A neurosurgeon, a rocket scientist and Bill Clinton walk into the Beverly Hills Hotel … It sounds like the set up for a joke, but the punch line here is more hopeful than humorous: A chance meeting seven years ago may have lead to the future of medicine, the first of a new generation of minimally invasive surgical devices that allows a surgeon to peer inside the body in panoramic 3-D. Surgery is about to become safer, more effective and less expensive.
The neurosurgeon is Dr. Hrayr Shahinian, the medical director of the Skull Base Institute in Los Angeles. Since the 1990s, Dr. Shahinian has been a pioneer of endoscopic brain surgery, using small diameter endoscopes to slip inside patients’ skulls through a small hole and excise tumors. It’s a procedure he says greatly reduces the risk and recovery time associated with traditional craniotomies, where large areas of the brain are exposed.
As great as a tool as Dr. Shahinian’s endoscopes are — today they provide true 1080p, high definition video — they still suffer from a major drawback: The image they give a surgeon is flat, whereas the brain and brain tumors are not. What Dr. Shahinian wanted was an endoscope that allowed him to see not only in HD, but 3-D as well. Unfortunately, fitting that sort of equipment into a 4mm diameter endoscope seemed impossible.
“Miniaturizing it down to that level, we are virtually skirting the limits of optical physics,” Dr. Shahinian said.
Enter the rocket scientist. Dr. Charles Elachi is the director of NASA’s Jet Propulsion Lab in La Cañada Flintridge, California. In November of 2007, Dr. Elachi and Dr. Shahinian found themselves seated next to each other at a dinner event at the Beverly Hills Hotel (Bill Clinton was the keynote speaker). Over the course of the meal, Dr. Shahinian described his plan for the ideal endoscope and Dr. Elachi, to Dr. Shahinian’s surprise, said that NASA was looking at the same technology for its Mars rovers. A week later, Dr. Shahinian was at his first meeting with a room full of NASA engineers at the outset of what would become a seven-year, multi-million dollar collaboration.
In late 2014, the result was the MARVEL (Multi Angle Rear Viewing Endoscopic tooL). The innovative use of two apertures with one lens rather than two complete parallel imaging systems allowed true 3-D in an unprecedented compact space: Dr. Shahinian wanted to fit everything into an endoscope no bigger than 4mm and the MARVEL comes in at 3.8mm. That extra .02mm of wiggle room gives the MARVEL a remarkable 120 degree sweeping view, a device that will allow surgeons to literally peek around corners in the body.
What this means for patients, Dr. Shahinian says, is safer surgeries with far less recovery time — a matter of 24 to 48 hours rather than several weeks — and in all types of operations not just brain surgery. And since, “The biggest ticket item in health care today is hospitalization; it will be a lot cheaper.”
What remains now is the process of FDA approval and the commercial production of the MARVEL, which Dr. Shahinian expects could be completed in as little as 24 months. He plans to conduct the first surgery with a MARVEL device at the Skull Base Institute.
The MARVEL is just the first step, however, the first model in what Dr. Shahinian says will be an entire ecology of similar surgical instruments.
“MARVEL is probably the crown jewel … but it is the first of many other inventions under this umbrella of smart instruments,” which he says will present surgeons 3-D views of the body with built in augmented reality overlays, like the heads up display in a fighter jet. “That’s the future, and the near future.”
Top screenshot courtesy of the Skull Base Institute