Brigham and Women’s Hospital is developing new ways to resect or biopsy intraabdominal tumors by incorporating cutting-edge imaging technology within the operating room. Specifically, the Brigham’s state-of-the-art Advanced Multimodality Image Guided Operating (AMIGO) suite—a 5,700-square-foot operating room that integrates an array of advanced imaging technologies—allows physicians to more easily identify and more accurately biopsy or resect lesions in the mesentery of the bowel and retroperitoneum.
“These lesions can be difficult to locate during procedures because anatomical landmarks can shift subtly when the patient’s abdomen is distended,” said Ali Tavakkoli, MD, associate director of the AMIGO suite. “As a result, extensive, time-consuming dissection is typically required.”
The Brigham’s AMIGO suite helps solve that problem by enabling surgeons to take advantage of an integrated CT system during surgery to accurately locate the lesions. Pre-operative images are superimposed over intra-operatively obtained CT or PET images, which are registered to the patient’s body during the surgery to provide the tumor’s exact location for biopsy by a laparoscopic device.
Dr. Tavakkoli, who is working with a team of engineers to refine the procedure, expects this approach will lead to more reliable and accurate lesion biopsies. “The AMIGO suite allows us to better assess intraabdominal lesions and pathologies. It also lets us pioneer new approaches that are less invasive, quicker and more reliable, allowing patients to have quicker recovery,” he said.
In addition to abdominal surgeries, other surgical specialists at the Brigham are using the AMIGO suite to research and refine image-guided therapies, including for cardiac, neurological, lung cancer and gynecological cancer surgeries.
National Center for Image-Guided Therapy
The AMIGO suite serves as the clinical translational test-bed of the National Center for Image-Guided Therapy (NCIGT), the country’s central resource for research into image-guided procedures, as designated by the National Institutes of Health. The NCIGT encourages multidisciplinary cooperation and collaboration among teams of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses and technologists—all focused on delivering safe and effective state-of-the-art therapy in a technologically advanced and patient-friendly environment.
The AMIGO suite houses a complete array of advanced imaging equipment and interventional surgical systems that efficiently and precisely guide treatment before, during and after surgery, without the patient or medical team ever leaving the operating room. It includes MRI, PET/CT, X-ray, ultrasound, molecular imaging and optical imaging—all within the surgical suite.
At the center of the three-room, integrated suite is its operating room, which is outfitted with a state-of-the-art, electronically controlled operating table. The operating table is mounted with an MRI-compatible anesthesia delivery system and surrounded by advanced mobile imaging and therapy devices, including navigation systems that track and display the location of surgical devices and tools. All procedure images and data are integrated and shown on large LCD monitors for viewing by the surgical team.
The operating room is flanked on either end by the suite’s MRI and PET/CT rooms. A transfer board is used to safely and efficiently move patients, anesthesia systems and patient-monitoring devices between rooms. The ceiling-mounted MRI also can be slid easily into the operating room and over a patient who is already on the operating table. The combined use of MRI and CT with PET enables multidisciplinary medical teams to integrate anatomical, functional and metabolic information to enhance their decision-making during tumor removals.
“Other hospitals have started to integrate imaging into the surgical suite, but none are doing it to the extent we are here at the Brigham, with such a wide variety of advanced, real-time imaging technologies,” Dr. Tavakkoli concluded. “The AMIGO suite is a perfect example of how the Brigham is pushing the boundaries of surgical innovation.”