What will the future surgery room look like?

A series of changes will be made to ensure that the surgery will be more economical, more effective and less risky for patients.

Hospitals are investing in digital devices, designs and technologies that promise a new era for surgery. This is part of the transition to escape traditional open surgery procedures including large incisions, excessive blood loss and long hospitalization. They show a future where more and more patients can opt for outpatient minimum intervention surgery with faster recovery, less complications, less pain and less scarring.

A series of technological advances has been developed. Some of which help surgeons can control the robot camera with eye movement as they move into the patient's body through small incisions. With some other technologies, doctors can create a GPS-like map that illuminates the patient's body to clearly see each cell before surgery, tracking surgical instruments and making surgery more accurate.

Other advancements aim to redesign the operating room, by adding surgeons' operating space as well as imaging devices that allow patients to receive X-rays and other tests right on the table. surgery instead of being taken around the hospital. Machine learning technology and artificial intelligence are being developed so that surgeons can exploit large data before, during and after surgery, for guidance from computer systems that have analyzed the procedures. and learn how to make recommendations.

The operating room will be smarter, more effective and much less risky for patients.

If successful, these changes may have a profound effect on the patient. Despite years of development, surgery is still a dangerous area. Infection is a frequent complication and can be fatal. Studies have shown that even in the same hospital there are major differences in outcomes among surgeons, involving differences in individual judgment, skills and abilities. Lower skilled surgeons have complication rates, patients return to hospital and return surgery higher. New technology can help balance these differences.

Santiago Horgan, director of the department of minimal intervention surgery at the University of California, San Diego, and executive director of the Center for Surgery, said: "The field of surgery is progressing very fast and technological progress. is making this field more efficient, more economical and improving the patient's results " . While surgery can never be fully automated, Dr. Horgan said that "in the future robots will be smarter and more interactive, bringing maximum information to doctors during the surgery".

Of course, many technologies are still being developed, and others are not yet widely adopted or fully evaluated for safety and cost effectiveness. Along with that, some health care experts warn about the application of new technology too quickly.

"We do not want to participate in the race to create more expensive therapies, and we must be careful not to apply technology unless it is more effective and improves results over time," said Steven J. Corwin, president and CEO of New York-Presbyterian Hospital, said.

Here are some new technologies, and how they will reform the treatment of patients in the coming years.

Extended surgery room

One of the most fundamental changes is the redesign of the operating room . Some hospitals are creating "hybrid" facilities that combine conventional operating rooms with imaging devices used in minimal intervention treatments based on small tubes inserted into the bloodstream or body cavity. That way, doctors can perform both open surgery and minimal intervention procedures instead of performing them at different times. For patients, that means avoiding two separate anesthesia procedures, less time in the hospital and less recovery time.

How can this change improve treatment? Take, for example, the interventional technique of cardiac catheterization, in which the tube is inserted into the bloodstream to reach the coronary arteries. The doctor may use a catheter to insert the support to improve blood flow to the arteries, but patients may also need open surgery to pass through the blocked artery. In the hybrid surgery room, the doctor can immediately switch from intervention to open surgery.

Another way is to better use the operating room with standard width over 18m2. Anjali Joseph, Director of the Medical Facility Design and Testing Center at Clemson University, said: "The surgery room is often cramped with no access and everyone climbs through the trolley and bends the device, creating to an extremely insecure environment ". Dr. Joseph is working on a federally funded project with Scott Reeves, an anesthesiologist at the University of South Carolina School of Medicine, to design a surgery room that increases patient safety and makes it easier. For team doctors can move around.

A prototype published in January will allow researchers to perform surgical simulations and test improvements such as reorganizing device storage to bring the device closer to the surgery table and keep it Let the doctor focus on the patient as well as improve the movement of the room.

The team is also working on a traditional approach to having a "sterile corridor" between adjacent operating rooms to reduce the risk of infection. While the idea is to reduce the infection by reducing the number of people moving from contaminated areas, preliminary project data shows the number of times the door to the operating room is open and without the presence or absence of Aseptic factor is important. "This will go against 50 years of conventional surgery room design , " Dr. Reeves said.

