Crohn’s Disease Patient Invites the Public to Look Inside His Virtual Colon, Shows 3D Model to Surgeon Before Procedure

Larry Smarr

Crohn’s disease is a painful and sometimes scary condition, but for Larry Smarr, it was a fascinating learning opportunity – not only for him, but for the general public he allowed to examine his colon in virtual reality. Smarr, the founding director of the California Institute for Telecommunications and Information Technology (Calit2) and a professor of computer science and engineering at the University of California San Diego, isn’t shy, and he’s very curious; in the past, he’s had his own blood and stool samples analyzed for the data contained in them. When he began having digestive issues in 2012, he took the opportunity to do his own research.

Smarr obtained MRIs of his abdomen and worked with computer scientists Jürgen Schulze to create a 3D image. As part of his work at Calit2, which is a joint venture between UC San Diego and the University of California Irvine, Smarr shows visitors the StarCAVE, an immersive, high-definition, walk-in virtual reality environment that can accommodate up to six visitors at a time. Why not, he thought, let visitors wander around in his own virtual intestines as a demonstration of the broad, real-world applications of virtual reality?

Why not, indeed? As a result of Smarr’s work with Schulze, the StarCAVE soon surrounded visitors with a 3D image of Smarr’s innards, allowing them to clearly see the inflamed area that would eventually be diagnosed as colonic Crohn’s disease. The diagnosis wasn’t the end of Smarr’s technological experiments involving his own body, though. Towards the end of 2016, the twisted part of his intestine became nearly closed off, requiring surgical removal. A few days before the surgery, Smarr invited his surgeon, Dr. Sonia Ramamoorthy, over to take a look at the 3D images he and Schulze had created.

Schulze works with the 3D images from Smarr’s scans.

As Dr. Ramamoorthy examined the virtual organ in front of her, she could clearly see how far back she would need to cut to make sure that all of the scarred, twisted tissue was removed. But as Schulze began adding in other, color-coded organs such as the bladder and spleen, she noticed something else that made her change her plans entirely. Because of the unusual path Smarr’s bowel took through his abdomen, it attached to his spleen in a more distant location than expected from the damaged intestine to be removed, meaning that Dr. Ramamoorthy would need to do some additional work to reattach the two ends of the intestine after the removal.

Dr. Ramamoorthy studies Smarr’s colon in the StarCAVE.

With that knowledge, Dr. Ramamoorthy cut five access ports in her surgical robot in different locations than originally planned. If she hadn’t known about the issue beforehand, she would have had to either abandon the robot altogether for a different technique during the surgery, or undock it and make a new access hole while her patient was on the table, adding at least 30 or 40 minutes to the procedure.

“He helped me see what I was going to encounter during the operation, to start to plan my road trip way in advance and already know where the traffic jams were going to be so I could work around them,” she said. “We were able to place our ports perfectly to allow us to accomplish the goal. Otherwise, we would have been off.”

The surgery took place at the end of November, and Smarr has recovered, keeping a 3D printed replica of the removed part of his colon as a memento. While 3D imaging and printing are becoming common in heart and brain surgeries, he says, they’re still rarely used in abdominal, and particularly colon, surgeries. He would like that to change.

Larry Smarr with his 3D printed colon

“It’s really in the last couple of years that you’ve been able to do this kind of simulation on a laptop, and I think it’s totally doable to increase the use of 3D in this kind of surgery,” he said.

He’d like to see a new StarCAVE located in UC San Diego’s Altman Clinical and Translational Research Institute building, which is attached to the new Jacobs Medical Center, so that a team could quickly and easily take MRI or CT scans and turn them into 3D models that surgeons could study the way Dr. Ramamoorthy did before Smarr’s surgery. In the meantime, Smarr still has plenty of his own work to do – he’s currently studying the microbiome of his colon to try to figure out how the inflammation that led to his surgery happened. Discuss in the Patient 3D Model forum at 3DPB.com.