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Defining New Standards of Care Technological advances are rapidly expanding the ASC landscape. BY TERRY BOHLKE

“We’re born, we live for a brief instant, and we die. It’s been happening for a long time. Technology is not changing it much—if at all.” —Apple co-founder Steve Jobs

It is a shame that Steve Jobs is no longer around to see how advances in tech- nology really are changing the equation. While death

is still as inevitable as taxes, technol- ogy is rapidly advancing the effective- ness of health care and vastly improving the clinical procedures we perform to lengthen our life spans and enhance the quality of our lives. When we hear about new technology,

we often think of computers, and there is plenty of innovation around computers, tablets, smart phones and all the soft- ware that is supposed to make our lives easier and less complicated. Hmmm. Less complicated? Well, technology also includes the vast array of medical de- vices appearing in our operating rooms, and even new ways of doing things that might not include a device of any kind. We could do an entire article on elec- tronic medical/health records (EMR/ EHR) and many have been written (see article on page 14 of November–Decem- ber 2012 issue), so let’s focus on the oth- er technologies ASCs are seeing today. Digital imaging is changing how we

do surgery. From high-definition arthros- copy and C-arms to digital ultrasound, many surgeries are now performed with some kind of digital imaging. “Anesthe- siologists are now routinely trained in residency to perform peripheral nerve blocks as well as some vascular access procedures exclusively with ultrasound guidance,” explains David Mahoney,


MD, an anesthesiologist and the medical director of Brentwood Surgery Center in Brentwood, California. “It is becoming a standard of care, necessitating our in- vestment in this technology.” Advances in imaging coupled with

advances in medical radiation have made Intraoperative Radiation Therapy (IORT) an important procedure for fighting breast cancer. Shawndra Simp- son, administrator of Aspen Surgery Center in Walnut Creek, California, describes the procedure as follows: “a balloon is placed in the breast space created by a lumpectomy, and an elec- tronic x-ray source is used to deliver radiation to the breast. The entire dose can be delivered at one time with in- creased target accuracy. A radiation on- cologist can perform this procedure af- ter the lumpectomy while the patient is still in the operating room (OR). IORT replaces several weeks of external beam radiation the patient would otherwise have to endure.” Since radiation gener-

ated during IORT has a limited range, minimal shielding requirements are necessary. The standard OR wall is suf- ficient to stop radiation scatter, making this an ideal procedure for the ASC. Another new technology that is

starting to find its way into ASCs is the robot. These are not the R2-D2 or C-3PO version from the Star Wars series. Rath- er, a robot can be as small as a softball, yet provide guidance for sophisticated procedures like spine surgery. “Having robotic technology is very expensive,” says Jennifer Butterfield, RN, admin- istrator of Lakes Surgery Center in West Bloomfield, Michigan, “but it has helped us develop a solid reputation of a high-tech ASC. Several spine surgeons have joined our medical staff because of this new technology.” Endoscopy technology has made

spine surgery less invasive and is lead- ing to better outcomes. In Warren, Michigan, spine surgeon Lucia Zamo- rano, MD, is using an endoscopic sur-

The advice and opinions expressed in this article are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


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