December 02, 2021

Surgical team members say interconnected suites improve how surgery is performed.

CREDIT: Paul Miller, MD
COMPLETE COMMAND The ability to control technology and equipment with the push of a button proves particularly useful during long, complex surgeries.

The amount of complex equipment in today's operating rooms is growing exponentially. The ability to control all of this connected technology from a central command console helps surgical professionals work more effectively and efficiently, according to a recent paper published in BMJ Open.

Integrated ORs allow members of the surgical team to control imaging displays on flat screen monitors, adjust surgical lighting, access patients' electronic medical records and adjust the functioning of equipment — all with a touchscreen pad. The authors of the BMJ paper interviewed 20 surgeons, surgical nurses and anesthesia providers from 10 hospitals who had worked in integrated ORs for a few months to several years.

Surgical nurses were most often responsible for controlling the elements of the ORs with touchpads, according to the survey. Nurses who controlled the functionality of the surgical equipment from within the sterile field reported having greater autonomy during surgery, did not report disruptions to their normal work routines and said the technology increased their abilities to cooperate with surgeons. This allows nurses outside of the sterile field, who are often tasked with controlling OR equipment, to allocate their time and attention to other tasks, such as documentation and the preparation of pathology specimens, with fewer interruptions.

The nurses who were surveyed say integrated technology led to better working conditions and improved ergonomics when compared with conventional surgical suites due to improved working postures, reduced risk of falling over cables and less need to move around the room during surgery. Additionally, the surgeons and nurses who were included in the survey say the advantages of integrated ORs are most apparent during longer, complex surgeries when equipment needs to be adjusted on a more frequent basis.

"Generally, both surgeons and surgical nurses say integrated ORs facilitated more smooth and efficient working procedures in terms of faster response on requests for adjustments of surgical equipment and functionalities and fewer disruptions during surgery," write the authors.

Surgeons around the country are using the technology to perform more precise procedures.

CREDIT: UC San Diego Health
FUTURISTIC CARE Dr. Richard Allen (left) performs a spine surgery while wearing an augmented reality headset.

Earlier this year, surgeons at UC San Diego Health became the first on the West Coast to use augmented reality during spine cases to place implants more accurately. Richard Allen, MD, PhD, an orthopedic surgeon at UC San Diego, says the technology superimposes CT images of the patient's specific anatomy directly onto the surgical site, allowing surgeons to navigate through a preplanned pathway without averting their focus from the patient.

Dr. Allen used augmented reality during a complicated spinal fusion to stabilize multiple vertebrae in about half the time it would have taken during conventional surgery, a benefit he says results in less blood loss and lower risk of complications. "Saving time should never be at the expense of patient safety," says Dr. Allen. "But with this technology, we can decrease operative time while actually performing safer surgery."

Late last year, surgeons at Johns Hopkins Medicine in Baltimore used augmented reality during a spinal fusion to remove a cancerous tumor from a patient's spine. "Augmented reality is like having a GPS navigator in front of your eyes in a natural way, so you don't have to look at a separate screen to see your patient's CT scan," says Timothy Witham, MD, director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory.

In September, Safdar Khan, MD, was the first spine surgeon in the Buckeye State to use augmented reality during spine procedures performed at The Ohio State University Wexner Medical Center in Columbus. "While viewing a 3D model of a patient's spine, I can plan my surgical approach in a more precise manner using smaller incisions," he says.

The augmented reality system Dr. Allen uses consists of a headset and navigation technology that lets him determine the position of surgical tools in real time and superimpose them on the patient's CT image. During surgery, Dr. Allen can simultaneously see the patient's spinal anatomy in three dimensions and follow the trajectory of his tools while placing screws in implants. He says augmented reality can be used to treat herniated discs, scoliosis, spinal fractures and spinal tumors.

Dr. Allen says the technology can also be used to help train the next generation of spine surgeons. Surgical residents can track his techniques in real time and see how he adjusts his movements based on each patient's unique anatomy. "Normally, residents can see only what my hand is doing," he says. "Now they'll be able to see the patient's spine as well, the trajectory of an instrument within the spine, and understand why I might choose to place a screw the way I do."

Sony's video-over IP platform enables nurses and clinical staff to see the real-time status of all ORs, all in one place.

CREDIT: Sony

2021 has been a game changer for the healthcare industry and hospitals and ambulatory surgery centers (ASCs) are reinventing their workflows in the wake of the global pandemic. Sony offers a variety of solutions ideal for ASC integration, ranging from our Video-over-IP solution to cameras, displays, recorders and HD, 4K and 4K 3D monitors.

The NUCLeUS OR Integration solution, designed specifically for ASCs, uses Video-over-IP technology to streamline every phase of the imaging workflow from video surgical capture, recording and sharing – without complex point-to-point wiring or time-consuming reconfiguration. Surgical teams and clinical staff can route multiple sources to any destination within the facility and optimize OR scheduling, cleaning protocols and turn-around time to better prepare for the next procedure.

The video-over IP platform enables nurses and clinical staff to see the real-time status of all ORs, all in one place. And because we know operating room space and other clinical space is limited, we made the footprint minimal. There are no racks of bulky equipment or spaghetti of cables, instead we use your existing IP network infrastructure.

