Ask the Experts: Emily Geist on advances in arthroscopic hip surgery
Emily Geist, assistant professor of mechanical engineering
Posted: March 01, 2012
Q: As part of your research, you are designing a computer-aided system that could help surgeons more precisely place their instruments during minimally invasive hip procedures. How will this system potentially change the way such surgeries are performed?
A: Arthroscopic hip surgery presents challenges for surgeons as they look for the best place to make an incision and position their instruments. Surgeons determine where to place their instruments based on many parameters.
In my research, I am trying to find out if we could take all of that information and have the computer do the math and suggest locations for the portal.
The system would not replace the surgeon, but it would offer information allowing the surgeon to make better decisions. The computer can calculate locations very quickly and tell surgeons how close they are to major arteries or indicate the quickest, safest path to the surgery site.
Q: Why is hip surgery more challenging than surgery on other joints?
A: Noninvasive surgery is so difficult because a portal incision is typically only a quarter-inch long, so the surgeon loses visibility except for the limited view from the inserted camera. Additionally, the hip joint is much deeper in the body and tighter geometry-wise than other joints because of the ball and socket anatomy, and there are a lot of critical structures around it to avoid, such as the sciatic nerve, the femoral vein and the femoral artery. One of the largest challenges for hip arthroscopy is placing the initial portal for correct access to the joint while avoiding critical neurovascular structures.
Q: How does the system you've designed work?
A: This system virtually increases joint visibility. It includes an encoder linkage that acts as a mechanical tracking device to record the position and orientation of surgical tools during a procedure. A visual display on the computer shows the surgeon's tools and the patient anatomy from various points of view. I am hoping to transform a passive device showing what the surgeon is doing into a more active system that suggests locations for where the incision should be and trajectories for where the tools should go.
Q: How can patients benefit from these advances?
A: The system would make a lot of smaller procedures easier to perform in a minimally invasive manner. Some research shows that injuries such as small tears in tissue or an uneven bone surface can be fixed with arthroscopic surgery, eliminating the need for more complex hip surgery later on. Arthroscopic surgery also has smaller incisions than traditional methods and has a shorter healing time, shorter hospital stays and a lower risk for infection.
Q: What are the next steps?
A: I'm continuing to test the system for accuracy. As a first step, I would like to build a simulator to serve as a training tool to give surgeons in training the most realistic experience possible. Experienced surgeons develop a feel and intuition about how to perform surgery, but newer surgeons would benefit from the kind of practice the system offers. Eventually, when it's as accurate it can be, I hope this technology will be used in the operating room.
Interviewed by Julia Ferrante
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