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Questionnaire Responses
To encourage discussion and the sharing of ideas, we are posting the questionnaire responses here. We will not identify the respondents. This page will be updated as more questionnaire forms are received. If you have any comments, suggestions, or criticisms, please email them to the program director, Kevin Cleary.
Question 1: What are the major technical problems and research needs for the operating room of the future?
Respondent 1: OR staff need to know what they are supposed to do and demonstrate that they can do it: This will require a research paradigm on training and assessment
Respondent 2: Patient safety, advanced devices – especially for MIS, surgical robotics
Respondent 3: Theragnostics: a full integration of diagnosis and therapy within the operating room. This includes advanced image fusion, 3D and functional intra-operative imaging.
Respondent 5: Cost-effective Surgical Robotics; 3D-Image-integrated/overlayed Robotic Surgery; Telesurgery: Bandwidth/Delay/Wireless/Security
Respondent 6: Improved intra-operative imaging, improved instrument tracking, smaller, more dexterous robots
Respondent 7: Creating procedures and techniques that yield high levels of success and are easily reproducible across a wide spectrum of health care delivery environments.
Respondent 8: Ready intraoperative access to preoperative imaging, integration of preoperative and intraoperative imaging, integration of imaging and functional platforms (image guided surgery), improved electronic medical record
Respondent 9: Intuitively manageable and flexible small robotic devices with a certain degree of autonomy.
Respondent 10: Integration of technologies, a common set of standards to enhance integration. Research: Measurement of the impact of change, both quantitatively and qualitatively
Respondent 11: Recordiing of all surgical procedures. Advanced user interface for surgical navigation instrument
Respondent 12: Detection and treatment of microscopic and preclinical disease
Respondent 13: Improved knowledge of location and boundaries of tumors; Certainty that the tumor has been completely removed.
Respondent 14: 1. Surgical robotic tools that extend the capability of the surgeon, allowing procedures that are not possible without them. 2. Integration of information to allow better simulation and online decision-making.
Respondent 15: Electronic medical records and integration between multiple systems used during surgery
Respondent 16: Plug & Play type systems integration, Complete data capture at micro and macro level, Optimized display of captured data to relevant stakeholders, Automatic process exception detection and annunciation, Universal electronic medical record
Respondent 17: Patient Safety, Efficiency (right instrument/equipment/ etc) and Logistics (right place at right time)
Respondent 18: Surgical robotics
Respondent 19: Designing medical imaging devices to meet the needs of interventionalists, as opposed to tweaking diagnostic imaging devices and sticking them in the OR. This includes the invention of wholly new imaging modalities. Integration is a big deal too.
Respondent 20: Zero-configuration ad-hoc device integration
Respondent 21: Improved intraoperative imaging and interfaces
Respondent 22: Technical problems are not the limiting factor – business processes and organizational commitment and resolve are the keys
Respondent 23: I feel the real problem is integration of the systems coming into the OR. The surgeon requires that she/he have a choice in imaging, instrumentation, and effectors used in the OR; and right now all of these devices are proprietary, and none speak to each other. This must be resolved.
Respondent 24: Improved Intraoperative Imaging
Respondent 25: Achieving enough systems integration to allow the OR to become a learning environment and to achieve a higher level of scripted activity.
Respondent 26: Non-invasive (or minimally invasive) methods to achieve and maintain registration between imaging and instrumentation.
Respondent 27: Surgical Strategy Desk, Surgical Robotics
Respondent 28: Surgical strategy desk, Medical traceability
Respondent 29: Provision of comprehensive situational awareness while reducing cognitive complexity. Comprehensive device integration to facilitate data collection, closed loop device control, and intelligent alarms/decision support systems.
Respondent 32: System integration and communication between different modalities and instrumentations
Respondent 34: Lack of integration of medical information, streamlining of data such that it is usable, visualization tools that afford greater communication.
