Overheard in a coffee shop: A better way to do brain surgery, based on Israeli simulation technology

It pays to pay attention at the coffee shop — you never know when you’ll hear a great piece of information in overheard conversations. And in the case of Dr. Warren Selman, an overheard conversation between two Israel Air Force officers led to a new medical technology idea that could potentially revolutionize the way surgeons work.

The idea for the Surgery Rehearsal Platform, known as an SRP, emerged, said Selman, when he overheard a discussion on flight simulation between former Israel Air Force officers Moty Avisar and Alon Geri. Knowing a good thing when he heard it, Selman, who is Neurosurgeon-in-Chief of University Hospitals in Ohio and Chairman of the Department of Neurological Surgery, Case Western Reserve University School of Medicine, got involved in the conversation. The result was the establishment of a new company with the Israeli experts (who were in Ohio working with Lockheed Martin’s office in Akron), called Surgical Theater LLC.

That conversation took place in 2009, and since then, Selman, Avisar and Geri have been developing the Selman SRP (named for Dr. Selman), using the same technology as flight simulators to allow realistic, interactive run-throughs of brain surgeries prior to actual procedures. The SRP uploads and transforms medical images, such as CT and MRI scans of patients, into life-like, dynamic and interactive 3-D models. Instead of being limited to 2-D images and having to extrapolate or speculate on the best ways to attack a problem, surgeons using the SRP will be able, for example, to view and interact with dynamic brain images of their patients, allowing them to plan and rehearse surgeries by seeing and interacting with an accurate replica of what they would see and use when operating on the patient.

After that initial conversation with Selman, said Avisar, the three got together again, with Selman introducing the idea of using simulator technology for surgeons. “It took us more than a year to respond to Dr. Selman’s challenge,” said Avisar, who is the company president, “but we were able to create a realistic program that even the most experienced neurosurgeons could appreciate.” Both of Selman’s Israeli partners worked in simulation in the Israel Air Force for years before being sent by the IDF to consult with US firms.

The SRP can be deployed for specific surgeries. The first model, to be officially introduced by the company this week at the Annual Meeting of the Congress of Neurological Surgeons (CNS) in Chicago, simulates the environment of a cerebral aneurysm, which Selman described as one of the most technically complex procedures performed by a neurosurgeon. Avisar believes that surgeons will quickly see the benefits of using the system. “We believe that once a surgeon experiences the clinical benefits he or she can gain from ‘pre-living the future’ of their patient’s case — by rehearsing and planning the surgery with the SRP — he or she will not want to perform surgery without the SRP,” he said.

Besides modeling, the SRP can be used to enable surgeons in other locations to collaborate on problems and issues. The system includes a Collaborative Theater platform, which includes broadband connection capability that can broadcast models over the Internet, enabling surgeons worldwide to consult on particularly tough problems — and enabling them to learn more effectively from the 3-D models the SRP produces. Until it is approved by the FDA, the company said, the system can be used for educational purposes only.

“The SRP developers understand the importance of making the scene as realistic as possible, so that surgeons can rehearse exactly what they’re going to do the next day,” said Selman. “I believe neurosurgeons will embrace SRP and it will emerge as an essential component of preparing for surgery — to improve the outcome and to provide the best care for our patients.”