Room to Operate

Dartmouth's new Center for Surgical Innovation makes space for research in clinical care

The new CSI surgical suites are spacious enough for research teams and equipment.

MRI and CT scanners slide in and out of operating rooms on overhead rails giving surgeons real-time 3-D images of complex organs like brains and spines. Students observe from a balcony overhead. This changes everything.

Imagining what life would be like if medical technologies never advanced is not hard. "We would be dying sooner and of many more diseases if we hadn't put money and effort into research," says Keith Paulsen, Robert A. Pritzker Professor of Biomedical Engineering; professor of Radiology at The Geisel School of Medicine at Dartmouth; director of the Dartmouth Advanced Imaging Center and co-director of the NCCC Cancer Imaging and Radiobiology Research Program.

Keith Paulsen

Keith Paulsen, co-director of NCCC’s Cancer Imaging and Radiobiology Research program, helped create the nation’s first surgical center reserved for research.

The Center for Surgical Innovation (CSI) features two operating rooms that are large enough to accommodate multiple researchers and equipment. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) systems can be moved from one operating room to the other along ceiling-mounted tracks. Two diagnostic imaging rooms can be used for nonsurgical or minimally invasive procedures. Windows overlook the operating and diagnostic rooms so researchers and students—from undergraduates to graduate and medical students—can observe surgeries, imaging sessions, and other research activities. The CSI also includes ancillary offices, patient holding spaces, control rooms, and labs, including a small wet lab for tissue studies.

A national destination for patient care and innovation

The value of medical research is why Paulsen and Sohail Mirza, MD, chair of Dartmouth-Hitchcock Medical Center's Department of Orthopaedics, have worked together to create the CSI the nation's first surgical facility dedicated to translational research.

Paulsen, CSI scientific director, and Mirza, CSI medical director, will oversee research that combines Thayer expertise in biomedical engineering, imaging, and computation with clinical expertise at Dartmouth-Hitchcock Medical Center and Geisel School of Medicine—research that uses the CSI to test new approaches in the operating room, such as complex real-time image-guided surgical procedures.

The nation's first surgical facility dedicated to innovative cancer research

The CSI mitigates a major limitation for researchers: a lack of operating room time and space for the clinical studies on animals and humans that must be carried out before any new technique or technology becomes standard practice. While various hospitals, including those affiliated with Duke and Johns Hopkins universities, have surgical centers dedicated to imaging research and innovation, the CSI is the only one where research won't have to compete with clinical care. Completely separate from Dartmouth-Hitchcock's busy operating rooms, the 12,000-square-foot CSI is largely free from the scheduling and financial realities that drive high-volume clinical surgical units. "The pressure to make this a profit center where patients need to get in and out won't be prevalent," says Paulsen.

Although most of the research will benefit patients in the future, Paulsen says the CSI gives Dartmouth-Hitchcock surgeons access to the most advanced surgical environment for handling complex cases that would otherwise end up elsewhere. "If we didn't build this center, all of our patients would go to Boston," Paulsen says. "If you want to do research, you have to create your own space."

The $20 million CSI began to take shape in 2010, when Thayer, Geisel, and Dartmouth-Hitchcock matched $10 million in federal stimulus money. Adjoining Dartmouth-Hitchcock's Advanced Imaging Center—which Paulsen, an imaging expert, also directs—the CSI occupies space below a new clinical radiology unit, which factored into the project planning.

CSI will support ongoing research in brain and breast imaging and other emerging research programs

The CSI will leverage previously funded research in brain and breast imaging and also roll out new programs in interventional psychotherapeutics and intraoperative biomarkers for guiding surgical resections. The CSI will introduce emerging research programs in prostate surgery, intraoperative oximetry imaging, and in vivo optical microscopy.

The CSI will also be open to researchers beyond the Upper Valley, including companies that need to conduct preclinical trials en route to securing FDA approval for new technologies, products, and procedures. "My goals for the CSI is to have enough resources and personnel to allow maximal use of the facility, and provide easy access to any student or faculty member anywhere in the world to bring their ideas here," says Mirza.

"The CSI will be a national destination for patient care and innovation," he says. "We want outside engineers, biomedical scientists, and physician-researchers to bring their ideas to the CSI because it will have the very best capabilities."

This piece was excerpted from an article by Anna Fiorentino in Engineer. Read the full article here.

April 14, 2014