shows how a surgeon is fitted with a pair of goggles used during surgery. The surgeon's actions will be guided by a holographic image seen while wearing
the goggles.At the point in surgery where he would have used the guide, an assistant fits Gasbarro with a pair of goggles, a Microsoft HoloLens 2. While he wears the goggles, he uses voice and gesture commands. He registers the patient's anatomy through the workflow
and then places the glenoid, or socket, pin, which assists with implant placement. With the goggles allowing him to see the holographic overlay, he can get the pin in place within 2 millimeters of the planned site and within two degrees of the
desired angle. Even if a surgeon uses a guide — the most recently developed technology for such procedures and a tool which takes two to three weeks to prepare — the placement of the implant can be off by 4 or more degrees, he said.
A surgeon sees an image like this one with measurements while using the Blueprint Mixed Reality Guidance system.As of early July, Gasbarro had performed five surgeries using the technology, the first one in early June. It has taken an average of 11 minutes of surgery time to work with the goggles in those five cases. A typical shoulder surgery takes about
45-75 minutes, he said.
Potential advantages of the mixed reality tool include shortening the learning curve and improving implant placement for surgeons who don't perform shoulder replacement surgery as often. The plan for the surgery is in place and the goggles act
as a guide, he explained. Gasbarro is hopeful the technology also will reduce costs and errors and improve outcomes.
It's too early to know what long-term results will be, but the science behind the technology has been approved by the Food and Drug Administration and has been around for at least five years, he said.
A video provided by Stryker shows how a surgeon is able to manipulate a holographic image used to help guide shoulder replacement surgery using mixed reality technology.
"I'm hoping, with this added layer of accuracy, that I continue to see good results with patients having a stable joint that's long lasting, with good range of motion over their head and especially behind their back, and, to make them happy and
return to all the things that they love," Gasbarro said.
He said he's part of a small group of surgeons who are working with Stryker, the company that makes the Blueprint 3D planning and
mixed reality software, and giving suggestions for improvements. "I think it's going to be something that is going to be very commonplace within the shoulder specialist world," he said.