The operating system, called OCULUS, transforms two-dimensional patient data sets — like angiograms, MRIs and CT scans — into 3-D virtual environments.
The lab seems plucked from a video gamer’s wildest dreams. Cushy chairs face two 3-D televisions mounted on the wall. By donning virtual-reality goggles and using handheld controllers, residents can navigate through an actual patient’s neuroanatomy, manipulating it — rotating structures, removing obstructing tissues — as they explore.
The operating system can also travel beyond the simulation lab, wheeled to operating rooms and clinics on mobile carts. Surgeons can use it to plan operations and guide their instruments during surgery, like a 3-D GPS system. In the clinic, patients are able to visualize their conditions in a new, totally customized way.
“Even patients that know everything about their disease benefit, because I guarantee they haven’t flown inside their spine or their brain,” Collins said.
Putting skills to the test
The OCULUS system is a powerful visualization tool for surgeons and patients alike, but it cannot offer residents hands-on training. With the opening of the anatomy lab, residents can put their anatomical acumen to the test in the physical world.
“The room looks a little less impressive than the simulation center, but it’s where all the dirty work gets done,” Veeravagu said.
The lab is equipped with shiny new tools, including high-speed drills, high-tech navigation systems and dissection instruments. “We are trying to recreate the OR environment in the cadaver lab so residents can have that same experience,” Singh said. A new microscope commands particular presence in the corner of the room. Standing taller than a man, it allows residents to project 3-D models directly onto their cadavers.
The lab’s donated equipment, worth more than $1.5 million, took about 18 months to procure, and now the lab is ready to go. The department recently got samples for dissection. Now, residents have unlimited access to the lab to study anatomy, practice surgical procedures and plan operations. The lab will also host workshops demonstrating rare procedures and new techniques. Beyond benefiting residents, these workshops could be instructive to practicing surgeons and draw practitioners from outside Stanford.
The anatomy lab was christened with one such workshop back in June. Residents gathered around the dissection stations to learn a new technique for treating carpel tunnel. The minimally invasive procedure uses high-powered ultrasound and requires an incision only the size of a pinprick. In the coming months, the lab will host workshops on minimally invasive spine and skull surgeries.
Lab a prototype
Though the lab is open for business, it is only a prototype. The Grant Building is scheduled for demolition in the next few years, and the neurosurgical anatomy and simulation labs will be relocated to a more permanent location.
The Department of Neurosurgery hopes to build the next dissection lab from the ground up. “Our current space is not made for a cadaver dissection lab — we basically converted it for lack of space,” Singh said. “The room has to be built in a certain way so you can explore the lab’s full capability.”
When you have a case come up, you now have a resource where you have a chance to practice before you do it.
Ideally, the future lab would have space for three additional stations, so six dissections could take place at once. The tables would be built into the walls and the room shielded for X-rays. The walls would be lined with freezers for long-term cadaver storage and LCD screens for endoscopic procedures, in which surgeons use instruments to look inside the body. The department also hopes to add to its microscope collection.
In the meantime, neurosurgery trainees are excited to take advantage of the current lab.
“The cadavers provide an education for the entire range of trainees we have, even medical students,” Veeravagu said. “Just getting to specific parts of the brain is very challenging and requires repetitive exercise, and that’s what the cadavers allow folks to do.”
“The real benefit is that, when you have a case come up, you now have a resource where you have a chance to practice before you do it,” said Xu.
Trainees’ work in the simulation center promises to make their time in the anatomy lab even more fruitful. Residents will visualize their case inside a 3-D model, perfect their procedural approach on a cadaver and bring that newfound proficiency to the operating room, said Veeravagu.
“It’s a seamless way to build confidence and training in what they’re doing,” he said.
Medtronic, Stryker, Haag-Streit USA and Mizuho donated equipment to the lab.