Design With Future Growth in Mind

This affordable, modular design enables you to start with a single OR and expand to many as your needs change. Instead of locking you into one modality or one type of procedure, the system supports a variety of modalities such as endoscopic, ultrasound, C-arm, 3D robotic and anesthesia systems. This helps make your ASC reconfigurable for all needs – today and tomorrow. And the system can accommodate virtually any image modality at up to 4K resolution over copper or fiber IP networks, ideal for new builds or retrofitting older facilities.

The NUCLeUS platform features multiple apps including rotation correction, which maintains a consistent endoscope "horizon," on-screen annotation as well as two-way audio that enables real-time consultation. This flexible system also integrates with HIS, EMR, DICOM and HL7.

For peace of mind, our exclusive SystemWatch® remote monitoring service helps maximize OR uptime. We monitor the NUCLeUS system 24/7 with proactive monitoring capabilities covering video sources from all connected modalities. SystemWatch can proactively detect and correct virtually any potential issue before it becomes an operational service interruption. SystemWatch maximizes uptime while greatly reducing the cost and need for onsite service technicians.

The Benefits of OR Integration

Learn how ASCs can take advantage of the many benefits of the NUCLeUS platform to strengthen their business. Sony's interactive brochure is available to outline these benefits which include:

• Bring together different imaging devices regardless of the modality.
• Make your ASC reconfigurable and efficient based on standard IP network connections.
• Maximize uptime while reducing the cost of on-site service technicians.
• Stream live procedures to other clinicians for collaboration, training and education.
• Monitor the status of OR's.
• Optimize OR scheduling, turnover and cleaning.
• Improve the patient experience.

As ASCs continue to reinvent their workflows and plan for their future in 2022 and beyond, the solutions for OR integration will play a significant role in moving facilities forward.

Note: For Sony's interactive brochure download here.

For more information, visit https://pro.sony/ue_US/healthcare/healthcare-solutions/ambulatory-surgery-centers?cmp=eml-f21-psa-20261&chan=eml&med=EML-EML&campname=AsmarterwayforyourASCtooperate&var=AsmarterwayforyourASCtooperate-3rdParty

High-speed networks will allow for the efficient transfer of critical healthcare data.

The Veterans Affairs (VA) Palo Alto (Calif.) Health Care System was the first hospital in the nationwide health system to upgrade to 5G, the infrastructure that allows for the transfer of large amount of data at speeds faster than ever before. It was a move intended to provide cutting-edge surgical care for the country's veterans. In November, the VA announced plans to expand the use of 5G throughout all of its medical centers to enable augmented reality surgery.

"This is perhaps the most exciting and dramatic time in medical history," says Thomas Osborne, MD, director of the VA National Center for Collaborative Healthcare Innovation at the VA Palo Alto Health Care System. "We're faced with a titanic confluence of growing healthcare challenges. At the same time, we're developing amazing technology that can dramatically advance care."

He says valuable medical data remains untapped because conventional digital infrastructures are not equipped to move it efficiently. "The next generation of digital networks provides the backbone that will help us unlock the potential to dramatically advance health care," says Dr. Osborne.

The high-speed signal provided by 5G creates opportunities to turn large CT and MRI images into 3D models that physicians can use to understand complex anatomy. "With this technology, presurgical planning can be more intuitive and realistic," says Dr. Osborne. "A clinician using the system can actually see where a problem is before making an opening in the skin. As a result, there is a potential for more efficient surgeries with less complications and smaller incisions.

"As the largest integrated healthcare system in the United States, these advances have the potential to have a far-reaching positive impact that extends beyond our borders," he adds.

New suites increased revenues at one of New Jersey's top providers of pediatric care.

Bristol-Myers Squibb Children's Hospital (BMSCH) quickly became a leading pediatric facility in central New Jersey after opening in 2001. Although the hospital served young patients in the New Brunswick area with a dedicated emergency room, radiology suite and intensive care unit, the hospital's leadership wanted to enhance its offerings by adding dedicated pediatric operating rooms.

Pediatric surgical volume was stagnant at BMSCH between 2006 and 2013, causing the hospital's C-suite to increase the recruitment of pediatric surgeons. Simultaneously, overall surgical volume at the affiliated Robert Wood Johnson Hospital, the flagship facility of RWJBarnabas Health, was exploding, necessitating the need to significantly increase its surgical capacity. Adding dedicated pediatric ORs to BMSCH would kill two birds with one stone, as Robert Wood Johnson could add more surgeries by shifting its pediatric cases to BMSCH, which would have the high-tech rooms it needed to attract top surgeons.

Work was recently completed on framing out BMSCH's empty top floor into six fully integrated ORs, six private pre-op rooms and 10 post-op bays. The new pediatric surgical department was fully staffed upon opening, allowing the hospital to accommodate a growth in surgical volume.

Cost is always a concern when adding high-tech ORs, but the hospital's leadership says the additional case volumes resulting from the addition of the new suites offset the construction expenses, partly because more revenue-generating outpatient cases were being performed. "Looking back, we would have built the ORs sooner," says Joseph G. Barone, MD, chief of pediatric urology at BMSCH. "The new rooms were a driver of volume and case complexity that fueled growth and development for the hospital."