Another recommendation from the project team is the employees' mobile workstations, high-tech digital screens on the walls so that everyone in the surgical team can see real-time tricks and surgical equipment racks. "plug in and run" wall to adapt to new technologies.

This outpatient surgery room at the David H. Koch Center of NewYork-Presbyterian, opened in April, aims to provide flexibility, reduce the risk of infection and improve the view and workflow of surgical group.

NewYork-Presbyterian has incorporated a number of new approaches into the new David H. Koch Center, opened in April with 12 outpatient surgery rooms, radiological intervention, imaging diagnostics and other services.

Establishments also try to solve another persistent problem in the operating room: infection. Floors made of terrazzo tiles do not "support" bacterial growth, while stainless steel wall systems are easy to keep sterile and can be adjusted to accommodate new equipment. Three surgical equipment racks with extremely long reach allow the device to hang on the ceiling, eliminating the risk of wires and cables on the floor. LEDs provide light with less heat, airflow circulation minimizes airborne microorganisms.

Technology will also help patients have a better experience, said Dr. Corwin. Before surgery at the new center, patients and families can complete remote paperwork and receive schedule information and guide their own pre-surgery and recovery rooms. In the waiting room of the family there is a screen showing information about the group of doctors and families who will receive electronic updates about the patient's condition and when they leave the surgery room.

One of the most fundamental changes is the redesign of the operating room.

Robot reacts faster

The study was combined with the benefits of assisted robotic surgery, introduced almost two decades ago as an alternative to surgery for less common interventions, or "keyhole" surgery , in that surgeon creates a small incision and uses a stethoscope - a thin telescope with lights and a video camera - to insert special devices with long and thin instruments. Many studies show that robotic surgery supports less complications and shorter hospital stay, but other studies show a lower success rate in some types of surgery and other subtractions, including higher cost.

Developers try to make such a system smarter, cheaper and more autonomous. For example, researchers are working on programming robots to perform tasks such as tissue sutures after surgeons are finished, which can help prevent problems for patients such as leaks from thread lines. not tight.

Tool set of surgeons

This field is dominated by da Vinci Surgical System of Intuitive Surgical Inc., which has been used in over five million surgeries worldwide. The surgeon sits at a console with a video screen, using robotic arms to manipulate small instruments through small incisions. In addition to better patient anatomy images, it also filters out hand tremors and is designed to keep surgeons in a comfortable position for lengthy and complex procedures. Intuitive is developing improvements to its systems, including a flexible robotic catheter that makes it easier for surgeons to find positions in the lungs to sample tissue while reducing the risk of harm to patients.

Intuitive executives Gary Guthart said the company is also working on more advanced robots, which can help "strengthen coordination and control between computers and surgeons ", just like between machine pilots fly and modern automatic control system.

Some new companies also entered the market, including medical device giant Medtronic PLC and TransEnterix Inc., which was approved last year by the Food and Drug Administration for its Senhance Surgical System. yourself in some surgical procedures.

The Senhance system has an optical sensor that allows the surgeon to move the camera and select commands with eye movement and provides tactile feedback, bringing a sense of touch and feel during pressure-based surgery. force and tension in the tools, "like a driver can feel behind the wheel when colliding with speed," said Todd M. Pope, founder and chief executive of TransEnterix.

Better decision with big data

The new generation of digital surgical tools aims to combine robots, big data and other technologies for surgeons to make better decisions while having surgery for patients.

The most notable 'new soldier' ​​in this area is Verb Surgical Inc., a Verily Life Sciences partnership of Google Alphabet Inc. and Johnson & Johnson's Ethicon surgical equipment department. The parties are referring to the concept of "4.0 surgery" , the next step after traditional open procedures, minimal intervention surgery and robot use.

Verb has only provided a few details about how the system works. But the idea involves using machine learning - computer programs that can collect data from thousands of past surgical procedures to determine best practices and potential errors.

Verb said the system can allow surgeons to train before surgery, and then evaluate their work, measure things like surgery time, movement advantages, quantity and type of use. tools used. Finally, the company said the system will help surgeons make decisions in the middle of a surgery, from proper technical suggestions during a specific surgery to warn of potential mistakes such as cutting off blood vessels.