Respondent 36: improved intraoperative imaging
Respondent 37: Better integration of imaging into surgical procedures. Smaller, less obtrusive imaging devices.
Respondent 40: Interfacing technologies—those that inject information into the surgical event at the appropriate time. This takes priority over tool development (ie surgical robotics) since the information will help guide tools of any sort.
Respondent 41: integration of all types of information
Respondent 42: High performance image and information fusion, automatic targeting guidance, miniature of surgical and robotic devices
Respondent 43: Matching technology with appropriate staff.
Respondent 45: Rapid turnover of patients, efficient use of staff and resources, Manage data & visual overload
Respondent 47: Improved use of advanced information and computational technology as well as medical instruments/equipment
Respondent 48: Improved intra-operative imaging
Respondent 49: System integration, improved intraoperative imaging, work flow in the operating room
Question 2: What are the major infrastructure and administrative issues that must be addressed to develop the integrated operating room of the future?
Respondent 1: Infrastructure and administration must flow seamlessly
Respondent 2: Understanding of the perioperative environment
Respondent 3: We may need more small integrating companies, such as BrainLab, providing end-to-end solutions including different imaging and visualization technology for each particular application/procedure.
Respondent 5: Telesurgery: Inter-state MD liscensure
Respondent 6: Integration of pre-op image acquisition-processing-transfer infrastructure with intra-op imaging and robotics in OR
Respondent 7: There is not enough emphasis on easily applied video telecommunications from the OR to various points inside and outside of the hospital. This is a matter of obtaining hardware; secure, reliable,broadband telecommunictions; data compression and developing the personnel to maintain and troubleshoot these systems.technologies,
Respondent 8: Coordination between technical and clinical personnel, better acceptance of and interest in (therefore, need for user friendly interfaces) emerging technologies
Respondent 9: Seamless integration and exchange of multimedia (data, image, text) data. Cognitively adequate access to these data directly at the location of the patient.
Respondent 11: Cooperation between medical and technical staff including human engineering
Respondent 12: Recognition of interdisciplinary research teams, improvement of general funding of healthcare, malpractice reforms
Respondent 13: Space; ;multidisciplinary teams
Respondent 14: High Tech tools engineers design must get much less expensive and more user friendly, so that surgeons will easily be able to purchase and use them.
Respondent 15: Standards, inter-operability of multiple vendor’s systems, financial support for development and system’s integration
Respondent 16: Universal deployment of automatic identification & data collection technology, Recognition that IS departments are not just cost centers, Accepted and utilized standards for medical device interconnectivity, Remove prohibition on closed-loop control of medical devices currently enforced in US
Respondent 17: Systems approach to logistics, patient safety, quality
Respondent 19: Data Communication/Image Reconstruction/Updated Visualization. We need all the imaging and robotics and PACS, etc… to talk to each other – plug and play. Many of these communications need to be in real time. Diagnostic imaging doesn’t provide this.
Respondent 20: Industry-wide standards adoption. New standards should be able to grow over time and retain compatibility with previous versions.
Respondent 21: Workflow
Respondent 22: Technical problems are not the limiting factor – business processes and organizational commitment and resolve are the keys
Respondent 23: I feel a standard is necessary to allow meaningful interaction, control, and information transfer between the various devices in the OR.
Respondent 24: System Integration
Respondent 25: Before technology can be adapted there needs to be a significant cultural change in the perioperative environment to avoid programming in bad management into technology.
Respondent 26: Reduce cost of use (e.g., disposables, OR time). Studies to demonstrate clinical benefit.
Respondent 27: Quantitative Analysis of Surgical Risk & Benefit
Respondent 28: Target controlled management, good communication between technical and clinical personel
Respondent 29: Robust technologies to integrate ORF systems are available. But, an effective solution will have to address hardware, system integration, and regulatory (liability) issues. The economic implications of plug-and-play connectivity must also be considered.
Respondent 32: Billing, and infrastructure cost sharing
Respondent 34: Conformance to standard communication protocols like DICOM, HL7, IHE, etc.
