Advancing technology has become a fact of life in virtually every area of society. New technologies – from Amazon and eBay to Uber and Netflix – affect the way we shop, travel and entertain ourselves.
The perioperative environment isn’t immune to technological advances. A wide range of new technologies are changing the way that surgeries are performed – while improving patient safety and outcomes and reducing health care costs in the process.
Going Star Trek
“Technology is an integral part of patient care,” says Sharon L. Morris, BSN, RN, CNOR, Surgical Services, North Valley Hospital in Whitefish, Montana. “And, there are so many advances in surgical technology today that it can be a challenge to keep up with them.”
“Let’s face it: Surgical technology has gone Star Trek,” Morris adds. “To practice in the OR today, a nurse almost has to be an electrician and a computer programmer in addition to being a caregiver.”
“New technology in the operating room has helped to avoid the consequences of human error,” adds Gail Horvath, Patient Safety Analyst IV with the ECRI Institute. She points to the surgical count to ensure that surgical items (especially sponges) are not unintentionally left in patients as being especially susceptible to human error.”
“Using bar code, RF and RFID technology in conjunction with the manual count significantly decreases the chance of retained surgical items being accidentally left in patients,” says Horvath.
James D. Fonger was a practicing cardiac surgeon for 25 years and now spends most of his time developing new medical device technologies. He places most surgical technology advances into three categories that he calls the “cornerstone surgical technologies” – smaller incisions, catheter-based therapies and robotics.
“For example, half of cardiac valve surgeries are now catheter-based,” Fonger says. “No one would have imagined this 15 years ago.”
“There is a move from invasive to less invasive and even noninvasive surgical procedures,” she says. “Minimally invasive surgery, robotic surgery and tele-surgery are continuing to replace traditional surgical procedures.”
Advancements in surgical technology are allowing shorter hospital stays and lessening patient pain, Morris adds.
“And fewer procedures require general anesthesia during patient treatment,” she says.
Horvath adds hybrid operating rooms to robotics and telesurgery as another primary area where surgical advances are taking place.
“These are becoming increasingly complex with MRI, CT scan and fluoroscopy capabilities allowing for immediate confirmation of tumor removal and more complex minimally invasive procedures,” Horvath says. “The result is decreased lengths of patient stays.”
Robots in the OR?
Since it first started to gain traction about 15 years ago, robotic surgery has become increasingly common for many different types of surgical procedures. These include prostate, hernia, gall bladder, colon and hysterectomy surgeries.
“Robotic surgery is rapidly expanding in cardiac, ENT, thoracic and neurosurgery, to name a few specialties,” says Horvath. “I believe the most common robotic surgeries are still in OB/GYN, general surgery and urology.”
According to Horvath, some believe that within the next three years, nearly one-third of all surgeries will be performed with robotic assistance.
While the term “robotic surgery” often conjures up images of robots in the OR, this isn’t actually the case. Robotic surgery is performed by highly skilled surgeons using their hand movements to operate robotic arms to control miniaturized instruments.
These instruments are inserted into the patient through a tiny incision, thus making surgery safer and allowing for faster recovery times. The surgeon performs his or her tasks in a robotic console that’s physically located up to 30 feet away from the patient, viewing a high-resolution 3D image of the surgical site through a camera.
“Robotic surgery has reproduced the hand motions of a surgeon,” Morris explains. “It has resulted in greater precision by reducing hand tremor while also providing enhanced visualization via video images. Some surgeons are now doing robotic total joint replacements.”
“Robotic surgery is rapidly expanding in cardiac, ENT, thoracic and neurosurgery, to name a few.” – Gail Horvath
Increasing Patient Safety
Augustine Temperature Management LLC and Augustine Biomedical + Design LLC CEO attributes many advances in surgical technology to an increased emphasis on patient safety.
“This is evidenced by SCIP and PQRS guidelines and by Medicare refusing reimbursement for many surgical complications,” says Augustine. “As an inventor and medical products developer, I have shifted my attention from creating ‘the better mousetrap’ to creating safer products and therapies to improve patient safety.”
One new technology advancement that Augustine is especially excited about is the market transition from forced-air warming (FAW) to air-free warming.
“Forced-air warming has been on the market for 25 years and is a Standard of Care, but studies now show that the waste heat from FAW causes contamination of the sterile surgical field,” says Augustine.
Specifically, Augustine points to two separate studies that have linked contamination from waste heat to 74 percent and 78 percent of joint implant infections.
“Clearly, avoiding forced-air warming during joint replacement surgery – or for that matter, probably all implant surgery – is a wise choice for patient safety,” says Augustine. “The obvious solution is air-free warming, which does not produce waste heat.”
Augustine’s company has also created the air-free, electric HotDog warming electric blanket and mattress.
“These are used simultaneously, warming from above and below,” Augustine explains. “This results in roughly twice the warming effectiveness of forced-air water mattresses or other electric mattresses.
“Also, there is no waste heat to cause sterile field contamination,” Augustine adds. “And HotDog blankets are reusable, resulting in 20 percent to 70 percent cost savings compared to forced-air.”
Also new is a temperature monitor, that measures temperature through the skin.
Augustine believes that virtually every surgical technology in use today – and especially those that have been in use for many years – should be re-examined in light of the admonition to “first do no harm.”
“In my opinion, many of the bigger opportunities for medical device technology in the OR are in the area of infection prevention,” says Augustine.
Borrowing from Aviation
In addition to being a surgeon and medical device developer, Fonger is also a commercial airline pilot. He believes there are many lessons OR personnel can learn from the aviation industry when it comes to the use of technology – primarily in the areas of surgical checklists, automated monitoring and crew resource management.
“Healthcare is far behind aviation when it comes to the use of checklists and automated monitoring,” says Fonger. “For example, an airliner cockpit display only shows about 10 percent of what it’s actually monitoring. There are hundreds of checks going on in the background, but most of these are only displayed if there’s a problem.”
Peering into the future, Fonger believes that augmented reality (AR) and artificial intelligence (AI) will play greater roles when it comes to OR technology.
“These can provide real-time surgical aids,” he says. “For example, AR can show surgeons electronic visual enhancements like checklists and reference materials ‘in the air.’ And AI can make it easier for surgeons to solve problems they encounter on the fly.”
If this sounds like a sci-fi movie, it isn’t. Now is the time to start thinking about and preparing for what the future of surgical technology might look like.
“Many of the bigger opportunities for medical device technology in the OR are in the area of infection prevention.” –Dr. Augustine