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OPERATING THEATRE TECHNOLOGIES


particular surgery so ground-breaking was that the patient was on a robotic bed that can automatically help perform a magnetic resonance imaging (MRI) scan while an Artificial Intelligence (AI) system actively supports surgeons by suggesting various procedures.


This was the first clinical use of the latest version of the institution’s Smart Cyber Operating Theatre, known as Hyper SCOT. Hyper SCOT transforms surgery from an analogue process, where standalone equipment is not connected, into a digital process – where data are shared. It provides surgical teams with a rich stream of data from networked medical tools, as well as AI-powered advice on surgical options. It can improve precision by helping brain surgeons to accurately navigate to a tumour site, and providing MRI scans during the procedure.


Throw out the rulebook


The Japanese SCOT system began as an initiative to enhance interoperability among devices used in the operating theatre, but a readiness to embrace change, push beyond the expected, and throw out the rulebook, is what took it to the next stage. When we disrupt and shatter the fixed mindset that can stifle innovation and the adoption of new technology in favour of a growth mindset, amazing things can happen. I have had experience of this myself. In 2008, I was invited to be part of the team from Northumbria Healthcare NHS Foundation Trust that was travelling to Tanzania to visit the Kilimanjaro Christian Medical Centre (KCMC). (HEJ – January 2011, May 2011, July 2014. April 2018, and January 2019). My role was to build a unique audio-visual telecommunications link to allow surgeons at the Trust to mentor their counterparts in Tanzania in laparoscopic surgery, with the aim being for them then to be able to carry out keyhole surgery themselves. The link had to be affordable, reliable, and of sufficiently high quality, to allow the surgeons back in the UK to clearly see and hear the surgery being carried out. This was not an easy thing to achieve with the meagre Internet service available in the region; sending an email was difficult enough.


A ‘bag of tricks’ from the UK However, it’s amazing what can be achieved when there are no rules, no expectations, and sometimes even, as in this case, no money. With nothing much more than ‘a bag of tricks’ brought over from the UK, and the unstinting support of the hospital and the rest of the team, I managed to succeed, against all the odds. The picture above, of me working on ‘the link’, as it became known, trying to bring together two countries over 5,000 miles


34 Health Estate Journal October 2019


Colin Dobbyne setting up the link at the Kilimanjaro Christian Medical Centre.


apart with a few bits of wire, a laptop, and a penknife, pretty much sums up the whole experience.


However, 10 years and several visits later, Dr Chilonga Kondo of KCMC and his two trained colleagues have now treated more than a thousand patients laparoscopically at a cost of just $50 per patient; this includes cholecystectomy, appendicectomy, and the newly introduced inguinal hernia repairs. They have expanded the service to run operations two days a week, and also provide courses themselves for new trainee surgeons. Thousands of Tanzanians have now been treated laparoscopically, and the next step will be to connect up to the local university for postgraduate medical education. KCMC is now a growing centre of excellence for the whole of East Africa, with surgeons visiting from neighbouring countries, as well as from other parts of Tanzania.


Nothing to hold you back When the rulebook is thrown out of the window, with no received wisdom or standard processes holding you back, and an absolute enthusiasm to embrace innovation, new products and solutions flourish and advance what can be achieved. If we are eager to adapt new techniques and gather metrics to support or disprove surgical decisions, we can improve patient outcomes. Patients don’t need to die from preventable medical errors if we seize the opportunity to learn from our mistakes: decreasing risks, increasing benefits, and dramatically improving outcomes – this is what open innovation can bring us.


Data is the lifeblood of innovation and improvement – as CEO of Big Blue Solutions, I am absolutely committed to the data-enrichment of the systems we design, and their interoperation with other systems. If one day I am the person on that operating table, I think I will go under the anaesthetic much more happily if I know that my surgeon, however brilliant they are, does not have to rely solely on


their own knowledge, but can treat me armed with the expertise of their colleagues, and the data gathered in countless numbers of other similar procedures. When it comes to major surgery, the fewer surprises there are, the better.


hej


References 1 Medical error – the third leading cause of death in the US. BMJ 2016; 353: i2139


Colin Dobbyne


Colin Dobbyne MIET is an experienced product designer, and the founder of Big Blue Solutions. He started out designing and building electronic products for technology and healthcare companies, before founding OR Networks, where he developed a brand of surgical video system – ORTV. He explains: “What made ORTV so radical was the way it encompassed live two-way links with image capture and recording systems for education and integrated operating theatres.” In 2011, OR Networks was acquired by KARL STORZ Endoscopy UK, and he joined as technical and commercial director.


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