Coming soon to an OR near you!

What is “plug-and-play”?

SATAVA: Plug-and-play would standardize interfacing between similar components that are interchangeable. Let’s say we have 6 different EKG machines, each with a different method for plugging in the leads. Our concept of plug-and-play goes from software that talks between devices to interchangeable tubing and electrical connections to the devices themselves. This standard is necessary to achieve even the most rudimentary information-based OR of the future.

Lack of plug-and-play connectivity has made it difficult even to get a patient’s allergy information from one database to another. At our institution, a couple software engineers took about 3 months to accomplish that. If this is what it takes to integrate 1 piece of information at 1 institution, we don’t have a chance.

Where do things stand with radiofrequency identification tagging?

PARK: Two types of RFID tags exist: A passive tag is a simple tag that when interrogated by a local node or cell just says it’s there. An active tag imparts a lot more information.

SANDBERG: An RFID tag would contain a patient’s critical medical data, but this vision has many problems at the moment. A tag with sufficient data storage is very expensive.

Security is another problem. The information is transmitted wirelessly and the encryption consumes tag memory. Passive RFID tags, which don’t require a battery and cost less to produce, simply can’t store enough information to be useful as a repository of medical data.

So we’ve discovered applications for RFID beyond the mobile patient record on the tag wristband. RFID can, at least in theory, be used for inventory management. Again, the problems with its costs and the need to scan the items limits its usefulness. Hospitals can use active RFID tags now for tracking high-value assets—not only expensive medical equipment but also personnel and patients.

PARK: We’ve been evaluating many different location RFID technologies in the operating room. We’ve found that the resolution of these technologies is miles from the manufacturers’ claims.

SATAVA: The trade-off for security is the inverse relationship between the level of security and the amount of computing power it demands, along with the amount of physical space available on the device.

Maybe in two years the computing power will increase and device size decrease, so we can get more on a smaller object, and its costs will decrease.

SANDBERG: Another problem with passive RFID is a high out-of-box failure rate. The antennae break off in manufacturing and shipping.

Besides cost, spatial resolution is another problem with active tags. On the other hand, passive RFID tags can have sub-centimeter resolution because the reader has to be so close to read the tag.

However, scanning the tag is another problem. Most of us in our workflows don’t have time to grab an RFID reader. Passive RFID reader technology is far from ideal for a busy OR.

Ideally, they should require no effort: objects brought into the OR would register on an as-yet-uninvented meter and localize in the room, ideally at 1 cm resolution or better.

What devices will be the stars of the OR of the Future?

LED Technology

SATAVA: With LED—light-emitting diode—technology and the small cameras now in cell phones, we have the opportunity to get rid of all the lights in the operating room.

The University of Barcelona has accomplished this.⁴ A sea of 100 to 150 cameras is placed around the room. You don’t have to move the cameras or lights. This clears up all the booms that are hanging down of these enormously inefficient lights that we have today.

This technology can leverage information systems that talk to objects and track instruments.

Wireless, miniaturized robots

PARK: Miniaturized robots, designed to be wireless in the near future, can actually rove the peritoneal cavity equipped with an end effecter or mobile camera. Dropped in through a 5- or 10-mm port, these devices can get to the target anatomy. Mechanical miniaturization is another way of getting around the loss of degrees of movement.

Better visualization with HD video

The minimally invasive revolution has moved us from having direct binocular visual contact with the target anatomy to working in a 3-dimensional space off a 2-dimensional image.

The next step is to take the vast amount of data we’re capturing, especially with HD video, from the operative field and use it to improve surgical visualization and ultimately outcomes.

This may involve real-time modeling and altering the visual perspective of the operative field as it is presented to the surgeon. We’re looking at new ways of making the data more intuitive.