Doctors at the University of Minnesota Masonic Children's Hospital used virtual reality to simulate a surgery to separate conjoined infant twins, a cutting-edge technique that spurred doctors to overhaul their surgical strategy—and likely saved the twins' lives, Peter Holley writes for The Washington Post.
According to University of Minnesota physicians, conjoined twins are rare, occurring in anywhere from one out of every 200,000 births to one out of every million births, depending on how they are attached.
Separating conjoined twins can be difficult depending on where they're connected and what organs they happen to share, according to the University of Maryland Medical Center (UMMC). For instance, according to UMMC, twins who are "joined at the sacrum at the base of the spine have a 68 percent chance of successful separation, whereas, in cases of twins with conjoined hearts at the ventricular (pumping chamber) level, there are no known survivors."
In this case, the twins—Paisleigh and Paislyn Martinez—were born with a condition called thoraco-omphalopagus, which means that they were attached from their lower chest to their bellybuttons, including partially conjoined hearts.
Building the VR simulation
To create a virtual reality simulation of the twins' surgery, the medical team, lead by the hospital's Pediatric Surgery Chief Daniel Saltzman and the hospital's Pediatric Cardiac Surgery Chief Anthony Azakie, teamed up with the University of Minnesota's Earl E. Bakken Medical Devices Center.
At the center, a team of experts used software to convert MRI and CT images taken of both infants to build a virtual model. In addition, the university's Visible Heart Lab generated a 3-D print model of the twins' hearts using a printer the team purchased online for just $300.
An unexpected discovery
Just moments after slipping on virtual reality glasses to explore the virtual model, Saltzman and Azakie discovered "something unexpected: new connective tissue—a 'bridge'—linking the girls' intertwined hearts, one of which had become heavily reliant upon the other," Holley reports. According to Holley, the defect meant that the twins' lives were in danger—and that a surgery to separate them had to be moved up several months early, before the twins were as healthy as physicians hoped they'd be.
As the physicians continued to assess the model, they realized the extent of the challenge: Incorrectly cutting the connection could cause the twins to bleed to death, while placing pressure on the girls' hearts could cause such severe blood loss or arrhythmia as to stop the organs from functioning.
To resolve the issue, the physicians used a "track system" in the 3-D model of the twins' hearts that enabled them to turn their heads without distorting the image. That ease of movement, they said, helped the team spot the solution: They'd flip the babies around on the operating table, coming at the operation from the opposite angle than originally planned. According to the physicians, that simple solution might have saved the infants' lives.
"In our line of work—especially in pediatric cardiac surgery—it's important that one is able to think on their feet and plan for the unexpected," Azakie said. "The imaging helped us prepare by developing an approach in the event that we came across something we didn't expect."
"It's completely surreal and the resolution is unbelievable," Azakie continued, adding, "It was like the Oculus Rift of pediatric heart surgery."
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Saltzman agreed, saying, "It felt like I was working in the future."
Twins expected to live healthy, independent lives
According to Holley, it's been about two months since the surgery, and the twins are still in recovery. However, physicians say the girls will grow up leading healthy and independent lives—and the only evidence of their medical past will be a scar on their chests.
The doctors attributed this success to the 3-D virtual reality imaging they used in preparation for the procedure, a technique they think will be recorded in medical journals and potentially used as precedent for surgeries with ramifications beyond procedures involving conjoined twins.
Saltzman said, "Separating these infants was no small feat. ... The fact that we got to do it using virtual reality for direct patient care makes that feat truly incredible" (Holley, Washington Post, 7/23).
What does virtual reality (VR) bring to health care?
For decades, VR has been evaluated for its potential to improve clinical training and education, interactive diagnostic imaging, pain management, psychiatric and behavioral treatment, and general patient health and wellness. Despite the evidence that demonstrates the promising medical efficacy of VR, most of this past research has been academic, and so this technology is not yet widely used in health care.
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