In November last year Olympus introduced Australia’s first fully integrated glass modular procedure rooms at QEII Jubilee hospital in Brisbane, QLD. This has had us thinking about the future of the operating room and what it will look like in a year, ten years and beyond.
As people so often do when they think of the future they turn to science fiction. The operating rooms of science fiction movies generally feature entirely automated operating rooms with medical robots performing surgery. This vision remains a distant possibility but the more immediate future involves innovations in technology to increase safety, operational success and to spread healthcare and education further than the walls of the theatre. We take a look at current technological developments and how they are shaping the future of the operating room.
Beyond the Cutting Edge
For our first look at the future of operating room we turn to High-Intensity Focused Ultrasound (HIFU) and Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS). This technology is already offering personalised non-invasive treatment to replace invasive procedures and offers therapeutic alternatives to millions of patients. For example, a quarter of women worldwide experience uterine fibroids and while the traditional method of hysterectomy has a high success rate it also involves 3-5 days of post-op hospitalisation followed by several weeks of recovery. HIFU and MRgFUS presents a walk-in, walk-out solution with the same ability to conduct the operation in real-time. The amount of time and effort it requires from total staff is a tiny fraction of that involved in a hysterectomy, plus the chances of complications are largely nullified. But most of all, the patient is hardly inconvenienced at all. This treatment method is now being explored as an alternative to radiation in treating metastatic bone tumours and has met early success in trials treating central nervous system diseases such as Parkinson’s and essential tremor.
This treatment method looks set to tackle cancers such as prostate cancer and brain tumours. It also has the potential to liquefy blood clots throughout the body and especially in the brain without any invasive procedures. With technology like this the future of the operating room for many surgeries could be free of the risk associated with invasive procedures. Hospitals can also run a reduced staff load or more effectively use the current staff to increase supply due to the lower demands placed on the team by the new surgery techniques. Technology like the MRgFUS also looks to provide surgical solutions for disorders currently untreatable by surgery, such as Parkinson’s. Through technology we see the future of the operating room expanding its influence over medicine to diseases previously untreatable, continuously improving the safety and success rate of surgeries and offering longer, healthier lives to patients.
Breaking Through The Fourth Wall
The QEII ENDOALPHA procedure rooms previously mentioned feature full high definition video conferencing, video streaming and recording capabilities. With a variety of image sources including a high definition in-light camera for broadcasting consultation and education sessions or live cases internally throughout the hospital, the Queensland Health network or even worldwide. The future of the operating room seems destined to spread beyond its walls.
The ability to disseminate high quality video across the globe presents fantastic opportunities for medical education and the increased quality of medicine worldwide. Further technological innovations in the ENDOALPHA procedural rooms include a HomeScreen user interface that allows control of all medical and non-medical equipment devices. The screen was designed to replicate the intuitive design and simplicity in today’s smartphones.
Through the HomeScreen, the new procedure room also has the ability to pre-program what Olympus has called “scenes”. These are pre-set configurations for all the medical equipment, documentation systems and audio-visual components of the room, that can be deployed with the single touch of a button. When combined with the previously mentioned features this allows the operating theatre to diversify the number of procedures it can conduct. The Chairman of the Metro South Hospital and Health Service Board, Terry White AO commented that “QEII Hospital’s Endoscopy Unit was previously seeing 1200 patients per year, however it now has the capacity to see more than 5000 patients per year…”. By creating a modular system that can quickly be deployed into an array of pre-set configurations the operating room of the future is able to cater almost 5 times the number of endoscopic patients every year. The future of the operating room will be extending this capability to other areas and increasing the number of patients that can be seen while decreasing the time and discomfort they experience through more effective and efficient procedures.
At the QEII hospital these advances in the infrastructure of the room have been matched by medical devices and equipment such as highly advanced diagnostic imaging platforms and narrow band imaging. With all these advances the future looks set to take on telemedicine and remote consulting, spreading specialist medical care and education beyond the four walls of the operating room to all those in need, while also increasing the effectiveness and efficiency of the on-site space.
It is Not Just About Gadgets
One of the crucial things to consider with the future of the operating room is that it is not just about
creating new medical devices and stacking them in the room. All devices need to be integrated into the existing setup seamlessly. The work being done at the Surgical Simulation and Training Laboratory at Cedars-Sinai Medical Center in Los Angeles goes a long way to testing and developing through open communication, the integrative capabilities between new technologies and techniques and the current practical situation in the operating room. Things such as app that displays a patient's vitals and distributes the information to the trauma team as they are assembling, or a text-messaging service that allows doctors and nurses around the hospital to communicate as they converge at the operating room. By working with the future surgeon's of the area the Laboratory provides a perfect place to intiate future change in the medical industry and a perfect sandbox to test potential widespread changes.
Something that has provided a glimpse of this integrated future of the operating room is 3D printing. Recently the first 3D printed skull replacement was conducted in the Netherlands; doctors printed out a new skull for a patient, removing the old one and implanting the new one. The possibilities offered by 3D printing are undoubtedly immense, as has been shown through its use in prosthetics and bone replacements. However, the technology can continue to be optimised in its medical application through multiple methods. The distant future of the interface between advanced imaging technologies and 3D printing holds possibilities such as a patient being scanned on the way to the hospital and a new bone being created to replace any shattered ones before they arrive. The future of the operating room thus stretches beyond the room itself to all the supporting players and facilities that help keep it running as efficiently as possible.
Tracking everything, everywhere
One technology that seamlessly integrates with hospitals' current systems is RFID. It offers the opportunity not only to track objects such as abdominal sponges but also pinpoint and analyse the whole workflow during the surgery and then create the most optimal patterns for use. The advantages stretch further than simple logisitcs and can even automatically signal for more help early in dangerous situations and initiate supportive actions. The Annals of Surgery 2008 Health Care Informatics reported that 12.5% of surgeries resulted in tool and sponge count mistakes. While this figure has been quoted at a lower rate of 1 in 5,000 it is still a risk that can be avoided through the use of RFID technology. Even if the tool or sponge is not inside the patient a lost item can cost around $150 to $400 per every minute of clinical time wasted searching for it.
Further technologies include the development of minimally invasive techniqes and medical devices such as the modern intra-operative C-arm and endoscopic imaging devices. Techniques with three-dimensional data acquisition and visualisation can also be used to help spatial orientation of the surgeon be extended and save time. These methods all focus on increasing the optimisation of the surgical procedure and decreasing the risk involved as every second spent in surgery is another second at risk for the patient.
All these innovations and methods look set to push the operating room to a future of increasingly less invasive procedures, increasing success and decreasing risk and injury, all the while spreading the influence and information from each operating room beyond its four walls. We couldn’t possibly cover all the innovations that will shape the future of the operating room in this blog or even subsequent ones so we would love to hear what you think. Let us know in the comments below of anything you think will shape the future of the operating room. If you are still interested in reading about the future, have a look at last weeks blog about the future of Australia's medicine graduates. Or if you would like to register for more information on healthcare market research click on the button below.