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Larry Smarr Drives Innovation as Experimental Patient of the Future

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visitors enthusiastic walk-through “tours” of his colon in the StarCave, an immersive visualization lab at Calit2, and used a 3D printer to create a model of his sigmoid colon.

Two weeks before his scheduled colectomy on Nov. 29, Smarr and the surgeon, Dr. Sonia Ramamoorthy, convened a planning meeting with about 16 doctors, osteophaths, and UC San Diego faculty from gastroenterology, radiology, bioengineering, robotics, design, and computer visualization. “Everyone involved is quite excited, and are planning on writing this up as a scientific paper and are formulating new grant proposals as a result of this pilot,” Smarr wrote to me in an email.

In advance of their meeting, Smarr worked with colleague Jurgen Schulze to painstakingly create a scalable, 3D “Google map” of the major organs involved in the surgery. They made the large intestine bright green. The bladder is light blue, the spleen is purple, the aorta is red, and the vena cava is blue.

(Image by Jurgen Schulze of Calit2/UCSD)

In an email, Smarr writes: “We found 3 key items that would be critical during the surgery. 1) the sigmoid colon had major kinks at both ends, 2) the sigmoid was sitting on the bladder, and 3) the upper part of the large intestine had 3 turns at the splenic flexure and was likely attached to the spleen.”

Ramamoorthy, who is chief of colon and rectal surgery at UC San Diego, said using “this perfect Google map” of Smarr’s abdomen gave the surgical team a much-better idea of what to expect, and enabled her to plan the operation more efficiently. She estimated it may have saved more than an hour from what turned out to be a five-hour surgery.

Normally, the imaging used to plan such a procedure could include standard MRI and CT scans. They are not three-dimensional views, however. Ramamoorthy also noted the organs in the gut tend to shift and move around.

In the operating room, a wall-sized screen is capable of displaying multiple, different images simultaneously. So, during the surgery itself, Schulze was able to provide a side-by-side comparison of the 3D visualization of Smarr’s abdomen with the live video feed from the four-armed DaVinci robotic surgery system.

“If we didn’t have this technology, it would have taken longer to figure out workarounds,” Ramamoorthy said. “It would not have gone as smooth.”

Creating an accurate image of Smarr’s vital organs enabled the surgeon to plan the operation in a more detailed and individualized way, she said. She also expects the technology to become less expensive over time. “There’s a lot to be gained by this type of surgery,” she said.

The operation was not a first in terms of using computerized visualization tools in surgery, Smarr said. “They do this kind of thing for brain surgery and sometimes arterial surgery, and that’s why I knew we could do it,” Smarr said.

But Smarr said he believes it’s the first time such visualization tools were used to remove part of a colon, and it puts San Diego at the forefront of combining computer visualization, robotics, and medical innovation.

In the three months since the operation, Smarr said blood tests show that his C-Reactive Protein (a key measure of inflammation) has declined from 61 milligrams per liter of blood (which is extremely high) to slightly more than 1.0, within normal bounds. Smarr, who will be 69 this year, said he feels like a new man.

[UC San Diego Health has posted more information about Smarr’s surgery here.]

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