Great Ormond Street Hospital. Apple Technology Helps Improve Surgical Treatment for Children
A month-old baby girl lies anesthetized in an operating room at London’s Great Ormond Street Hospital for Children (GOSH). Her life prospects up to this point have not been good. She suffers from a congenital condition known as atrioventricular septal defect (AVSD) — a complex hole between the right and left sides of her heart, compounded by a drastically undersized left ventricle – the chamber that pumps fresh, oxygenated blood from her lungs to the rest of her body. Without corrective surgery, she faces a shortened life and a childhood robbed of vitality.
Professor Martin Elliott and his surgical team have planned this surgery carefully on a Mac using a 3D model derived from CT scan images. They have already closed the hole, dividing the heart into its normal right and left sides. Their mission now is to enlarge her left ventricle to create normal blood flow. Elliott is working inside a heart the size of a walnut, in a ventricle less than a cubic centimeter in volume. He inserts the 3mm tip of a camera into the ventricle. Instead of the normal smooth interior, the camera’s monitor display reveals multiple trabeculi - bundles of muscle - connecting its right and left sides. He cuts the bundles, and the ventricle springs open to normal size.
This is a new procedure, created for a tiny patient with a rare and unusual problem. Captured on video, archived, edited, and labeled using Apple technology — it will be shared with surgeons around the world. Many other children will benefit.
Using the Mac to Plan and Capture Surgeries
Dr. Elliott is head of the Cardiothoracic Unit at GOSH, a teaching hospital devoted to children. He plans his delicate surgeries using OsiriX, a Mac-based open-source medical image viewer. Using OsiriX lets him review scan images locally on the Mac.
“We use OsiriX to process CT and MRI image files into 3D images and work out what we can do for these kids,” says Elliott. “We get a lot of scans from referring physicians on CDs. Rather than beat them through the hospital’s PACS system, which we find quite limited, we put them through OsiriX on our own Macs. That gives us the ability, not just to view and manipulate the images in a local, user-friendly way, but to very easily export them as QuickTime movies for Keynote presentations, for written or published work, or for the families of these children.”
Once his demanding, hours-long surgeries — like the real case described above — have been planned and executed, Elliott and his team face another challenge: How do you tell other surgeons about it? Elliott virtually invented a new procedure to deal with the little girl’s unusual AVSD defect, and he is always concerned about passing his experience along to other surgeons, starting with the students who observe him during the operation.
“Only the surgeon can see inside the heart during the operation,” says Elliott, “When you’re learning, you stand opposite the surgeon and you can only see the heart by leaning over. From that view, you see it upside down and back to front. If I want to teach you a procedure, I have to assume you’ve learned enough to do it the other way round, and that’s a big risk for a baby.”
On the other hand, video of the procedure, taken from the surgeon’s viewpoint and captured on the Mac, is a superb tool for teaching surgical techniques. When they operate, surgeons in the unit wear a head-mounted camera that relays images to four screens around the operating room. They use a glass tube camera to get close-up looks inside the heart. They capture video of the entire operation on the Mac.
“We have shifted our video storage from the hospital’s system to our own Apple-based system,” says Elliott. “We had been recording on DV tape, but we’re now recording directly to a hard drive on a Mac.”
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The Impossible Airway Procedure
For children born with very narrow tracheas — as narrow as a millimeter — life is a desperate fight for air. Most children in the UK and northern Europe with this defect are referred to Dr. Elliott, who runs a National service to deal with the problem.
“We do an immense number of operations using a technique called slide tracheoplasty,” says Elliott. “Quite a difficult operation to explain to parents and other surgeons. The principle you can describe fairly easily, but people don’t believe you can do it.”
Elliott cuts the airway in two, severing it at the midpoint. He makes a lengthwise cut on the top of one section, and one on the bottom of the other. He opens them wide, slides one section over the other, and attaches them along the length.
“You create a new airway that is half the length but has four times the radius and much greater circumference,” says Elliott. “You have a much wider, shorter trachea.
“Recording those operations and making videos about it on the Mac has not only helped other surgeons learn this technique but it’s also helped parents and families understand what we need to do for their children. And I think the ability to share those videos has greatly increased the confidence of other surgeons and families in the outcome of the treatment.”
GOSH: A Remarkable History of Helping Children
In 1852, a third of the children born in London never reached adulthood. Great Ormond Street Hospital opened that year with just ten beds, dedicated to help stem the tide of infant mortality. Queen Victoria quickly offered support. J.M. Barrie donated the copyright to his play Peter Pan. Charles Dickens’ powerful fund-raising speech at the Freemason’s Hall brought in enough to buy the house next door and double the number of beds. Fundraisers helped GOSH back on its feet after a World War II bombing.
Today the hospital treats thousands of children a year who suffer from rare and complex conditions that often threaten their lives. The British National Health Service funds operations, but the hospital relies on its charity to deliver the exceptional resources these young patients need.
