When Bob Carter, MD, PhD, chief of neurosurgery at UC San Diego Health was recruited from Harvard University five years ago, one of the major attractions was the opportunity to help design a center for surgical innovation at the planned
Jacobs Medical Center.
As a neurosurgeon, his particular interest was to build a top-tier “brain suite” to conduct the most technically challenging surgeries, such as spinal fusions or “awake” surgeries in which patients are conscious during operations to remove brain tumors.
When Jacobs Medical Center at UC San Diego Health opens its doors to patients in 2016, Carter’s vision – “a patients’ and surgeons’ dream” he calls it – will become reality.
“For me, this was a wonderful opportunity to collaborate with the architectural and design team from conception to construction,” Carter said, referring to the six-room intraoperative imaging suite.
“Many health care centers have a version of this in an older hospital or in a renovated operating room, sometimes wedged into a space that is not specifically designed for its purpose,” Carter said. “We have a suite specially designed for multiple modes of intraoperative imaging and real-time surgical guidance.”
The intraoperative imaging suite that Carter and colleagues helped design will consist of a pod of four operating rooms (ORs), with a shared control corridor for radiologists and technicians and a shared medical team work room where views into all four ORs will be displayed on wall-mounted monitors. Each OR will also have a “wall of knowledge,” upon which images and videos can be viewed and manipulated during procedures.
“Everyone in the operating room will have the surgeons’ view,” Carter said. “The team will be able to view the surgical field on the monitors. Anesthesiologists will no longer be cordoned off behind a screen. This will help operations to be performed more effectively and efficiently because all OR team members will be able to visualize important anatomic structures and anticipate the next steps in the surgery as the procedure is performed.”
The suite’s technical heart is its imaging equipment: a 3T MRI machine and 64-slice CT scanner that can be brought to the operating table for real-time imaging of soft-tissue and bone before, during and after a procedure. The imaging equipment will be fully integrated with sophisticated surgical navigation and 3D surgical modeling systems.
During a spinal fusion surgery, for example, surgeons will be able to build a 3D representation of a patient’s vertebrae and model where screws should be placed. Surgeons can then use a guidance system to insert the screws in the precise location.
For brain tumor patients, the system can create a color-coded 3D image of the brain that depicts structures critical to speech, motor and cognitive functions. Surgeons can then plan surgical trajectories that avoid sensitive brain regions and may re-scan the brain during a procedure to assess whether the procedure has been successful or requires further work.
“Our surgeries will become less invasive and more accurate with these new systems,” said
David Barba, MD, director of functional neurosurgery at UC San Diego Health. “We will also able to collaborate with neuroscientists, neuro-radiologists and our patients in a way that has not been possible before.”
The 10-story Jacobs Medical Center, the largest hospital project in southern California, is scheduled to open in the summer of 2016.
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