OPERATING THEATRE TECHNOLOGY ‘‘
Colin Dobbyne says: “The current generation of robots are not autonomous machines; they are precision manipulators where the human surgeon is in full control of all movements. In future this will surely change to semi-autonomy and beyond.”
same way you would not send an aircrew into congested airways with no radar, radio, or ground intelligence, you should not send a surgical team into the void, cut off from potentially life-saving support from modern technology. In all other technical fields, the move
towards better communication, crew/team resource management, and the availability of reliable information, have improved performance and increased safety. So, why has it not been done yet in surgery? If you consider this kind of connectivity to be unnecessary in operating theatres, believing that surgeons and teams carry with them all the knowledge that they may need, then consider for a moment the fundamental issue of wrong-site, wrong- patient errors (WSPEs). Approximately 1 in every 100,000 procedures results in a WSPE – that doesn’t sound much until you consider that in 2019 there were 48 million surgical procedures conducted in the US alone.
Communication issues Analysis of these errors reveals that communication issues were the prominent underlying feature, and that 80 per cent of WSPEs are a direct result of simply confusing left and right. Although this particular confusion does not account for the unfortunate woman who underwent an invasive cardiac procedure intended for another patient, an enquiry revealed that there were 17 distinct and avoidable communication errors that culminated in this wrong-patient procedure going ahead. Preoperative briefings are now
commonplace, and proven to reduce such errors, but what about improving the procedure in more subtle ways? If our surgical teams are capable of operating on the wrong patient, removing the wrong part of an organ, or removing the wrong organ altogether, what more subtle improvements could be made if they had better communication and better information at their fingertips?
Processing power and storage should be distributed, unlimited, and unbreakable, with redundancy built in
Better informed Surgeon responsibility is so great, and the risks so high, that it makes sense for them to benefit, in a preoperative briefing, or even during surgery at a moment of indecision, from the distillation of the experience of everyone else who has ever carried out a given procedure, rather than being stranded by their own personal experience – i.e. to be informed in the choices they make, and to benefit from a collaborative support system that is somehow monitoring surgery, managing resources, and generally watching their backs for the welfare of the patient.
What is Surgery 4.0? My own vision is that the operating theatre should be a cyber physical system just like almost every other aspect of our life – from driving and navigation, where cars are constantly streaming and receiving data, to how we learn and shop online, listen to music, or have film and documentary recommendations sent to us in e-notifications. These cyber systems take care of our safety, warn us of delays or dangers, or impending bad weather, or inform us about things to do in a given area at a given time – our preferences are being gathered and honed to provide us a better ‘life experience’, it is claimed. Imagine surgery like that, where every
piece of available data is scanned to predict or forewarn of clear and present dangers, where information is made available, where treatment options are presented at decision bifurcations, where aftercare is tailored to the patient, and where the hospital’s resources are constantly analysed in order to modify scheduling to achieve 100 per cent optimised efficiency – saving money and improving outcomes. I believe that the data generated in an
operating theatre is the hospital’s data, and that any hospital partner with the authority and credentials to use that data meaningfully – to turn data into insights – can improve the hospital’s efficiency, productivity, and, ultimately, patient outcomes. This democratisation of data and knowledge is crucial if we are to make this transformation.
A typical integrated OR deals with clutter and cables, but does not embrace connectivity to any real enterprise level.
58 Health Estate Journal September 2022
Advances in the next 20 years The Commission on the Future of Surgery, set up by the Royal College of Surgeons
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