AR Headset Helps Surgeons Place Implants: Interview with Louie Vogt of Enovis Surgical

Enovis, a medtech company based in Delaware formerly known as DJO, recently announced the launch of ARVIS (Augmented Reality Visualization and Information System), an augmented reality technology that is designed to assist surgeons during implant placement in the hip and knee. The hands-free technology consists of an eyepiece that is mounted on a surgical helmet that provides the surgeon with real-time information about the position of an implant with respect to patient anatomy.

It can be difficult for a surgeon to accurately track patient anatomy obscured by a variety of obstacles, such as sterile drapes. The aim behind this new device is to allow a computer to assist with that task while impacting the surgeon as little as possible with a hands-free design. The augmented reality system is smaller and less complex than many existing surgical robotic systems.

It allows highly experienced surgeons to perform procedures themselves rather than largely outsourcing them to a machine, yet the new system provides insights that only a machine could. The technology includes infrared cameras that can track the position of surgical tools and the surgeon can mark specific landmarks on the patient anatomy to help orient the system at the beginning and throughout a procedure.

Here’s a video introducing the ARVIS system:

Medgadget had the opportunity to speak with Louie Vogt, President and General Manager of Enovis Surgical, about the technology.

Conn Hastings, Medgadget: Please give us an overview of the challenges surgeons face in inserting and aligning implants during orthopedic surgery.

Louie Vogt, Enovis Surgical: Each patient has a unique anatomy which influences the optimum placement of an implant for them. Most surgeons make detailed plans of where to place their implants based on pre-operative scans but when it comes to the actual surgery, they have limited information available to them to follow that plan. There are a lot of visual barriers, whether soft tissue or sterile drapes, that make it difficult to relate the implant location to the overall patient anatomy. Traditional instrumentation attempts to get around these limitations by mechanically guiding implant placement but there is little customization based on patient anatomy. Surgeons can also take intraoperative x-rays to confirm implant position, but this adds time to the procedure and radiation exposure for patient, surgeon and surgical staff. In contrast, ARVIS takes easily accessible landmarks registered by the surgeon and then provides the surgeon with real-time numerical feedback on their implant placement in addition to what they can see and feel.

Medgadget: What inspired you to create this system?

Louie Vogt: We saw augmented reality starting to take off in other industries and saw huge potential for this in orthopedics. To have the cutting-edge computing power of a robotic system shrunk down to something wearable, tracking from the surgeon’s vantage point and providing information right over the operative field is game-changing. We think this is the best of both worlds, it keeps the surgeon in control with their wealth of experience, but uses technology to provide them with additional information to increase their confidence in implant placement.

Medgadget: Please give us an overview of the system and how it works.

Louie Vogt: The surgeon wears the ARVIS eyepiece attached to their surgical helmet. This puts an augmented reality heads up display right in front of them, directly above the operative site. The eyepiece has infra-red cameras that track instruments which are attached to the patient and surgical instrument. At the beginning of the procedure the surgeon registers known landmarks on the patient (such as the knee center) which ARVIS uses to map out a reference frame of that patient’s specific anatomy. Then, when the surgeon is making a resection or placing an implant, ARVIS tracks their instruments to provide real-time feedback on the position. At the end of the case the surgeon is presented with a dashboard that summarizes the final values of the navigated steps of the procedure.

Medgadget: How does the technology compare with surgical robotic systems or screen-based systems? What are the advantages of a head mounted setup?

Louie Vogt: Compared to surgical robotic or traditional navigation systems, ARVIS is incredibly space conserving, portable, and low-cost. Because the system is self-contained and wearable, it adds minimal footprint to the OR. This is especially important as many ORs can get crowded between staff and equipment needed which makes it harder to maintain a sterile field. ARVIS is also controlled by the surgeon, unlike robotic systems which usually require an additional person in the OR. ARVIS captures all required data intraoperatively, unlike other systems that require a pre-operative CT which increases cost and radiation exposure. ARVIS reduces waste because there are no single use plastic components in the system that need to be disposed after each case. Additionally, ARVIS is unique in that it tracks from the surgeon’s viewpoint, not only does this keep the surgeon’s eyes on the patient and minimize the opportunity for interference, but also opens up exciting future applications like video recording, remote surgery support and more. Finally, as more surgeons start to operate out of ambulatory surgery centers (ASCs) and hospitals, ARVIS can be easily transported between sites, adding flexibility and increasing patient access to this technology.

Medgadget: What sort of impact will this system have for surgeons and patients?

Louie Vogt: ARVIS is going to expand access to surgeons and patients for high-tech, precise, computer assisted surgical guidance. Because of its streamlined, space and cost conserving design ARVIS can be adopted not just in big research hospitals, but also in ASCs, community hospitals, and other places that haven’t historically had access to this type of technology.

Medgadget: How do you see this type of technology evolving in the future? Do you think that AR systems will be useful for other surgical applications beyond orthopedics?

Louie Vogt: Absolutely, this just the beginning of ARVIS’s feature set. We wanted to start by providing real clinical value in total knee and hip arthroplasty, but the hardware in the system has the capacity to do so much more. I think of this introduction of AR into the OR as reminiscent of the first generation of cell phones. They were designed to just make calls and text but have so quickly evolved into integral parts of our lives. By giving surgeons access to a wearable computer that augments their view of the operative site, the future potential applications we could unlock are truly amazing. From teaching and telesurgery to interfacing with other smart tools to increasing OR efficiency by interfacing with hospital management systems and more, we are excited to explore those applications in the future.