Respondent 36: Standards, interoperability
Respondent 37: Potential for turf wars with radiology, integration with existing technology/procedures
Respondent 40: The administrative focus should be on patient safety. Safety has technical, ethical, clinical and political urgency that will allow the investment necessary to drive this successfully.
Respondent 41: adequate computing resources and integration standards
Respondent 42: Development of global patient database networks, patient confidentiality and data security, HIPPA-like universal regulations
Respondent 43: Space and dedicated trained staff are essential. This is problematic in today’s or environment.
Respondent 45: Teamwork and collaboration throughout patient care in the surgical experience. Seamless and transparent connectivity and application, untettered patient
Respondent 47: Agreed with the examples
Respondent 48: Integration of the surgical navigation systems into the scanners, which provides fast, seamless, hassle-free guidance.
Question 3: What piece of technology or technological advance do you wish you had today?
Respondent 1: Surgical robotics, an every-day telemedicine system that sits one EVERY physicians desktop computer. However, we need prospective blinded trials demonstrating the efficacy of this technology to support implementation
Respondent 2: Advanced image-based Surgical simulation
Respondent 3: Intra-operative combined anatomical and functional imaging, e.g. not only visualizing and locating the tumors but also their properties (degree of malignancy) and eventually proof of their total removal after the resection.
Respondent 5: Surgical Robot with 3D CT Overlay “HUD”
Respondent 6: Robust real-time affordable 3D intra-operative imaging devices
Respondent 7: Easily movable CT/MR flourosocopy unit for real-time introperative imaging and image quided surgeries.
Respondent 8: More compact, light-weight, fully integrated computer assisted surgery device (surgical robot), with capability to import and integrate digital patient imaging
Respondent 9: Robots for minimally invasive surgery that would give you a perfect sense of “total immersion” by employing all senses
Respondent 10: Patient centric electronic record, available to all care providers at point of care.
Respondent 11: Portable super computer that enables us to solve 2-D /3-D or 3-D / 3-D registration problem
Respondent 12: Wireless non-line-of-sight internal fiducial tracking without ionizing radiation
Respondent 13: Small device that tells me where tumor is and is not
Respondent 16: Universal data display and device control on tablet PC
Respondent 17: Better integration of what is available; therefore better performance improvement; perhaps achieve with “work flow” engine combined with wireless access to data mining
Respondent 19: Advanced molecular imaging contrast agents for use in intervention.
Respondent 20: inexpensive 3D display devices
Respondent 21: Surgical PACS and Surgical DICOM
Respondent 22: Target Controlled Infusion devices for anesthesia in OR, sedation in other sites [like clinics]
Respondent 23: Integrated control computer allowing management of all systems in the OR.
Respondent 24: wireless communication
Respondent 25: RFID for instruments and supplies.
Respondent 26: Small 3 dof (or higher) position sensor that is sterilizable, accurate and does not impose limitations on the line of sight and amount of metal in the surgical field.
Respondent 27: Secure Broad-band Network, Robotics, Tele-communication
Respondent 28: tele-communication, tele-control
Respondent 29: Wireless team communication device; Spy-cam to view remote activities; Single EMR that was populated with all events and activities.
Respondent 32: A decent inexpensive intraoperative MR
Respondent 34: Pervasive access to all my relevant data, communications, etc.
Respondent 36: Image guided surgery systems that are easy to ‘tap into’ and integrate with other pieces of equipment (e.g. intraoperative imaging)
Respondent 37: Plug-and-play (or plug-and-work) instrumentation
Respondent 40: Intraoperative MRI
Respondent 41: integration hardware
Respondent 42: Automatic targeting guidance and display system that dynamically locks on the targets inside the body regardless of the movement of the patient or the physician
Respondent 43: Integrated computer system.
