OR of the future: Surgical navigation systems and integrated devices

While it is commonplace for operating room staff to work together as a team, the collaboration of operating room systems does not always work so well – many devices are still separated from one another, causing the OR processes to be prone to mistakes. The same applies to surgical navigation technologies that represent the interface between imaging, the surgeon and therapeutic devices during the surgery.

In this interview with MEDICA-tradefair.com, Prof. Andreas Melzer talks about the integration of devices in the OR of the future, describes how this is intended to make the work of the staff easier and defines the role surgical navigation plays in this concept.

Prof. Melzer, what are the goals of the ICCAS?

Prof. Andreas Melzer: ICCAS aims to optimize diagnostics and primarily therapy through the use of computer-assisted systems. The physician should receive all the necessary information for complex treatment decisions during surgical interventions. We want to make a digital model of the patient available in which all relevant information is merged, supplemented by literature and current guidelines. Decision making of physicians today relies on their experience, but we are often unable to keep track of the latest findings and result of clinical trials. Computer assistance, like the one we provide in our experimental operating room at ICCAS, helps to avoid mistakes during these complicated processes.

The ICCAS team is trying to realize the "OR of the future" with your experimental OR – what exactly does it look like from your perspective?

Melzer: We have been part of the nationwide OR.net joint research project. Its goal is to link all OR components to allow communication and integration into a central control system. The idea is to improve efficacy, to avoid errors, and to increase patient safety. I am convinced that the OR of the future will be shaped by smooth interaction of medical devices but not by a certain setup or specific equipment.

Which needs of the OR staff should the integration meet?

Melzer: Typically, devices in the OR today have to be started and adjusted by a staff member upon surgeon's request. The type of networking of devices we aim for saves time by automating the startup and adjusting the remaining devices to the new process step. It increases process safety and reduces the error rate. The reliability of system components can be further increased by integrating "preventive maintenance". In doing so, staff can focus on the procedures in the OR and the patient without the need to continuously correct disruptions in the process. Thereby the staff can fully concentrate on the patient’s needs.

Which OR components play a special role when it comes to integration?

Melzer: Those are primarily the invasive surgical instruments such as milling and cutting tools. They must function and be adjusted optimally and the surgeon need to be provided with information about them and remote control options. Our solution plans to no longer just display this on the actual device, but rather on a central, well visible screen, which can be operated by the surgeon himself.

What role do surgical navigation systems play in this OR?

Melzer: Navigation systems enable surgeons to gain full access to the anatomy of a surgical site in the body even if the site is very small and partly invisible. It creates the link between the diagnostic imaging data taken before or during the surgery and the surgical measures such as, dissection, tissue ablation or local injections. This is crucial during difficult procedures, for example in the para nasal sinuses or the brain.

How would you integrate this type of system into the OR of the future?

Melzer: Aside from otorhinolaryngology (ENT) and orthopedic surgery facilities, most neurosurgical ORs already feature navigation. However, the systems are often not booted up and ready to be used until they are needed. The setup is a complicated step that takes time and the collaboration of several people. The system registers the position of the patient and instruments in the room. Based on these records, the volume of the patient body is registered with the available imaging data. The instrument is displayed as a projection on the 3D images. The surgeon is subsequently able to detect where his instrument is located and can avoid damage of hidden import structures.

Our ICCAS operating room model has an integrated navigation system. It starts up the moment the surgeon picks up the probe. The radiological images are also automatically uploaded. This is a huge advantage that not only saves time – after all, the operating room time is one of the hospital's most expensive resource-intensive areas – but also improves the workflow and in doing so, might create room for other surgical interventions.

From your perspective, how far away are we from the OR of the future?

Melzer: The implementation will still take several years because integration systems also need regulatory approval. Today's neurosurgical operating rooms are most advanced in this area, but cardiac surgery, where heart valve replacements are positioned or where heart arrhythmia problems are being treated by using imaging techniques run a close second. This process has been implemented for the first time in the MRI here at the Heart Center Leipzig.

Imaging-assisted navigation has been a mainstay in both of these disciplines for quite some time and the operating rooms overall feature very advanced equipment in these instances. That being said, the communication aspect and central control system are already making their way into other fields as well. The final step as it relates to the optimal surgical suite design to assist surgeons will still take some time, but the way is paved and most necessary components are already available.

Is Computer Assisted Surgery going to change the surgical profession?

Melzer: We are currently studying non-invasive procedures that uses magnetic resonance-guided focused ultrasound. Our goal is to enable cancer treatment without the need for surgical incisions by only using ultrasonic waves, which heat the target tissue and destroy it accordingly. During the treatment, the surgeon is seated at a console outside the MRI room, where he marks the individual ultrasonic point contacts with the PC mouse. Within the scope of this or similar procedures, the surgeon monitors the screen, without physical exposure to the surgical site.

Needless to say, this changes the job description dramatically. Obviously, not all surgeons will work in this manner, but the percentage will significantly increase in certain fields. For most of surgeons, manual dexterity and working with patients will remain a primary focus of their work.