138 - Improving Efficiencies in the Spine Laser Interstitial Thermotherapy Procedures
Description: A large comprehensive cancer center began using Magnetic Resonance Imaging in the BrainSUITE for the resection of brain tumors in 2006. However, since 2013, MRI technology in conjunction with laser therapy has been utilized for the resection of spinal tumors due to metastatic disease. Spine Laser Interstitial Thermotherapy (SLITT) is a minimally invasive procedure that has provided patients with less pain and faster recovery times. Extensive preparation and planning for all team members is necessary as SLITT procedures are new and must be carefully managed. A SLITT procedure workflow needed to be created to help minimize the potential for patients being compromised due to the length of the procedure. To prevent a negative impact on patient care and increase efficiency, a mock surgery was performed. Participants included nurses, surgical technologists, nursing assistants, anesthesiology, certified registered nurse anesthetists, surgeons, surgical residents or fellows, MRI technologists, neuro navigation technicians, radiology technologists and a laser system representative. This allowed the team a chance to practice the workflow and avoid potential complications. Patient positioning was discovered to be one of the issues recognized during the mock procedure. The MRI trumpf table has a bar that guides the table into the MRI machine. The bar on the trumpf table was found to hinder the c-arm machine from taking a lateral view of the patient's torso making positioning more difficult. Other positioning challenges included placing bilateral arms at the sides. Extra attention was needed to ensure that the patient was adequately padded, especially in larger patients, since the bore of the MRI was small. Additional padding was also necessary along the arms since the body coil is placed directly on them. Results of condign a mock surgical workflow for the SLITT procedure resulted in the discovery of issues proactively in positioning that would be crucial to the success of the procedure as even slight movement of the patient or the navigation array could cause inaccuracies. This exercise also allowed correct placement of the array to assure placement of the laser fibers would also be accurate. Additionally, this allowed MRI-compatible navigational instruments to be customized for the procedure to obtain optimal results. Constant updates to the SLITT procedure workflow are still needed since it is still considered to be in its infancy, so continued improvement in patient outcomes can be made. The staff who regularly work in the BrainSUITE need to continue to adhere to strict MRI safety training procedures and laser safety protocols. Further research on available positioning devices will assist in better patient care and in turn, better patient outcomes.