By Don Sadler
Technology changes at such a rapid pace that it can be hard to keep up with the latest developments. This is especially true when it comes to healthcare technology in general – and perioperative technology specifically.
A wide range of new technologies are changing how many perioperative procedures are performed. Often, the results are improved surgical outcomes and higher levels of patient satisfaction.
But these new technologies present many challenges for OR nurses and other personnel. “As the health care environment and the technology toolbox evolve, OR nurses will need to evolve with them and maintain both their team and patient relationships,” says J. Scot Mackeil, CBET, senior anesthesia BMET.
An Up-close View
As a biomed, Mackeil has an up-close view of many cutting-edge technologies that are being implemented in ORs today. He says he’s especially excited about surgical systems and video technology used in conjunction with 3D surgical navigation systems in integrated video surgical rooms.
“The ability to see clearly inside the body with 4K HD video surgical systems is far better than the first generation composite video systems and 480p TV monitors I was involved with during my first year of biomed practice in 1991,” Mackeil says.
“When you couple the improved resolution of HD video with 3D navigation, refinements and innovations of surgical instruments, and today’s surgical techniques, the changes since 1991 are amazing,” he adds.
3D printing is another technology that Mackeil believes has tremendous potential.
“3D printing has allowed my biomed department to prototype and deploy some innovative holders, brackets and positioning devices for medical equipment, as well as fabricate an occasional replacement part that was not available from conventional sources,” he says.
Mackeil believes we may witness a time when 3D metal printers and scanners plan, construct and print surgical implants in real time to aid in plastic and orthopedic surgeries.
“We might also see biomaterial printers producing patient-specific implantables,” he adds.
Hybrid Imaging Technology
Danielle C. McGeary, MS, BME, CHTM, PMP, vice president, Healthcare Technology Management with AAMI, points to the use of hybrid imaging technology as one of the biggest technological advances currently impacting ORs.
“In a hybrid OR, advanced imaging equipment is combined with cutting-edge surgery, which enables more complex surgeries to be performed,” says McGeary. “This allows perioperative teams to preform technologically advanced procedures with fewer incisions, which results in faster patient recovery times and reduced health care costs.”
James Piepenbrink, BSBME, deputy executive director with the AAMI Foundation, echoes McGeary’s enthusiasm about hybrid ORs. “One example of a hybrid OR is converting a traditional cardiac catheterization system into a cardiothoracic operating system all in a single OR suite,” he says.
“The benefit of this is that a single room can now meet two functions,” Piepenbrink adds. “It also eliminates the transport time from the catheterization lab to the OR and the inherent risks associated with that.”
Piepenbrink also points to the use of so-called “smart ORs” by hospitals to perform minimally invasive surgeries.
“Traditionally, separate devices are brought into the OR environment, such as electrosurgical units, insufflators, printers and recorders,” he says. “But this results in a very crowded space and also introduces potential safety hazards.”
According to Piepenbrink, smart OR suites have booms where these disparate devices are housed and connected to a centralized control system. “Features and functions of the systems can be controlled to achieve specific requirements of the procedure,” he says.
Surgical Robotics and AI
No discussion of OR technology would be complete without mentioning surgical robotics and artificial intelligence (AI). “Surgical robots are an evolving tool in the surgical toolbox,” says Mackeil. “The current robotics extend the surgeon and his tools to places where conventional instruments and human hands just cannot go.”
According to Mackeil, the first generation of surgical robots can augment and assist perioperative personnel by holding and guiding cameras or positioning and guiding surgical tools in conjunction with surgical navigation systems. “But I hope to see the next generation of surgical robots evolve considerably beyond this in the near future,” he says.
“For example, I expect to see multi-functional robotic arms mounted to the light column to position cameras and retractors, and maybe even pick up and deliver instruments and supplies from a preloaded sterile cassette with voice commands,” Mackeil adds.
Meanwhile, Mackeil believes that achieving the scale of AI that will be necessary for health care applications will require tremendous computational power and the IT infrastructure necessary to support it.
“The computer power needed for this is now on the horizon and the medical software engineers who can create the matrix are out there,” he says. “In the short term, I would hope that AI will be able to help improve scheduling and resource coordination and help make hospital HIS systems more user-friendly.”
Michael Blaivas, MD, MBA, FACEP, FAIUM, chief medical officer for EchoNous, notes that AI algorithms are being used with ultrasound devices to do much of the work of calculating in the perioperative environment.
“For example, AI combined with ultrasound can help nurses easily and non-invasively identify how much urine is in a bladder,” Blaivas says.
Ultrasound guidance for challenging peripheral IV placement has taken what Blaivas says was once nearly a mythical artform and made it routinely easy to perform. “AI can help novice nurses identify correct structures and suggest the best approach and even catheter and needle size,” he says.
According to Blaivas, acute and dramatic patient changes in perioperative settings can be difficult to assess. “AI-driven ultrasound applications can help even a near-novice OR nurse identify a pneumothorax causing hemodynamic instability or oxygenation problems in seconds,” he says.
“In the near future, automated cardiac assessment with AI-driven ultrasound tools will be able to rapidly help identify hypovolemia, depressed systolic function, pericardial effusions and other pathology which could cause rapid patient deterioration at the most critical times,” Blaivas adds.
Technology and Training
McGeary points out that with new technology comes the need for training on the new equipment. “Since this is such a complex environment, it is essential that nurses, interventionalists, physicians and anesthesiologists all learn how to work seamlessly together in the perioperative environment,” she says.
“OR nurses become very involved in the training and support of technology during procedures and help navigate the use of equipment so the surgical team can be efficient,” adds Piepenbrink. “This is a great example of how OR nurses are becoming more systems-focused and have expanded their knowledge of technology.”
Blaivas says that technology training associated with AI integration with ultrasound will be highly focused and limited.
“Spending days at courses is simply not feasible given the pressures on staff time and resources,” says Blaivas. “Staff will be required to familiarize themselves with the product, how it works and some basics about ultrasound and anatomy.”
Mackeil points out that technology itself does not improve patient outcomes. “It takes good doctors, nurses, technicians, clinicians and support staff all working together with a shared vision of using technology to support the mission of improving patient satisfaction and clinical outcomes,” he says.
“It all comes down to one thing: the people who are working in the OR environment,” says Mackeil. “Technology only gives us tools we can use to enhance our efforts in support of our mission to care for patients.”