The world of jaw reconstruction has been revolutionized by virtual surgical planning (VSP), but there are concerns about its accessibility for Australian patients. VSP, utilizing high-resolution CT imaging and 3D printing, has transformed the way surgeons approach complex procedures, offering a more precise and collaborative approach. It enables the creation of patient-specific cutting guides and positioning jigs, reducing operative duration, ischaemia time, and postoperative complications. This technology has shown promise in reducing operative time and improving cost-effectiveness, making it a valuable tool for surgeons, especially those early in their careers or in lower-case volume units.
However, the author highlights a potential issue: the disparity between VSP's intended and actual use. The Commonwealth review has raised concerns about access restrictions, and the author argues that withdrawing publicly funded VSP without sufficient evidence would be detrimental. The current evidence base is limited, with most studies focusing on small patient cohorts from overseas health systems, and there is a lag between planning and implant placement. This lag can lead to biological changes, such as cancer growth, making it challenging to modify implants if needed.
The author emphasizes the need for better data on the real cost and effectiveness of VSP in Australian settings. They suggest a coordinated, prospective effort to capture operative duration, complication rates, length of stay, and whole-of-episode cost, benchmarked against conventional freehand surgery. This data will provide a more comprehensive understanding of VSP's value and help justify its continued use.
Additionally, the author supports the development of in-house CAD/CAM capability in Australian centers, which can address issues related to outsourcing planning overseas. While VSP has its limitations and isn't without cost, the author believes it has made jaw reconstruction more precise, collaborative, and reproducible. Restricting access to VSP without further evidence, they argue, would be a setback for patients and a regression to less precise techniques.
In conclusion, the author calls for a more thorough evaluation of VSP's benefits and costs in the Australian context, ensuring that patients receive the best possible care and that the technology's potential is fully realized.
