Surgeons at Penn Vascular Surgery and Endovascular Therapy are now using Fiber Optic RealShape (FORS), a recently FDA-approved alternative guidance system, for minimally invasive endovascular aortic surgery. Penn Medicine is one of five medical centers in the United States granted access to FORS at this time.
FORS is a unique advance in that it permits real-time, high-fidelity 3D intraoperative visualization of devices (e.g., catheters and wires) inside the body in the near absence of radiation.
"FORS is a significant advance not only for the reduction in radiation risk, but because we're now able to visualize catheters and wires in three dimensions using multiple different projections simultaneously — head-to-toe views, for example — that were previously impossible," says Darren B. Schneider, MD, chief of Penn Vascular Surgery and Endovascular Therapy.
FORS — A Force in Imaging Guidance
A screen capture of the biplane visualization tools available with the Fiber Optic RealShape system.
FORS is based upon laser light refracted along optical fibers and analyzed through integration with images obtained preoperatively to generate real-time renderings of the shape of intra-body devices, as well as detection of strain, bend, and twist along these devices. Intraoperatively, FORS-enabled wires and catheters containing thin optical fibers are rendered on screen as magnified 3D images with distinct colors to improve visibility. These renderings can be further superimposed with images from patients' CT scans and x-ray images to provide non-radiation-based guidance during complex endovascular procedures.
FORS is incorporated into a hybrid operating suite, and consists of a desktop viewing station; a trolley on wheels (the "FORS engine") containing the light source and hardware necessary to process the returned data; and a docking station attached at the bedside, which connects FORS-enabled catheters and guidewires to the engine.
"FORS is a very intuitive system, and one we've been able to adapt very quickly into our existing hybrid OR environment," says Dr. Schneider. "Most importantly, using FORS we are performing complex endovascular procedures-such as minimally-invasive repair of thoracoabdominal aortic aneurysms-better and with significantly less radiation exposure to patients and staff than ever before."
Initial studies of FORS demonstrate that the technology is safe and efficacious in diminishing procedural complexity. To date, FORS has been applied primarily in complex endovascular aortic interventions, such as endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched stent grafts, and early findings have been encouraging.