Respondent 45: Optimization decision support tool that that plan and resolve OR schedule based on patient, staffing and resource need and constraints
Respondent 47: Video and multimedia technology integrated with computer networks within the OR and connected to the Internet
Respondent 48: Real-time inexpensive high quality intra-operative imaging system
Question 4: Who is known in the field for innovation (technical or clinical) and where is the exciting work being done?
Respondent 1: Grant Holcomb:- Telemedicine
Respondent 2: David Rattner @ Mass General; Adrian Park @ UMaryland; Ron Merrell @ VCU; Tim Broderick @ UCincinnati, Steve Dawson @ CIMIT; Rick Satava @ DARPA
Respondent 3: In many places including BWH, King’s College, Utrechts, JHU, London Ontario, …
Respondent 5: Jacques Marescaux, Strasbourg FR; Marohn/Talamini/Taylor Johns Hopkins; Intuitive Surgical, CA.
Respondent 6: Eve Coste-Manière,
Respondent 7: Dr. Louis Kavoussi, Johns Hopkins Medical Center, Dr. Inderbir Gil, Cleveland Clinic, Dr. Marshall L. Stoller, University of California San Francisco, Dr. Ralph Clayman, University of California, Irvine.
Respondent 8: Jacques Marescaux, Mehran Anvari, Mark Talamini, Michael Marohn, IRCAD/ Strasbourg, FR; Hamilton CAN; Johns Hopkins/ Baltimore, MD; Stanford
Respondent 10: MGH – OR of the Future
Respondent 11: Ron Kikinis, Dave Hawkes, Ramin Shahidi
Respondent 14: There are many universities with active research in this area. Johns Hopkins has Russ Taylor, Allison Okamura, and several others and partners with many of the preeminent researchers in this field.
Respondent 16: Nat Sims, M.D. (technical innovation, MGH), Dwayne Westenskow, Ph.D. (technical innovation, U of Utah)
Respondent 19: I like the work at SPL as well as the work at JHU; both those are obvious. My favorite up-and-comer would be Ross Whitaker at Utah, working on 3D C-Arm image reconstruction and analysis.
Respondent 20: Richard Bucholz at Saint Louis University
Respondent 21: TATRC
Respondent 22: MGH / U MD / Cleveland Clinic / UCLA
Respondent 23: I think the group at the Brigham with Ron Kinkinis is doing great work with imaging, but as for OR integration, no one has really addressed this yet.
Respondent 24: Ron Kikinis M.D.
Respondent 26: ERC-CISST (JHU, BWH, CMU), Univ. British Columbia, Imperial College, Grenoble, Intuitive Surgical, Inc., ISS, Inc., Medtronics, Inc., many others
Respondent 27: Prof. Masakatsu G. Fujie (Waseda Univ., Tokyo, Japan), Prof. Makoto Hashizume (Kyushu Univ., Fukuoka, Japan)
Respondent 28: Prof. Masakatsu Fujie (Waseda University), Prof. Makoto Hashizume (Kyushu University)
Respondent 29: Pockets of activity and forward-thinking in many environments. Research-based ORF agenda at MGH.
Respondent 32: Henry Fuchs and UNC (chapel hill)
Respondent 40: Washington University in St. Louis. Richard Buholz.
Respondent 41: Pittsburgh, innovative surgery based on image fusion
Respondent 42: Fro example, SPL
Respondent 43: Dr Mahron
Respondent 47: Sclabassi, Robert J.
Respondent 48: David Hawks (Guys Hospital, UK)
Respondent 49: JHU, BWH, CMU, Univ. of Tokyo
Question 5a: What will be possible over the next 5 years?
