OPERATING THEATRE TECHNOLOGY
Creating a roadmap for more automated surgery
Colin Dobbyne CEng, MIET, operating theatre control system designer, examines the IoT (Internet of Things) technology that he says could modernise operating theatres, transforming them ‘from isolated workspaces to being part of an active collaborative support system’, harnessing Surgery 4.0, and, in the process, ‘radically changing the way surgery is performed’. He explains the technology needed, the potential benefits, and how to remove current barriers.
I will begin this article by looking at where are now in terms of the prevalent operating theatre technology – and in the main we are locked in Surgery 3.0, which is where we have been for almost 60 years. Surgery started thousands of years ago as a manual intervention, performed in the best light that you could find – Surgery 1.0. This carried on right up until the late 19th century, and the advent of electricity, and the light bulb in particular, transforming surgery, and giving rise to the birth of effective endoscopy – Surgery 2.0. The next evolution – Surgery 3.0 – came with the invention of the silicon chip in 1961; electronics rapidly brought amazing advances, with sophisticated systems such as anaesthetic machines, electro-surgical units, programmable logic controllers, computing, sensors, endoscopic cameras, lasers, and so on.
A ‘typical’ theatre environment In a typical operating theatre, equipment is arranged around the room, and a nurse sets up each device as required by the surgeon – very rarely are these machines connected together or to a data network, let alone the internet. The floor is often covered in cables and cords, creating trip hazards, risking the pulling out of an essential plug during surgery, or the chance of damage to the equipment. This is improved upon with an integrated operating theatre, but even those, in their current form – although more ergonomic – only provide a moderate improvement in terms of greater efficiency, better teamwork, and reduced stress levels, and do not really progress us to the next stage. Before surgery begins, preoperative data
is provided for each case. This may come digitally from different systems that talk clumsily to each other, or even on paper; generally, there is no ability for external communication with operating theatre devices. Even if physical connections were possible, the vast majority of integrated operating theatre systems are ‘closed’ systems, and proprietary, meaning they are
not designed to share data easily – rather ‘by invitation only’.
Adoption in ‘mission-critical’ applications In my system designs for my medical technology clients, I make use of SDVoE (Software Defined Video over Ethernet) technology that is revolutionising the professional video market, and that has been adopted in mission-critical applications such as NASA control and command centres. The problem of closed and proprietary systems is overcome because the SDVoE format is, by design, an industry standard open to many manufacturers to contribute to its eco-system. The key to the evolution of the modern operating room is to have a vendor-neutral system architecture that operates on standard IT infrastructure and communication protocols. Closed systems are bound (and limited) by the appetite
and will of the proprietors to develop new services, and with the added high cost of meeting new regulatory requirements, many R&D projects are being shelved. To break free of these constraints, and
promote interoperation, the eco-system needs to be open to allow other third- party manufacturers to integrate their services, breaking the stranglehold of proprietary systems – as the old adage goes, ‘monopoly stifles innovation’.
Why operating theatres need to be ‘connected’ In terms of invasive therapy, the operating theatre is the ‘cockpit’ of a hospital – a place where split second decisions can have a significant impact on a patient’s life – positively in the main, but occasionally catastrophic. It is also the profit centre of the hospital, with a constant drive for improvements in outcomes and costs. It just seems common sense then, that in the
Surgery ongoing at the Kilimanjaro Christian Medical Centre in Tanzania in 2009 – on the first occasion that TheatreWatch was used with no UK surgeon present in the operating theatre. Surgeons in the UK theatre, 5,000 miles away in Northumbria, are guiding Dr Chilonga Kondo through a laparoscopic procedure.
September 2022 Health Estate Journal 57
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