Penn Medicine Pioneers Non-Radiation-Based Fiber Optic RealShape (FORS) Guidance for Aortic Surgery

FORS system
A screen capture of the biplane visualization tools available with the Fiber Optic RealShape system.

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 (including the renowned Penn Aorta Center) 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

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 superimposed with images from patients' CT and x-ray scans to provide non-radiation-based guidance during complex endovascular procedures.

FORS is integrated into a hybrid operating suite, and consists of three main components: a desktop viewing station, a mobile trolley (referred to as the "FORS engine") that houses the light source and the hardware required to process the returned data, and a docking station located at the bedside, which connects FORS-enabled catheters and guidewires to the engine.

"FORS is a very intuitive system, and we have quickly adapted it to our existing hybrid OR environment," says Dr. Schneider. "Most importantly, by using FORS, we are able to perform complex endovascular procedures—such as minimally invasive repairs of thoracoabdominal aortic aneurysms—more effectively 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.

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