Respondent 1: VR integrated into every procedural based medical specialty, national technical skills proficiency levels
Respondent 2: Improved MIS, telesurgery
Respondent 3: Regular use of Computer Aided Diagnosis, integration of intra-operative 3D imaging and pre-operative imaging (including functional) of deformable organs and advanced 3D visualization
Respondent 5: Military applications of Telesurgery w/ daVinci
Respondent 7: Improved robotic assisted surgery
Respondent 8: Routine remote surgery
Respondent 9: Routine 3D individualised navigation through perfect integration of all available imaging modalities
Respondent 11: Intelligent surgical navigation system that can be operated by speech and gesture recognition
Respondent 12: “Real-time” pathology in the OR
Respondent 13: Labeling of tumors so that their location and margins are better defined. This may occur with molecular markers, antibodies, agents that are taken up by tumors
Respondent 14: In the next 5 years information in the OR will get more integrated. Computers will get faster and better at graphics, and less image integration will be done in the surgeon’s head. The devices used will get incrementally less expensive and surgeons will be more used to technology and start embracing new tools.
Respondent 16: Very little if major medical equipment manufacturers are allowed to capture near-monopolies in their fields (e.g., GE)
Respondent 17: Robotic supply chain; Better image guided surgery with improved safety parameters; RFID technology to track patients, staff, surgeons and equipment/instruments
Respondent 19: Human-less operating rooms.
Respondent 20: remote surgical consultation in common practice
Respondent 21: Improved interfaces with appropriate standards
Respondent 22: Target Controlled Infusion devices
Respondent 23: Integrated control of systems in the OR.
Respondent 24: Non Invasive thermal ablation
Respondent 25: Complete situational awareness in the perioperative environment.
Respondent 26: Routine computer-assisted spine surgery.
Respondent 27: Day Surgery in General Neurosurgical Field
Respondent 28: Computer aided design-Computer aided manipulation based on surgical strategy desk
Respondent 29: IT and connectivity based solutions.
Respondent 32: Reliable and precise Intraopertaive soft-tissue navigation
Respondent 37: Routine 3D imaging for updating surgical progress
Respondent 40: Information enhanced surgery.
Respondent 41: minimally invasive surgery for almost all brain tumors
Respondent 42: Development of semi-automatic targeting guidance and increasing use of surgical robotic devices
Respondent 43: Smaller robot with more operating arms.
Respondent 45: Untettered patient monitoirng system that facilitate movement and transport of patients in the hospital
Respondent 47: Networked consulting/collaboration and surgical monitoring
Respondent 48: Fully scanner integrated image guidance systems, with no setup time
Respondent 49: Universal electronic patent database. Tele monitoring capabilities
Question 5b: What will be possible over the next 10 years?
Respondent 1: 10 years an open surgery VR simulator VR part of board certification for interventional procedures e.g minimally invasive surgery, interventional cardiology etc
Respondent 2: Robotic surgery
Respondent 3: Intra-operative functional (including molecular) imaging and its use for better targeted minimally invasive surgery
Respondent 5: Surgical Robot with 3D CT Overlay “HUD”
Respondent 6: Routine port-access surgery using micro-robotics and model-based image-guidance.
Respondent 7: Routine telementoring. Emphasis on image guided, minimally invasive tissue ablation over extirpative surgery.
Respondent 8: Significantly autonomous computer assisted surgery
Respondent 9: Context-aware agents (robots) in the OR that “know what they are doing” and have some skills of anticipation what is (going to be) necessary in a given situation
Respondent 11: Intelligent surgical procedure monitoring system that fully understands surgical procedure
Respondent 12: In situ minimally invasive pathology
Respondent 13: Instruments for the OR that make the use of such agents practical
Respondent 14: Haptics will mature as a field and we will have more flexible robot assistants capable of displaying force feedback to surgeons. The operating room will continue to embrace technology leading to better visualization and hence decision-making for the surgeon.
Respondent 16: It all could be possible…
Respondent 19: Cancer-removal at the cellular level – enabled by precision control of instruments and imaging.
Respondent 20: Physiological and biomechanical simulation and modeling of the patient as a whole.
Respondent 21: More interdisciplinary culture in surgery
Respondent 22: Seamless flow of electronic medical information across locations, among various clinical disciplines on a variety of form factors that is easily user customizable
Respondent 23: Meaningful telepresence where a distant operator can assist in complex cases.
