What will the operating room of the future look like? Will it be a specialty-specific facility or a generic OR? Our Symposium panelists, each a primary investigator in an “OR of the Future” project at his own institution, share their ideas of what the future holds, from getting clutter off the floor and onto the ceiling, to integrating patient information, imaging, and robotic systems.
Panelists also share their visions of what the OR may look like in 25 years and what obstacles need to be overcome to make the futuristic vision a reality. Robotics, smart displays, information management and integration, and image-guided surgery may become as common as the stapler and the scalpel.
The making of the “OR of the Future”
PARK: It’s been said that the operating room of the future means that we take the clutter off the floor and put it on the ceiling, but we need to have a much broader view.
“OR of the Future” embodies a vision of improved patient safety and outcomes—from evaluating and assimilating existing technologies, to identifying technologies that need to be developed or brought in, to integrating the technologies that will get us there.
SANDBERG: The “OR of the Future” is also about therapeutic effectiveness for our patients and organizational effectiveness for the hospital.
The OR of the future is a concept through which a big organization such as an academic hospital can foster innovative projects. It can designate a place within its own organization that’s politically, financially, and physically separate from the main workflow and objectives, where the hospital can test processes and technologies.
“Wall of Knowledge”
A matrix of real-time screens
This operating room at Memorial Sloan-Kettering Cancer Center is one of 21 that employ the “Wall of Knowledge,” the matrix of screens in the background that show patient and OR data, high-resolution video of surgical and laboratory images, and two real-time monitors for viewing radiographs.
“Dashboard” data monitoring
One component of the “Wall of Knowledge” is the OR-Dashboard (LiveData, Inc, Cambridge, MA) that captures data from multiple information systems, physiological monitors, and medical devices and displays it to the OR team.
PHOTOGRAPH BY RICHARD DEWITT, COURTESY MEMORIAL SLOAN-KETTERING CANCER CENTER, COURTESY LIVEDATA, INCThe goal is to develop safer systems, evaluate technology, and accumulate evidence to prove these technological innovations are effective. This also involves developing new processes for information management and patient flow.
Will Gyns share their OR?
SATAVA: I think of two kinds of OR of the future: The near-term, in the next 20 years or so, will concentrate an information-based system, such as imaging, robots, computers, and just-in-time inventory.
Shared, yet specialty-specific OR
We will continue to have multiple ORs in the near future because we will still need specialization. Neurosurgeons, gynecologists, and pediatric surgeons will still find it difficult to share the same OR—no matter how flexible it is. What these multi-specialty ORs will have in common is the way they’ll leverage information technologies.
To the cell level and beyond
The second kind of OR of the future is longer term and harder to describe. Here, biotechnology and energy-directed systems will replace mechanical and, to an extent, information-based systems. For example, in 30–50 years we’ll be using lasers for intracellular operations. Rather than physicians injecting various drugs or immunochemistry, they will actually use lasers and optical tweezers and manipulate the various organs—the mitochondria, operate on the DNA directly, and change cell biology rather than remove organs.
Will your office be your OR?
SATAVA: A capital-intensive facility such as a hospital or dedicated outpatient surgery center for complicated procedures will always have its place, although we’ve seen more minimally invasive surgery move out of the hospital. Beyond minimally invasive procedures are noninvasive procedures. High-intensity focused ultrasound and terahertz energy are the types of technologies that can safely move out of an operating room.