Operating rooms of the near future: fewer wires, more information

Delft 01 June 2005Once the new Reinier de Graaf Hospital building opens in Delft in 2009, the operating theatres will be equipped with the very latest technology to facilitate the work of the specialists there. TNO Science and Industry is working together with medical specialists and suppliers of operating theatre equipment primarily to find wireless solutions. - Published in TNO magazine, June 2005 and reprinted with kind permission of the TNO magazine editors

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The project, which began last summer, is focused on the operating theatre of tomorrow where medical equipment will communicate exactly the kind and form of information the surgical team needs ... without any wires.

"When I was approached to take part in the project a good six months ago, I immediately saw a whole range of possibilities", says Dick Cornelisse, anaesthesiologist at the Reinier de Graaf Hospital. "One of the biggest sources of irritation in our profession is the amount of wires in the operating theatre - cluttering everything up. The fewer the wires, the better." Surgeon Dr. Maarten van der Elst backs this up. "You could break your neck falling over all the wires and cables in the operating theatre. We need to get rid of them as fast as possible."

The anaesthetist divides his attention over two operating theatres at the same time. During the operation he constantly monitors the patient - heart rate, blood pressure and a whole host of other body functions are read off on various devices. The anaesthetist closely follows what the surgeon is doing in the event that the medication has to be adjusted or that some other form of action is necessary.

Cornelisse: "What I'm looking for is a handy, portable screen that can clearly show all the data of the patient in the operating theatre. I want to be able to see at a glance what I now have to check separately on different devices. If I'm occupied in one operating theatre, I can then tell the medical staff in the other theatre what action has to be taken without having to be present myself."

Information provision

Cornelisse would also benefit a lot from a system that provides the anaesthetist with rapid information in the operating theatre about syndromes and the corresponding medication. For an emergency operation, you type in one or more key words and the screen shows straightaway what the anaesthetist has to take account of. "For instance, you never know enough about a patient that comes in following a road accident. Imagine being able to enter his data and the system presents you with all the possible risks. Now, that would be ideal." TNO is currently busy developing a so-called "information mediator".

"The anaesthetist knows a lot", says project leader Dr Thijs de Graaff, "but it's a matter of that single aberration that you may come across once in your working life. All the information is available, in manuals or on the internet. We ensure that it is exactly the required information, filtered for the specific circumstances of the patient, that is available in the operating theatre and customised to the individual medical specialist."

Speech recognition

Van der Elst is very optimistic about speech technology, which he hopes will allow him to adjust the operating table or the lamp above as and when the need arises. "Sterilisation is vital in the operating theatre. There's no question of adjusting the table or a lamp with your carefully sterilised gloves. We have special operating theatre assistants to do that for the surgeon. And that costs money, so it would be really quite an advantage if such tasks could be speech controlled."

He also sees another possibility for speech recognition. Writing up a report after an operation is time consuming and you always run the risk of having forgotten something. "I hope that TNO and its partners succeed in developing a wireless, virtual dictaphone that will enable me to speak in the details for the report in situ during the operation. It's an application that you could also use for letters to general practitioners concerning treatment for the patient", Van der Elst says.

TNO trials with speech recognition are highly promising but the results don't go far enough. Before rolling out the spoken word and text from a PC, the error margin has to be reduced to a maximum of two per cent in the opinion of De Graaff. In the operating theatre there are various sources of interference that have to be eliminated. TNO already has the basic technology to do this but is talking with large software suppliers and manufacturers of microphones about commercial production.

Optimism

The question is whether TNO is able to realise the desired applications. De Graaff is optimistic. "We are already at an advanced stage with ten relevant applications. To some extent they are working, though not yet in the operating theatre. Ultimately it's the manufacturers that have to get to grips with our concepts. In the meantime, we have given demonstrations to suppliers of medical equipment in the company of the medical specialists of the Reinier de Graaf Hospital. They've seen what we can do and what works. There was plenty of enthusiasm." Van der Elst adds, "They all seemed to think it was great so I reckon they will want to get started on TNO's inventions."

Other applications

A few other applications being developed by TNO:

  • Operation protocol available in the operating theatre in multimedia form. During the operation the surgeon can gain speech-controlled insight into the steps to be taken in, for instance, unexpected complications. It can also be used as a teaching aid at hospitals.
  • A wireless visualisation tool that shows the anaesthetist data on the status of the patient.
  • An intelligent system that follows the operation using cameras and is able to show the images integrated with other data. That offers added value to the anaesthetist whose view of the wound is often impaired. The moving images can also be shared with colleagues both at home and abroad. The specialists can rewind and analyse the images both inside and outside the operating theatre.


Ruud van der Ros

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