iPod-based navigation app helps doctor in surgery

• iPod-enabled technology gives Indiana surgeon 3-D view of the inside of patient's knee
• The FDA has approved Brainlab's Dash Smart Instrument Technology
• Indiana doctor is first in USA to use device for a pinless knee replacement

INDIANAPOLIS — A surgeon in Indiana performed the first operation in the state Tuesday with an iPod-based navigation system that allowed him to check his surgical incisions and decisions, doing more accurate and less invasive work.

At Franciscan St. Francis Health in Indianapolis, Dr. Timothy Williams went through the usual steps as he operated on Lee Couch's knee. But he stopped periodically to check his work with an unusual colleague — an iPod Touch encased in a sterile cradle.

Probes attached to the iPod made calculations in milliseconds. Then the equipment gave the doctor an in-depth 3-D view of the inside of his patient's knee, reassuring him that he was on the right track for placing an implant that would serve the patient well for years to come.

"Traditionally we try to eyeball it in until we get it right," said Williams, a surgeon with the Center for Orthopaedic Surgery & Sports Medicine, as he looked up from the operating table.

Invariably the iPod's measurements let Williams know he was on the right track, the surgeon's version of a high score in a video game.

Doctors in a handful of other places have adopted the device, which has been approved by the Food and Drug Administration and has been in use for a few years in Europe. Williams, however, is the first in the United States to use it to perform a pinless knee replacement that entails fewer incisions and requires a navigation system.

That's where Brainlab's Dash Smart Instrument Technology enters the operating room.

Couch, 68, doesn't own an iPod or iPhone. But as she waited before her surgery Tuesday morning she seemed tickled by the notion she would be the first patient in Indiana to have an iPod assist her surgery.

"I think it's great," she said. "But I don't know technology."

The Indianapolis grandmother of 15 hoped that the operation might restore her ability to take a walk or head to the gym.

Some of her grandchildren have iPhones, but it's not as though any non-medical person could use the free app to teach themselves orthopedic surgery. The secret behind the app's surgical success is the instruments that work with it. Probes that are attached to the iPod help the surgeon visualize where he's operating and the navigation camera.

The iPod and an iPad that display the information serve as relatively low-tech screens.

Other navigation systems exist. But most of those are expensive, large and hard to move. Some even require presurgery imaging. The Dash system changes all of that, hospital and company executives say.

While they declined to talk about the price of the equipment that accompanies the free app, they agreed that it was not as costly as most other alternatives.

In addition, the Dash system can readily move from operating room to operating room as it consists only of an iPod with some probes attached, an iPad and a navigation camera on wheels.

"This product has all the traditional benefits of computer navigation, however it brings efficiencies to the procedure that are unique for this technology," said Chad Galloway, Brainlab's national director of sales.

For now, Williams said he would rely on the iPod and Dash system to check his own calculations.

"I'm using this more as a check so if I agree and the computer and the iPod agree, then I'm very comfortable that we have this thing in the right position," he said. "If there is a discrepancy I will have a fallback. ... I want to do a good job for every single patient and this allows us to be a little more accurate."

Company executives say the device can be particularly helpful with complicated cases where it's difficult to see a patient's anatomy.

But it may be a long time before doctors see proof that using the iPod for joint replacements results in better outcomes, Williams said.

On average knee replacements today last 15 to 20 years. Theoretically a replacement performed with the iPod on board would hold steady even longer.

That could prove critical as the average age of joint replacement candidates has dipped in recent years. In addition, people are living longer than a generation ago. For instance, knee replacement patients used to be in their 70s; now surgeons routinely treat those in their 60s and 50s, Williams said.

Tuesday's surgery wasn't without glitches. At times a surgical instrument blocked the camera's ability to pick up and broadcast what the probes on the iPod saw.

In addition, the device was not sterilized in time for its originally scheduled debut as the first surgery of the morning.

Still, once the device arrived, sterilized and all, Williams marveled at his new toy as he put it through its paces.

"You can hold the technology in the palm of your hand now," he said. "Before you had to be set up on a desk."