Terry Peters

Can a combination of ultrasound and virtual reality be employed to provide guidance to surgeons while performing interventions inside the beating heart?

Such a procedure would ultimately permit surgery (valve repair, patching of atrial-septal defects; ablation therapies for abnormal heart behaviour) to be performed without requiring the patient to undergo a sternotomy, (cracking the chest open); stopping the heart; and placing the patient on a heart lung machine. This would eliminate the excessive recovery time required for traditional techniques, and remove the risk of further cardiac or neurological problems that can be induced by attaching the patient to a heart-lung machine.

Can a selected number of images acquired on a standard MRI scanner be combined in such a manner that abnormalities in brain structure and function that cause epilepsy,  be determined with sufficient accuracy to permit the affected region in the brain to be approached and ablated through a simple burr hole in the skull.

Currently localization of epileptic  regions in the brain  is  quite crude, and is often only as specific as to which side of the brain the seizure focus is located. For this reason, often most of the temporal lobe of the brain is removed, even though the affected region may reside within a few cubic millimetres of tissue located within the lobe. Excessive tissue removal can affect speech, cognitive and memory function of patients. Accurate minimally-invasive removal of the focus after identifying this region via  MRI will spare these functions after surgery.

Can real-time ultrasound, when combined with pre-operative CT/MRI and stereoscopic video images, (as seen through an endoscope during laparoscopic tumour resection in the kidney and other abdominal organs), provide the surgeon with additional information about the tumour, allowing its complete removal, while sparing as much surrounding tissue as possible.

The combined use of ultrasound, pre-operative datasets and endoscopic images will enable increased use of minimally invasive techniques to remove tumours from organs in the abdominal cavity, giving the surgeon a complete view of the affected organ and its internal characteristics, and allowing him/her to make informed decisions “on the fly” relating to the amount of tissue that must be resected,  thus sparing healthy tissue, nerves, and vessels that might otherwise be destroyed as part of the surgical procedure.

In addition to the facilities in the VASST Lab, Scientists involved in projects requiring Image-guided intervention tools, now have access to the newly established Pre-clinical Image-guided Intervention Facility,  located on Level 0 of the Robarts.

This facility contains an experimental operating suite, built to Biosafety Level 2 standards to accommodate surgery on non-human primates (NHP) and designed explicitly for the development and validation of minimally invasive procedures. This will take maximal advantage of the existing state-of-the-art 3T and 7T MR imaging facilities on the floor immediately above. With access to such imaging facilities and the ability to perform surgery on non-human primates, this facility will be unique in Canada, and likely the world. The facility incorporates an existing intraoperative Cone-beam CT scanner, a state-of-the-art image-guidance platform incorporating an “Exoscope” (a revolution in intra-surgical imaging that replaces the conventional operating microscope); Human and NHP sized stereotactic neurosurgical robots; a hand-held confocal neuro endoscope with micron resolution, fully integrated high precision magnetic and optical instrument tracking devices; High resolution Virtual and augmented reality visualization facilities, as well as intra-operative vascular, cardiac and abdominal ultrasound facilities; and infrastructure to support minimally-invasive cardiac procedures.

This new operating suite supports the spectrum of image-guided intervention research projects at Robarts and Western, and with its enhanced functionality and NHP access,  complements existing animal research facilities in the Canadian Surgical Technologies & Advanced Robotics (CSTAR) facility within LHSC, which are not equipped to deal with NHPs and do not have the CT and Neurosurgical robotics facilities. It is also a core resource for BrainsCAN Western, which focuses on the understanding of networks in the brain, to ultimately develop novel therapies via targeted interventions.