Technology
Digital operating theatres: ethical considerations
Digital technology in surgery may improve or worsen the patient experience, depending on how it is used. Richard McAuley explains the implications of digital technology in operating theatres – from stringent data privacy regulations, challenges around obtaining informed consent, to clinical training.
The operating theatre is one of the most complex and critical environments in healthcare. In recent years, advances in digital technology have transformed the way surgical procedures are performed, enhancing efficiency, safety and outcomes. The early video and vision systems used in the operating theatre were mostly analogue based technologies providing comparatively low resolution images. These systems did, however, facilitate the sharing, distribution or storage of content for a wider audience. This capability allowed for the development of teaching and support solutions locally, in real time, or remotely via recordings. The development and adoption of digital technologies expanded these capabilities exponentially. Imaging and vision system resolutions increased, as did colour depth and image contrast ratios. New, lightweight, flat panel displays could
now be located directly in the surgical field supported on counterbalanced accessory arms. Content could be easily stored, transmitted and shared with multiple locations and real-time video and audio feedback systems could be deployed between surgical environments and outside facilities. As vision, audio and control platforms moved into the fully digital world, it became possible to add computer generated content in the form of simple patient data or complex augmented reality to the medical platforms.1
The operating theatre became part
of a wider integrated solution that provides for data analysis, communication, storage and distribution of content. In the modern operating theatre, integrated
systems that allow seamless communication and coordination among the surgical team, as well as access to real-time data and images from various sources, have become much more common. The widespread use of unified communication platforms such as ‘Microsoft Teams’ or ‘Zoom’ has led to the development
of systems that integrate the imaging and communication systems within the operating theatre to external locations. For complex procedures, support can be provided by subject experts and clinicians located outside the operating theatre. For teaching, seminars and training, it has become relatively simple and comparatively cost effective to stream live procedures for remote viewing. Medical device imaging systems can now use live augmented reality and enable immersive viewing and object identification for surgeons and other clinical staff. For example, artificial Intelligence combined with video processing can assist in identifying areas of concern during endoscopic procedures by highlighting abnormalities in the field of view. Medical device imaging systems that use augmented reality can also provide immersive training and simulation for surgeons and other staff, by enhancing the real environment with virtual objects or information.2
This can create
realistic and interactive scenarios that mimic the actual surgical situations, such as anatomy,
pathology, instruments, complications or team dynamics. This can help surgeons and other staff to improve their technical skills, clinical knowledge, decision making, communication and teamwork. It can also help them to practice rare or complex procedures, rehearse specific cases, or assess their performance and competence. Immersive training and simulation can also reduce the need for animal or cadaver models, save time and resources, and increase patient safety and quality of care. Medical imaging systems can also provide patient education and engagement, by enhancing the real environment with virtual objects or information. This can help patients to understand their condition, diagnosis, treatment options, risks and benefits, or expected outcomes. It can also help them to participate in shared decision making, consent processes, or self-management of their health. Patient education and engagement can also increase patient satisfaction, trust, and confidence. When creating a comprehensive specification or design for any modern operating theatre,
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