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May 31, 2018

Inside the OR of the future: X-ray vision, 'Siri for surgeons,' and more

Daily Briefing

    Hospitals are eyeing—and in some cases, have already adopted—futuristic OR designs and technologies to make surgery more effective and less risky, Laura Landro reports for the Wall Street Journal.

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    Why hospitals are making changes

    According the Journal, hospitals are making the changes as part of a shift away from open procedures that commonly lead to heavy blood loss and lengthy hospital stays. The changes, Landro writes, signal a future in which more patients can opt for minimally invasive outpatient procedures that lead to less pain and scarring, fewer complications, and speedier recovery.

    Redesigning the operating room

    One fundamental change hospitals are eyeing is physically redesigning the OR space, Landro reports.

    For instance, some hospitals are opening "hybrid" facilities that are equipped for conventional open surgery but also include the imaging equipment used in minimally invasive procedures. Because surgeons can complete both types of procedures in the same room, patients who need both types may need to go under anesthesia fewer times—and that translates to less time in the hospital and recovery.

    Hospitals are also examining better ways to use the space in a standard 600-square-foot OR, Landro reports. The typical OR, according to Anjali Joseph, director of the Center for Health Facilities Design and Testing at Clemson University, is "often so cramped with no space to walk in and people climbing over carts and bending over equipment, which makes for an extremely unsafe environment."

    Joseph and Scott Reeves, an anesthesiologist at the Medical University of South Carolina, are co-leading a federally funded project to improve ORs with a focus on patient safety and maneuverability. Specifically, the pair is examining whether changes such as reorganizing equipment storage to bring surgery tools closer to the operating table will result in improvements.

    Joseph and Reeves have recommended that redesigned ORs include mobile workstations and digital displays, which should be placed high on the OR's walls to allow everyone who is part of the OR team to watch the procedure in real time.

    Joseph and Reeves are also examining whether a "sterile corridor" between adjacent ORs can reduce infection risk by lowering traffic from contaminated areas. Preliminary data suggest, however, that a more important factor in reducing infection risks is limiting the number of times the door of an OR opens.

    Meanwhile, NewYork-Presbyterian has adopted several new approaches to reduce the risk of infection at its new David H. Koch Center. For instance, the facility has terrazzo flooring, which does not promote the growth of bacteria, and LED lights to illuminate the facility while producing less heat—this supports airflow that minimizes airborne microorganisms, Landro reports.

    In addition, the Koch Center has adopted ceiling-mounted surgical booms, which eliminates the hazard of cables on the floor by suspending equipment in the air

    NewYork-Presbyterian Hospital president and CEO Steven Corwin also pointed to the role technology will play in patient experience. At the Koch Center, a screen in the room where families can stay while a loved one is in surgery will display information about the medical team, and families will receive electronic updates about their loved one's status, Landro reports.

    Using responsive robots

    Developers also are continuing to research and advance the potential of surgical robots.

    So far, research on the benefits of robotic-assisted surgery has shown "mixed" results, Landro writes. Many studies indicate robotic surgeries have lower complication rate and shorter hospital stays. However, other studies find lower success rates and other drawbacks, such as higher costs.

    Intuitive Surgical Inc.'s da Vinci Surgical System is perhaps the biggest name in the field. Surgeons operate the da Vinci using a console and a video monitor to make tiny incisions using very small instruments.

    Intuitive CEO Gary Guthart said the company is in the process of developing advanced robots that will increase "collaboration and control between the computer and the surgeon," similar to the way aircraft pilots and automated control systems allow for increased collaboration.

    And newcomers—including Medtronic, TransEnterix, and more— are joining the market, Landro reports. FDA in 2017 approved TransEnterix's Senhance Surgical System for use in certain surgical procedures to allow surgeons to move a camera, choose commands for eye movements, and receive feedback based on changes in tension and pressure in the instruments.

    Using digital imaging

    According to the Journal, the University of Pittsburgh and ChemImage Corp are collaborating to develop a method to allow physicians to better visualize tissues and organs in real time using digital imagining and spectroscopy.

    Patrick Treado, founder and chief technology officer of ChemImage, said the technology, called Molecular Chemical Imaging, could be broadly applied in the hospital. Treado said the technology in the future will be designed for procedures involving endoscopies, which let physicians view and operate on organs by inserting a tube with a camera in a patient.  

    Elsewhere, Centerline Biomedical, a Cleveland Clinic spinoff, is developing an alternative to fluoroscopy-guided procedures: X-ray technologies that physicians currently use to place stent grafts within an artery, which expose patients and physicians to high levels of radiation. The alternative is designed to use a mathematical algorithm and electromagnetic tracking to offer 3-D color visualizations to allow surgeons to see the position of their instruments on a screen.

    Through a federal grant, Centerline is evaluating whether the system could function with Microsoft's HoloLens, which are mixed-reality smart glasses, to superimpose outlines of a patient's internal systems onto a physician's field of view. Karl West, a mechanical engineer and director of medical-device solutions for Cleveland Clinic and scientific adviser to Centerline, said it would be "like having X-ray vision."

    Leveraging big data

    In addition, hospitals are employing a new generation of digital tools that bring together big data, robotics, and other technologies to improve decision-making during surgeries. For example, Verb Surgical, in a collaboration with Alphabet's Verily Life and Johnson & Johnson's Ethicon, is developing a system to use artificial intelligence to identify best practices for surgeries based on data from thousands of previous procedures.

    Few details about the system are publicly available, but according to Verb, it will provide warnings and suggestions during surgery, including advising surgeons on the appropriate technique to use and how to avoid potential mistakes. 

    Verb expects to release its first product in the next four years.

    Umamaheswar Duvvuri, a head and neck surgeon at the University of Pittsburgh and the medical director of the university's new surgical innovation center, said, "Decisions need to be made in a matter of minutes during surgery, and there is an unmet need in translating existing data on outcomes to the immediate needs of surgeons." He said, "If we could have big data crunched and available at the time we are doing surgery," it would be like being able to say, "'Hey Siri, if I cut this nerve, what happens?'" (Landro, Wall Street Journal, 5/28).

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