How mixed reality gives Dr. Dave Shukla a new perspective on shoulder surgery

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Dave Shukla, MD, became the first surgeon to use mixed reality for a shoulder replacement in New York state, New York City-based Mount Sinai told Becker's in a March 23 email.

Dr. Shukla used Stryker's Blueprint mixed reality system, he told Becker's. He shared his experience with the system and his outlook for orthopedic medtech.

Note: Responses were lightly edited for clarity and length.

Question: What was the biggest learning curve when training with this?

Dr. Dave Shukla: The biggest learning curve was the hand gestures and voice commands.  This required some practice, which was done prior to the surgery, to master the gestures that allowed me to move the patient's 3D hologram of their anatomy within my field of view. However, once done, it allowed for a far greater intraoperative understanding of the anatomy than ever before. Also, I was able to see, using the "bone transparency" function, exactly where I intended my implants to be according to my preoperative plan. This drastically helped minimize any deviations from that plan. In shoulder replacement surgery, slight deviations of even 1 or 2 millimeters or 5 degrees in the wrong direction can significantly affect how the implant functions and how long it lasts.

Q: How has your first patient been postoperatively? Can you say anything about her recovery compared to similar patients?

DS: [She] has been recovering well. Her surgery was slightly more complex as there was a history of prior injury and surgery elsewhere, with existing hardware and bone deformity at the time of her surgery with me. As compared to similar patients with her level of preoperative complexity, she is recovering as expected. 

Q: What is the outlook for mixed reality in your practice? Do you have more cases planned? Do you think you will use this for other applications besides the shoulder?

DS: Mixed reality will be utilized heavily in my practice, and likely for most shoulder replacement surgeries moving forward. The technology offers significant advantages throughout the spectrum of care surrounding shoulder replacement. Increased utilization of 3D imaging and templating has greatly enhanced our understanding of patient anatomy and how to reconstruct a functional joint.

Preoperatively, I utilize the ability to display the hologram on a peripheral monitor and can really explain to patients their anatomy and operative plan beforehand by actually pointing out specific features on the hologram itself, which really enhances shared understanding and shared decision-making between the patient and the surgeon.

Intraoperatively, I have the ability to visualize anatomy in 3D and see a hologram of the intended implant position greatly improves my ability to execute the plan as closely as possible, but also to adjust and adapt to unexpected challenges.

Q: How do you expect mixed reality to grow in orthopedics? Are there any other technologies that excite you in the specialty?

DS: We are just scratching the surface of the potential possibilities of mixed reality currently.  This technology may be very useful for orthopedic trauma as well. I would expect its use to grow as more features are incorporated into the technology, such as the ability to reliably use it for instrument navigation.

Instrument navigation, without mixed reality, has been used in shoulder surgery and is an emerging technology that holds immense promise. Along with instrument navigation comes robotic surgery, which is currently in use for hip, knee and spine surgery, to name a few. This technology is gradually making its way into the shoulder replacement space and has the potential to improve accuracy and reliability.

Q: Are there any other major developments in surgical tech at Mount Sinai?

DS: The most significant major development in surgical tech at Mount Sinai was the $11.6 million grant from Mayor Eric Adams and the New York City Economic Development Corporation (NYCEDC). This grant was provided to launch the Comprehensive Center for Surgical Innovation and to expand Mount Sinai Biodesign, which will help change the future of surgery, advance quality care and contribute to the economic growth of New York City.

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