Respondent 24: totally automated surgery
Respondent 25: Automation of significant perioperative processes, e.g. supply chain, SPD
Respondent 26: Routine use of computer assistance (such as robotics) for minimally-invasive procedures in many areas, such as orthopedics, cardiac, ENT.
Respondent 27: There will be no general operation room in general hospital. (Surgeons can treat patients anywhere using innovative surgical system)
Respondent 28: mobile operating theater based on remote surgery & tele-communication
Respondent 29: Intelligent decision support systems; Long-acting local anesthetics to reduce total anesthetic drug load and simplify post-op analgesic management. Comprehensive wireless monitoring of patient throughout periop period with intelligent alarm generation/annunciation.
Respondent 32: Routine robotic surgery and emergence of intraopertaive micro sensor technology
Respondent 37: Complete integration of application-specific imaging hardware into surgical devices rather than as an afterthought.
Respondent 40: Multiply redundant systems that ensure patient safety, prohibit unsafe action and archive both safe and unsafe action for subsequent surgeon training.
Respondent 41: routine consultation and remote brain surgery
Respondent 42: High degree of automation in targeting guidance and widespread use of surgical robotic devices in large hospitals
Respondent 43: Integrated computer system.
Respondent 45: Greater than 90 % of surgery conducted in ambulatory surgical settings. Widspread use of image guided surgery
Respondent 47: Remote surgery by guest surgeons anywhere in the world
Respondent 48: Multi-modal scanners in OR
Respondent 49: Routine robotic surgery. Tele surgery capabilities. Image/sensor based physiological and biomechanical simulation capabilities
Question 1: What 3 to 5 procedures do you most commonly perform?
Respondent 1: Gastric by-pass, hernia, nissen
Respondent 7: Ureteroscopic stone extraction, Extracorporeal Shock Wave Lithotripsy, Laparoscopic Nephrectomy, Percutaneous Nephrolithotmy
Respondent 8: Laparoscopic foregut surgery, laparoscopic colectomy, laparoscopic solid organ surgery, open endocrine surgery, facilitate laparoscopic advanced urology procedures
Respondent 13: Biopsy of tumors and pre-cancerous tissues
Respondent 16: General anesthesia, Central venous and peripheral arterial catheterization, Regional anesthesia
Respondent 22: Variety of bread and butter type of anesthesia support – General endotracheal anesthesia / sub arachnoid block / epidural / IV sedation and monitored anesthesia care
Respondent 23: Craniotomy for tumor; craniotomy for epilepsy; vagal nerve stimulator implant; craniotomy for trauma and evac intracerebral hemorrhage.
Respondent 24: Brain surgery, cryosurgery, Focused ultrasound surgery
Respondent 28: malignant brain tumor(glioma) surgery
Respondent 29: Anesthesia for adults undergoing minimally-invasive general and gyn surgery.
Respondent 40: Craniotomy for tumor, craniotomy for trauma, craniotomy for aneurysm, lumbar discectomy, lumbar fusion
Respondent 41: involved in: i) vasular cases ( both open and endovascualr); ii) skull base tumors; iii) spinal tumors; iv) spinal stabilizations; v) microrecordings for DBS
Question 2: In what 3 to 5 procedures will the integrated operating room of the future be most important?
Respondent 1: Gastric by-pass, and advanced MIS procedures for mentoring
Respondent 7: Percutaneous nephrolithotomy, Laparoscopic Partial nephrectomy, Image guided percutaneous tumor ablation.
