Engineering in Surgery

WARNING: presentation contains some graphic surgical images.

Maxillofacial surgeon Dr. Ninian Peckitt speaks to the Melbourne TEDx group at Monash University, Melbourne, Australia on January 17, 2009.

For the last 20 years, Peckitt has been pioneering an engineering approach to surgery that eliminates human error, produces vastly superior results and lowers the cost of healthcare to patients and insurers.

Here he discusses some of the amazing techniques he has used to successfully rebuild the faces of patients who have suffered badly disfiguring illnesses and accidents. From CAT scan to CAD data to laser-treated resins, Peckitt develops a comprehensive model of the damaged skull, both in a CAD program and in a physical prototype.

He then engineers a solution that creates a structurally sound facial implant shape that fixes facial symmetry issues as well as structural ones. This implant is prototyped several times, and then built through an electron-beam melting process that can create shapes that five-axis milling is unable to, with no wastage and at a fraction of the cost.

When it comes time to perform the operation, Dr. Peckitt has already had the chance to plan and practice his approach on the resin skull model. He simply pulls the skin back from the face, cuts out any damaged or cancerous bone that needs to be removed, using a jig to eliminate error, then puts the insert in. It fits perfectly, first time.

In this way, surgical procedures that might have involved bone grafts, free flaps, 15-20 hours of operating theatre time and teams of surgeons can be reduced to as little as 60 to 90 minutes. Some of the cases Peckitt illustrates can go home as day care patients despite having large portions of their faces rebuilt.

Peckitt's Engineering Assisted Surgery has demonstrated some remarkable results - patients can walk in with a badly disfiguring injury that severely impacts their quality of life, and walk out a few hours later with a brand new, perfectly symmetrical face. Dentures can simply click into a titanium palate, speech is made normal again and the solutions have been proven to outlast more "creative" bone graft and free flap operations.

Importantly, the industrialised approach also leads to vastly reduced costs - in some cases as little as half the price of a traditional operation, and this will scale as volume is increased. The Engineering Assisted Surgery method also takes a lot of the thinking, errors and creativity out of the operating theatre, designing a solution that will fit perfectly and reshape the patient's face perfectly the first time the job is done, with minimal surgical trauma.

You'll agree that Dr. Peckitt's work is truly astounding.

Acknowledgements:
Dr. Ninian Peckitt (for more information, go to maxfac.com)
Melbourne TEDx team
Monash University, Caulfield
Erik Unger & Rob Caporetto for video and sound recording


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Surgery