Community Hospital Develops Cutting-Edge Surgical Technology

Kamal Thapar, MD, PhD, a neurosurgeon at Sacred Heart Hospital in Eau Claire, Wis., laughs at the idea that only large academic medical centers can have cutting-edge technology.

Thapar"It's arrogant to expect that all advances have to come from big university centers," says Dr. Thapar, director of Sacred Heart's Brain & Spine Institute, which boasts a $10 million Smart OR with a state-of-the-art intraoperative MRI scanner to detect brain tumor tissue during surgery.

The intraoperative MRI, or iMRI, is just one of many high-tech features that you wouldn't expect at this 344-bed community hospital in a city of 100,000 people that is a two-hour drive from Minneapolis.

But Dr. Thapar, a member of nearby Marshfield Clinic, prefers the smaller setting. "Sacred Heart allows me to do research and innovation without the encumbrances of the university environment," he says. "This kind of program, merging technology with software-guided surgery, has elevated the entire institution. It allows other things to flourish."

In Sacred Heart's Smart OR, which opened a year ago, the iMRI makes scans the patient during the operation, while the brain is still exposed, so that tumor remnants can be detected and removed before surgery is completed.

"It is necessary to take an MRI scan after surgery has begun because it is difficult for the surgeon to see with the naked eye whether all of the brain tumor has been removed," Dr. Thapar says. Without an iMRI, he says, some tumor tissue is left behind in 20 to 30 percent of surgeries, forcing the surgeon to decide whether a risky second operation should be done.

Usually, the post-op MRI scan is taken the day after surgery. Taking an MRI scan during the operation, when the surgeon can immediately remove the tumor tissue, makes more sense, but it's tricky because the MRI's powerful magnet precludes use of anything metal anywhere near it. Surgeons have tried using non-metal tools, such as ceramic scalpels, but with limited effect. The iMRI is a breakthrough because it is housed in a "garage" next to the OR, far enough away from the operation to allow use of metal instruments. When the patient is ready to be scanned, everything metal is removed and the iMRI is rolled to the patient on overhead tracks.

The scans are taken and the exact data are fed into the Smart OR's BrainSUITE surgical mapping system. A device called VectorVision Sky precisely locates points in the brain in the same way that a GPS system works. Viewing this information through their surgical microscopes, surgeons can work with pinpoint accuracy when they resume the operation.

iMRI justifying the investment
Surgical results from using the iMRI have been impressive. In 50 initial cases in Sacred Heart's Smart OR, no repeat surgeries were required. Areas not affected by the tumor remained intact, reducing recovery times and permanent impairment of speech, vision and thinking processes. The technology may be expensive but "how could I, in good conscience, give care when I know there are better methods?" Dr. Thapar asks.

With introduction of the Smart OR, "so much of the institution has benefited in ways we couldn't possibly expect," he adds. For example, the new system has also improved staff skills. Special precautions needed for the iMRI require a more evolved sense of teamwork among all people who have any role in the work, from the chief surgeon to the housekeeper who cleans the OR.

"You have to re-learn everything you ever have done before in surgery," Dr. Thapar says. Metal tools have to be meticulously counted and removed. Even turning on a light at the wrong time can destroy an image.

Introducing this cutting-edge equipment into Sacred Heart has spawned other high-tech programs. For example, the hospital has established a critical care program that can take care of the sickest neurosurgery patients, not just from brain surgeries. And it has acquired da Vinci robotic surgery equipment for urology, gynecology and other disciplines.

While just 100 to 150 surgeries for brain tumors are performed each year Sacred Heart, the number of spine surgeries at the hospital is five times that amount. Therefore, the hospital plans to open a second Smart OR with an intraoperative CT for certain types of complex spine and trauma surgeries.

"The Smart OR and other innovations have made us one of the leading referral centers in the region," Dr. Thapar says. The Brain & Spine Institute has opened a learning lab that is available to surgeons from around the world and the cutting-edge technology at Sacred Heart makes it easier to recruit ambitious young physicians.

"If you want to create an institution that is functioning at the highest possible level," he says, "I advise adopting new technology."

Learn more about Sacred Heart Hospital.

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