OPERATING THEATRE TECHNOLOGY
data acquisition technology. There has been little demand on suppliers to include services to enable artificial intelligence and knowledge sharing. Even the latest 4K integrated operating room control systems fundamentally only push video around a room, and, as we said earlier, they tend to be closed proprietary systems from endoscopy equipment manufacturers, whose primary interest is in promoting endoscopy, not communications and data-sharing. Equally, those endoscopy equipment manufacturers that do wish to open up to the IoT, and the non- endoscopic companies that purport to focus on data-enabling, are hampered by choosing underlying technology that is, in turn, proprietary and closed.
Preoperative meetings are mostly paper-supported discussions, but ‘could be greatly enhanced’ with IoT technology such as 3D modelling, Colin Dobbyne contends.
3D technology 3D technology leads us on to the ability to create devices, implants, and prosthetics, from additive manufacturing, or 3D printing, as it is often called. This will surely advance into creating artificial tissue and bespoke organ manufacturing. We are currently working on many support services – such as feeding command and control centres with data and media streams, providing desktop status views for theatre managers and remote support helpdesks for medical physics and IT staff, blackbox recordings to enable research into best practice via the correlation of statistics to outcomes, and cloud-based content management to share that knowledge in a global community. One fast-developing area, accelerated
by the COVID pandemic, is the ability to allow surgeons to be virtually present in an operating room (rather than on-call, and making themselves physically present), to either assist or mentor juniors, or to train surgeons in lower income countries wishing to develop modern surgical techniques, and particularly minimally invasive interventions.
‘Virtual’ application with a high profile This virtual application enjoys a high profile currently, with many claims as to the identity of the innovator. However, we installed our system, TheatreWatch, in Tanzania in 2010, which we believe was the first ever intercontinental tele- mentoring link over the internet, and which consequently won the coveted British Medical Journal Karen Woo Surgical Team of the Year Award in 2014. The system was used to connect surgeons at Northumbria Healthcare Trust with surgeons in the Kilimanjaro Christian Medical Centre in
Tanzania (HEJ – January 2011 and July 2014), and is now being used to export their expertise to other hospitals across the region. More recently, a much-updated system offering full HD video was installed in Ndola Teaching Hospital, Zambia, connecting surgeons to their mentors at King’s College Hospital in London. What has changed in that decade or so is that the advances in internet availability and data speed have made this service much easier to provide compared with when there was no fibre optic infrastructure, 4G, or 5G, or applications such as Teams or Zoom. Unfortunately, we had to design our own software encoder to handle the rather meagre internet available, because at that time even Skype would not work. There will be many more surgical and support applications emerging once it is generally accepted that the operating theatre is not cut off or a data black hole, but rather accessible and a hotbed of informed interventions, and a generator of a wealth of data from intelligent machines assisting the entire patient journey.
What are the obstacles to knowledge sharing? There are a number of factors holding us back, and they are from all stakeholders. The first are the surgeons themselves, as there is still some residual fixed mindset resisting advanced communication and
‘‘ 60 Health Estate Journal September 2022
A fight over video standards The professional video and broadcast television industries that provide the technology for endoscopy and 3D robotics have fought over video standards for years, and rarely have they agreed on a standard. We currently have formats such as SDI, HDMI, DisplayPort, HDBaseT, VGA, SOG, and DVI. The problem is that these signal types cannot be transmitted over a data network. Furthermore, a major technology provider for the suppliers of integrated operating theatres uses a non- standard and proprietary form of encoding and decoding – but what it calls video over IP is actually its exclusive version of IP; it cannot be shared outside of its own eco-system without buying another single- source decoder to convert to a common video format. In conclusion, we have the users, the manufacturers, and the underlying technologies combining to make it difficult to make operating theatres accessible and break out of a vendor lock. Over time, this situation must change, as a younger generation of surgeons that do not subscribe to the fixed mindset, together with hospital systems that demand deeper integration, and evidence-based white papers that incrementally and relentlessly demonstrate the improvements to be gained by knowledge sharing and artificial intelligence, will force the opening up and accessibility of the operating theatre.
Is there such a thing as having too much data? The answer to the above question is a resounding ‘no’. The problem is access to data. In the operating theatre that
We currently have very inefficient data management systems. We typically maintain multiple systems for queuing data; what is needed is a centralised system that efficiently stores and can publish that data, but only to those systems that need or want it
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