Simulating Conjoined Twin Surgery Case Study

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Conjoined twins are among the most fascinating and rare of medical occurrences, happening approximately once in every 189,000 births. Conjoined twins have a relatively low survival rate and even when they do survive, they often face significant practical and social challenges throughout their lives. While surgical separation has been attempted in such cases over the years, it has a similarly low survival rate, often ending in the death of one, if not both twins.

Most often, the problem lies in  the fact that the connections between the twins are too delicate and complex to sever without great risk. But what if it was possible for surgeons to explore conjoined twins’ internal connections intimately prior to the surgery? Could success rates be increased? Thanks to virtual reality (VR), it may be possible.

 Photo by  rawpixel  on  Unsplash

Photo by rawpixel on Unsplash

The Virtual Edge

Currently available VR solutions allow surgeons to study patient-specific DICOM data like MRIs and CT scans in fully immersive simulations. With 1:1 scale, perfectly-mapped movements, and tactile feedback, every step of the surgery, every motion and incision, can be planned in advance. Not only that, but VR allows surgeries to be rehearsed as many times as needed—the entire medical team can become familiar with the procedure and all contingencies can be taken into account.

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Case Study: Simulating Conjoined Twin Separation

Led by Dr. Deepak Gupta, a team of doctors at the All India Institute of Medical Sciences in New Delhi used the ImmersiveTouch Mission Rehearsal® virtual reality (VR) surgical platform (now known as ImmersiveView Surgical Plan) to plan and rehearse separating craniopagus twins—twins fused together at the head. The normal success rate for such a procedure is below 25%, a figure based on a mere 50 attempts around the world since 1952.

Using VR mapping techniques, the team was able to plan the surgery in phases, successfully completing the first stage by creating an alternative venous channel, expanding the skin, then separating the brain.

“We could see, feel and study connected tissue, discuss anatomy, and examine surgical pathways,” said Dr. Deepak Gupta, Professor of Neurosurgery, AIIMS. “Our team of roughly forty doctors from pediatric neurosurgery, anesthesia, plastic surgery and cardiovascular sciences used the Mission Rehearsal® platform to practice the surgery multiple times and plan the most effective surgical roadmap.”

With a clear plan and much of the guesswork removed, Dr. Gupta and his team were able to enter the operating room with far more confidence. VR offers a vast improvement over x-rays and other more traditional forms of imaging, which tend to misrepresent the challenges and complexity inherent in invasive procedures. Even DICOM data, while they are fully 3D representations, are abstracted because they are seen from a 2D screen. When surgeons can experience the data in an immersive way and with haptic feedback, they can truly understand and practice on the patient’s unique anatomy.

Moving Forward

As this case shows, the use of VR can improve the planning, practice, and outcome of all kinds of complex surgeries, making traditionally risky procedures much more viable. As the technology continues to improve, its abilities will only increase. Contact us at ImmersiveTouch for a demo of the platform today, and see for yourself.

Nik Amarcase study, vir, surgery