Verb plans to launch its first product in 2020 and says it has a full operating system for its parent companies."Currently, we have an unconnected surgery room, with isolated devices and robots, like a car in 1970 disconnected without any sensors or connections," Director Verb Surgical executive Scott Huennekens said. "Our desire is that eventually a connecting system will be present in every operating room, giving surgeons the tools to make changes in surgery."

Some surgeons have expressed interest. Umamaheswar Duvvuri, a head and neck surgeon at the University of Pittsburgh and director of the university's surgery innovation center, said: "Decisions should be made every minute during the surgery and you The surgeon needs to know the result data right away to make a decision, if we can collect big data and be available at the time we are performing the surgery, then everything will happen. like, Hey Siri, if I cut this nerve, what will happen? ".

A clearer view into the patient

Surgical robot will be a great assistant for doctors.

A range of technologies aims to give surgeons a better view of what they are performing inside the patient during surgery.

Take the case of cancer surgeon. Removing the tumor is a delicate balancing act between removing the disease and keeping it healthy. But contrast dyes are often used to illuminate diseased areas that must be injected into patients beforehand, and may not always work as expected. Dyes are also toxic and can cause allergies.

The University of Pittsburgh is working with ChemImage Corp., a company that is developing a method that allows doctors to better visualize organs and tissues in real time, such as showing where the tumor ends and tissue Where does healthy start. The company's technology, molecular chemistry or MCI imaging, combines spectroscopy, uses light to measure digital materials and images.

ChemImage's founder and chief technology officer, Patrick Treado, says the technology is widely applied and will be designed in the future for use with endoscopic procedures, in which the doctor inserts a tube with A camera allows them to view and conduct surgery on organs. It produces real-time images based on the assessment of individual colors in the visible light spectrum and beyond what the eye can see in the near infrared light spectrum. MCI uses more colors than the current camera, which uses only red, blue and green in the visible light spectrum.

"Our goal is to provide advanced visualization for surgeons without changing the way surgeons are currently performing surgery, instead providing them with much better information on demand." , Mr. Treado said. For example, images may make it easier to remove the uterus when determining which tubes carry urine from the kidney to the bladder so that the surgeon doesn't accidentally cut it. In addition to seeing better tissue through fat, fat and blood, MCI has the potential to make surgeons more effective with less training.

An attempt to improve what visible surgeons are being developed by an initiative of Cleveland Clinic, Centerline Biomedical. This idea is an alternative to fluorescent endoscopic procedures, X-ray technology that doctors currently use to place a stent in the artery.

The traditional approach does not only depend on contrast dyes but also makes doctors and patients exposed to high radiation doses continuously. The images created by fluorescent endoscopy are only 2D gray images.

Therefore, Centerline is developing a system to reduce the need for fluorescence endoscopy and prevent the harmful effects of radiation. Using mathematical algorithms and safe electromagnetic tracking, the system provides 3D color images and allows surgeons to track the location of patients' anatomical devices on high-precision screens. - similar GPS for cars.

With a new federal grant, Centerline is currently testing the HoloLens system, a practical, smart smart glass made by Microsoft. The glass will superimpose a sketch of the patient's 3D vascular system into a doctor's observation field, "like X-ray vision" , Karl West, mechanical engineer and Cleveland Medical Device's director of medical equipment. and Centerline's scientific advisor, said.

At Lucile Packard Children's Hospital, affiliated with Stanford University, Frandics Chan, pediatric specialist, worked with EchoPixel Inc. to develop an actual interactive technology called True3D. This technology converts MRI, CT scans and ultrasound into 3D images that can be viewed with polarized glasses to filter images to the left eye and right eye before the screen during surgery. The surgeon uses a stylus to rotate and test every anatomical layer, collecting more information than a 2D image. This system is used to separate conjoined twins for 17 hours at Lucile Packard Children's Hospital.

EchoPixel has found a way for surgeons to see images without glasses using a screen that can transfer images accurately to the left and right eyes. Dr. Chan said that eliminates the need to change lenses during surgery and the risk of contamination for sterile surgery. The new method will be used in the hospital's new surgery center opened in July.

"We really hope that this technology will help surgeons be safe at every stage so there's no need to guess something," Dr. Chan said.