Virtual Planning Enhances Care at Cincinnati Children's
A neurosurgeon and plastic surgeon duo at Cincinnati Children’s were among the first adopters of virtual surgical planning (VSP) for volumetric calculations, specifically for comparative analysis in craniosynostosis—and one of the first teams to use the technology for single-suture craniosynostosis surgeries. Now, they’re building a dataset showcasing how they’re harnessing the benefits of VSP to demonstrably change outcomes.
Jesse Skoch, MD, faculty neurosurgeon in the Division of Pediatric Neurosurgery at Cincinnati Children’s, and Brian Pan, MD, director of the Division of Pediatric Plastic Surgery at Cincinnati Children’s, started using VSP in 2016 for challenging syndromic cases, but quickly realized the technology’s benefits could extend to more single-suture cases, too.
“Initially, our impetus for using it was ease of use and to decrease OR times,” Pan says. “We also wanted to have more consistent post-operative results with regard to optimizing shape and decreasing blood loss.”
Skoch and Pan noticed that instead of trying to apply one-size-fits-all surgical solutions to each patient, using the technology to map out even standard procedures could lead to better, more personalized outcomes when used along with computer-aided design and manufacturing (CAD/CAM) of 3D stereolithographic models.
“When you spend the time making those customizations and tweaks, even for routine cases, it really helps optimize the flow of surgery, and it helps optimize the actual craniotomy—the cuts we make and the way we reassemble the bones—so that it’s highly tailored,” Skoch says. “We’re not trying to fit everyone into the same glass slipper. We’re making a pre-planned, custom-cut craniotomy for every single patient.”
Building a Dataset of Benefits to VSP
Another reason Skoch and Pan decided to incorporate VSP into routine cases was for quality improvement in craniofacial surgeries.
“How do we continue to get better?” Pan says. “How do we decrease the overall length of the hospital stay? All those pieces fit into our why.”
As the two performed more and more surgeries using VSP, they also realized the safety benefits it provided.
“There’s significantly less guesswork when you can virtually map out your procedure beforehand,” Skoch says. “When you do the actual surgery, you can just go in and concentrate on maximizing your technique and executing your plan.”
Skoch also appreciates the active role VSP allows him to play in surgical planning. And how it helps put families at ease. “We’re describing some pretty scary surgical details,” he says. “When you tell the family you’re going to literally practice it and perfect it so you’re as happy as you can be with the plan before even bringing the patient back and putting them under anesthesia, it can be very comforting. I’ve noticed parents breathe a small sigh of relief.”
Now that Skoch and Pan have been using VSP in routine cases for several years, they’ve accumulated data to help support the benefits they initially sought.
“Decreasing OR times, decreasing lengths of stay and blood loss, no one has published on that yet,” Pan says. “So, we’re excited about being able to study this and build that dataset.”
(Published May 2024)