Respondent 8: Complex cancer surgeries involving reconstruction
Respondent 13: Improved resection of tumors with smaller surrounding margins of normal tissue. Improved treatment of metastases
Respondent 16: For anesthesia: General anesthesia and conscious sedation, For ‘surgery’: Endoluminal, endovascular and endoscopic surgery; real-time image guided versions of above
Respondent 22: IV sedation and monitored anesthesia care
Respondent 23: Cranotomy for tumor; cran for epilepsy; implant deep brain stimulator
Respondent 24: Tumor Ablation , Vascular Bypass, Transplantation
Respondent 27: Tumor Resection
Respondent 28: computer aided design – computer aided manipulation(CAD-CAM) surgery
Respondent 29: ORF will be most valuable when not restricted to 3-5 procedures. Overall safety and efficiency improvements must be more broadly applicable to provide value.
Respondent 40: Spinal procedures, brain aneurysm procedures, brain tumor procedures
Respondent 41: all of the above
Question 3: What are the major difficulties in developing the operating room of the future? Please list between 1 and 5 difficulties. These could be clinical, technical, or administrative.
Respondent 1: 1. mind-set of OR staff (including surgeons!), 2. Training, 3. money, 4. operating room size 5. communication between engineers and clinicians
Respondent 7: Financial resources. Specifically proving to administration that the emerging technologies are cost-effective and result in improved outcomes and patient safety.
Respondent 8: Acceptance, infrastructure, integration, ‘open’ architecture standards
Respondent 13: Lack of an OR research facility. When new techniques are introduced they take additional time to perform and to problem solve.
Respondent 16: Information flow into & out of the space, Access to records, Facilitation of completing perioperative workup prior to day of surgery, Translating innovation to practice in tradition-bound environments, Access to funding for translational work, Getting equipment manufacturers to make what we need instead of what they can make
Respondent 17: Change in culture; the OR has a deeply embedded culture that spans a century. Change is difficult to achieve. New technology is critical but not sufficient
Respondent 22: Technical problems are not the limiting factor – business processes and organizational commitment and resolve are the keys
Respondent 23: Commercial infighting between vendors. No one sees the value of an integrated OR, so no one is stpping up to the plate to handle it. Also, the hospitals are in terrible condition, so they have no way to pay for it.
Respondent 24: Intergration of imaging with therapy
Respondent 27: Maintenance Fee, Law, Patient Selection, Reliability of Surgical Instruments and System.
Respondent 28: patient selection, reliability of surgical tools and system, collaboration between instructor of surgical strategy desk and surgical staffs
Respondent 29: Defining the ORF concept for each institution/environment; Optimizing for some procedures/services results in increased efficiency for those teams but decreases broader applicability. Selling and then maintaining focus and vision - ORF concept is not only about technology or speed or research etc.; Programs of this size and scope require long term funding
Respondent 40: Introducing change into a large organization in which status quo is entrenched. Justifying learning curves in an environment where expertise is paramount. Transplanting successful paradigms between institutions.
Respondent 41: i) Uniform standard between manufacturers; ii) lack of knowledge by manufacturers about what is needed.
Question 4: What would you like to be able to do in your specialty that you cannot do right now?
Respondent 1: Have OR staff (including surgeons) know what they are supposed to know and do it! Be able to competently operate OR equipment we currently have
Respondent 8: Integrate digital images across imaging modalities and integrate the images with functional platforms
Respondent 13: Identify and treat pre-cancer
Respondent 16: Real time access to patient specific medical records; real time access to process models based on compiled aggregate data for the purpose of comparing my instantaneous trajectory to the model
Respondent 22: Target Controlled Infusion devices for anesthesia in OR, sedation in other sites [like clinics]
Respondent 23: Have a meaningful consultation with someone while I am doing a difficult case.
Respondent 28: pin point surgery
Respondent 29: Rapid on/off of neuromuscular blockade. Miniature imaging tools for line insertion. Continuously monitor patients wirelessly/non-invasively throughout periop process.
Respondent 40: Use full, updatable image guidance in the spine.
Respondent 41: Integrate functional and visual data in realtime across teleconsultation facilities.
Question 5: What are the most time consuming aspects of the procedures you regularly do?
