Surgeons used pre-surgical planning software to develop transplant guides for the donor (left) and recipient (right). [Image courtesy of NYU Lagone Health]
Surgeons used DePuy Synthes technology for the world’s first whole-eye and partial-face transplant.
The 21-hour procedure was performed by a 16-person surgical team and 80-person operating room team on Aaron James, a military vet who lost his left eye and much of his face in a high-voltage power accident while working as a utility lineman.
Led by NYU Langone Health’s Dr. Eduardo Rodriguez, the team gave James a donor’s eye and part of their face, including the orbital bones, surrounding eye tissues and the optical nerve, left upper and lower eyelids, left eyebrow, nose, upper and lower lips, and underlying skull, cheek, nasal and chin bone segments, including muscles, blood vessels and nerves.
James spent 17 days in the intensive care unit after the May 2023 procedure, which NYU Langone said was one of the fastest recoveries among Rodriguez’s face transplant patients.
Eye and partial face transplant recipient Aaron James [Photo by Mateo Salcedo/NYU Langone Health]
In September, James returned to his family’s home in Hot Springs, Arkansas. It’s not yet known whether he will ever be able to see with the transplanted eye, but NYU Langone said the eye is showing “remarkable signs of health.”
“It was a historical moment for medicine [and] a proud moment for us, but even moreso for Dr. Rodriguez and his team, and most importantly, for Aaron,” said Oray Boston Jr., the worldwide president of trauma, extremities, craniomaxillofacial, animal health and sports at DePuy Synthes.
In an interview with Medical Design & Outsourcing, Boston and Marianne De Angelis — director of global growth marketing for craniomaxillofacial, thoracic and upper extremities at the Johnson & Johnson unit — discussed how DePuy Synthes technology played a role in the first-of-its-kind procedure.
Speed was of the essence to limit how long the transplanted eye and face tissue went without oxygenated blood. The surgical teams also wanted to minimize the procedure time to limit how long James was under anesthesia and reduce the risk of complications.
Marianne De Angelis is director of global growth marketing for craniomaxillofacial, thoracic and upper extremities at DePuy Synthes. [Photo courtesy of DePuy Synthes]
Surgeons used specialized components from DePuy Synthes and the company’s Trumatch CMF software for 3D, virtual surgical planning. That software used CT scans of James and the tissue donor to plan both surgeries and develop 3D-printed polymer cutting guides and anatomical models. Then surgical teams in situations like these will rehearse with mock cases, looking for ways to improve the plan each time through.
“For every one of those cases, this technology is utilized as if it was the real [procedure]: patient/recipient scan, put into place, planning done, guides made, models made, implants implanted — the MatrixMidface plates and screws. [They’ll do] this repeatedly, time and time again,” De Angelis said.
In this case, the teams rehearsed over the year leading up to the procedure. When it was time for the real deal in two operating rooms, the software helped the surgeons make high-precision bone cuts and place the Depuy Synthes MatrixMidface craniomaxillofacial plates and screws to reconstruct James’ face.
Oray Boston Jr. is the worldwide president of trauma, extremities, craniomaxillofacial, animal health and sports at DePuy Synthes. [Photo courtesy of DePuy Synthes]
“When they went through the transplantation, everything was planned so that it was seamlessly executed. … The facial bones and the tissue and the entire eye all lined up to precisely where it needed to be,” De Angelis said.
“Every minute counts. … They were there for 21 hours,” Boston said. “So imagine if this were trying to be done without this technology, how many hours it would have been — and could the patient have withstood that amount of time on the table?”
NYU Langone said James is looking forward to Thanksgiving for his first holiday meal with his family since the accident. He’ll return to New York monthly for follow-ups.
“What we’re witnessing now is not something we ever expected or thought we’d see,” NYU Langone retinal specialist Dr. Vaidehi Dedania said in a news release. “The first step is having an intact eyeball. A lot of things could come after that; this is a first in the world, so we are really learning as we go.”
Dedania will continue tests of James’ transplanted eye, including helectroretinography to measure the electrical response of the retina to light. The eye has a viable cornea and “great blood flow” in the retina, NYU Langone transplant surgeon Dr Bruce Gelb said. The team injected stem cells into James’ optic nerve during the transplant to try to enhance nerve regeneration, another first-of-its-kind procedure.
“We’re now crossing into the frontier of the central nervous system,” NYU Langone neuro-ophthalmologist Dr. Steven Galetta said in the release. “Whatever happens next allows the opportunity for various methods to try to enhance the remaining aspects of the retina, whether it be through growth factors, stem cells, or a device that can pick up the signals and then bypass things along that optic nerve pathway.”