Surgical Data Recording Technology

A Solution to Address Medical Errors?

Neal A. Shah, BS; Jessica Jue, MAS; Tim K. Mackey, MAS, PhD

Disclosures

Annals of Surgery. 2020;271(3):431-433. 

In This Article

Surgical Data Recording Technology Features

Surgical data recorders have undergone technological advancement. Fundamentally, they are systems designed to monitor, record, and potentially analyze data collected in the surgical setting but exhibit variability in functionality (see Table 1 for summary examples of types of surgical data recording systems).

For example, rudimentary surgical data recording technologies can start with collecting nondigital data tabulating failure events on index cards and locking them away in a container for further review. These systems can eventually progress to real-time data collection with timestamped notes, and finally toward video recording to corroborate notated information.[5] Such was the case with St. Louis Children's Hospital, and as their data capture methodology advanced, so did the frequency of surgical failures detected, reflecting the interplay between technology utilization and error reporting.[5] The transition to more advanced recording systems also created a positive change in the surgical team's workflow; pediatric cardiac surgeons began documenting unanticipated error.[5] Analysis of those errors revealed common clusters of mistakes, such as communication errors correlating with patient blood failures associated with the process for delivery from the blood bank to the OR.[5] This led to implementation of a more efficient blood-product delivery process, which reduced blood delivery time and blood-related failures.[5]

Modern surgical data recording technologies synthesize audio-video input, along with other novel metrics. These technologies are generally comprised of microphones, cameras, and sensors linked to computers that integrate numerous medical data inputs, allowing for more detailed capture of intraoperative and external information. A 2018 study discusses and assesses a surgical data recording system developed by a team led by Dr Teodor Grantcharov, a surgeon scientist at St. Michael's Hospital in Toronto.[6] Their OR black box ("ORBB") functions as a multifaceted system, including several cameras, microphones, sensors, and software to document intraoperative auditory and visual data, patient physiology, and environmental parameters.[6] A prospective cohort study of laparoscopic surgeries at the University of Toronto using this system revealed frequent disruption and error from various sources.[6] Auditory distractions were recorded a median of 138 times per case.[6] In addition, equipment, such as surgical instruments and laparoscopic consoles were either absent or malfunctioning in one-third of the cases, and technical error was recorded a median of 20 times per case.[6] Such error led to adverse events; a median of 8 adverse events per case were recorded, with bleeding being the most frequent.[6] There were also often errors of technique, such as underestimation of force applied or distance to tissue.6 At the Academic Medical Center in Amsterdam (AMC Amsterdam), the ORBB was employed during gall bladder removals and esophageal surgeries to capture data typically not prioritized or explorable.7 In addition to video and audio recording of the operation itself, details about the operating room set-up, room temperature, number of surgical personnel, personnel movements, pre and post procedural sponge counts, and frequency of the operating room door opening and closing were collected.[7] The robust data collected by the ORBB provides a glimpse into what is possible with advanced, multifaceted recording devices-improved data capture and error identification from numerous sources, and the future possibility of integrating artificial intelligence (AI) and computer vision with these systems.

A final example is a surgical data recording device used by urology surgeons at the University of Southern California that collects kinematic data via the da Vinci Surgical System.[8] Called the "dvLogger," this device records metrics about the precise movements and speed of instruments during robot-assisted radical prostatectomies.[8] Parameters such as time to completion of defined operative steps, camera movement frequency, instrument idle time, camera path length, and instrument travel distances were recorded.[8] Such data were analyzed to assess the quantitative foundation of skillfulness in surgery. Expert surgeons showed increased technical efficiency and ergonomic movements relative to novice surgeons in specific speeds and movements during various steps of surgical procedures.[8] Hence, accurate identification of precision unique to experts and detection of high discrepancies between experts and less experienced surgeons can aid in more targeted technical training.

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