I-Corps: Increasing surgical sensitivity

Icahn School Of Medicine At Mount Sinai, New York NY

Investigators

Abstract

The broader impact/commercial potential of this I-Corps project is the development of technology to impact the 400,000 spinal fusion patients within the United States annually. Over the past ten years, spinal fusions have moved toward minimally invasive techniques supported by improved pedicle screws and better image guidance. These techniques have allowed smaller incision sizes, reduced tissue damage, and fewer misplaced pedicle screws. Despite these technical advances, studies have reported 10-40% of patients experience new or residual pain following spinal fusion. Moreover, 15% of patients need revision surgery within five years of their first spinal fusion. Smaller incision sizes have been linked to reduced patient back pain, time to ambulation, hospital length of stay, opioid use, and risk of surgical site infection. By creating tools tailored to the unique clinical needs identified by spinal surgeons, this technology can help these surgeons avoid complications and minimize the likelihood of pain and revision surgery. The development of smart tools offering surgeons greater degrees of intraoperative freedom can be expanded beyond the screwdriver, opening up a vast array of commercial applications in medical and surgical practice. This I-Corps project is based on the development of technology to make surgical screwdrivers smart by offering neuro-navigation compatibility, high surgeon comfort and ease of use, retention of haptic feel, and angular feedback. This technology offers surgeons tools with greater degrees of freedom and this technology can be expanded beyond the screwdriver to different surgical tools and other medical procedures. The technology for screw placement in surgery is limited and relies on fixed screw delivery or difficult to control variable angle screwdrivers that offer a maximum range of 45°. Increased angular range for screw delivery improves a surgeon's ability to minimize the initial incision size, as well as decreasing the likelihood of expanding that incision or making secondary stab incisions. Increased incision size is associated with higher patient pain, increased likelihood of surgical site infections, and poorer patient outcomes. Moreover, the variable angle screwdrivers on the market cannot pair with neuronavigation to provide real time visual and quantitative feedback of location in the body. This screwdriver technology offers surgeons the ability to select the ideal angle of screw placement without sacrificing the reliability or stability of screw delivery. This work includes, but is not limited to, catheters in neurosurgical burr hole procedures, cement cannulas in orthopedic vertebroplasties, and scissors/cauterizers in abdominal surgeries. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.