Respondent 7: 1. Percutaneous access of the urinary tract. 2. Control of bleeding. 3. Waiting for sterile supplies in the OR
Respondent 8: Paperwork- in its myriad iterations…
Respondent 13: Waiting for the results of pathologic examination
Respondent 16: Setting up
Respondent 22: Gathering pt information and discussing pt issues with other members of the OR team
Respondent 23: Set up – getting all the equipment in the OR, making certain it works, positioning the patient, etc.
Respondent 28: real time decision making
Respondent 29: Date access and verification during pre-induction period.
Respondent 40: Ad hoc intraoperative image analysis, tool retreival
Respondent 41: everything
Respondent 43: Percutaneous access of the urinary tract. Control of bleeding. Waiting for sterile supplies in the OR
Question 6: What are the most common complications or errors in your specialty? What advanced technology help reduce these complications or errors?
Respondent 7: Urinary leakage after extirpative and reconstructive procedures. Newer generation sealants will hopefully improve this. Intraoperative and postoperative bleeding: selalants and new generation cautery units. Retained stone fragments in the urinary tract. No advancements
Respondent 8: Electronic, automated OR management could reduce time, errors, and improve efficiency
Respondent 16: Medication errors, AIDC enabled workstations
Respondent 17: Wrong equipment/instruments at start of case; prophylactic antibiotics not administered on time or at all; blood transfusions errors; patient not prepped at start time (ie, late start with consequences for entire schedule of day)
Respondent 22: Too much / too little anesthesia - Target Controlled Infusion devices will help greatly
Respondent 23: Getting lost in the brain is still common. Not performing the right operation due to uncertainty in histological diagnosis. Small hospitals doing procedures that they do rarely, and do badly, as they get paid to do them, as opposed to send the patient to a center experienced in the condition that has the technology to give optimal care.
Respondent 24: Bleeding
Respondent 28: aphasia, motor paresis, residual tumor
Respondent 29: Laparoscopic insufflation-induced hemodynamic instability. Not developing optimum anesthetic plan due to lack of awareness of relevant medical problems (including allergies) documented in missing records or illegible charts. Solution to former ? Simplified solution to latter -> better integrated EMR systems.
Respondent 40: Insufficient primary brain tumor resection, nerve injury in spinal surgery
Respondent 41: Everything we do is aimed at reducing morbidity
Respondent 43: Urinary leakage after extirpative and reconstructive procedures. Newer generation sealants will hopefully improve this. Intraoperative and postoperative bleeding: selalants and new generation cautery units. Retained stone fragments in the urinary tract. No advancements
4.3.1 Working Group Questions--Operational Efficiency and Workflow:
Question 1: What are the major technical problems with Operational Efficiency and Workflow?
Respondent 3: Need for end-to-end solutions including new interfaces and working environment, which maximize the role of all players in the operating room to improve the quality of surgery, and reduce both the time and the cost of the surgery.
Respondent 8: Lack of automation (as RFID) to reduce time, errors, and improve efficiency
Respondent 10: Lack of availability of real time over the horizon information regarding upstream and down stream processes. This means the system is slow to respond to variance, of which there is a lot.
Respondent 16: Information flow, Manual searches for data, Manual data entry
Respondent 17: Lack of adequate information technology for OR setting;
Respondent 20: Too much expertise is required for current equipment set up.
Respondent 21: Interface standards
Respondent 23: Work flow is chaotic right now. With huge turn over in staff you have to re-educate the staff every time you do a case.
Respondent 25: Lack of situational awareness.
Respondent 27: Patient Preparation, Communication between staffs. (Information Sharing)
Respondent 28: shared medical information about patient’s cindition and surgical procedure in surgical staffs
Respondent 29: Lack of comprehensive situational awareness to align concurrent activities. Patients who arrive late or ignore NPO orders.
Respondent 32: Complexity of utilizing 3D and 4D into the workflow.
Respondent 41: Poor scheduling practices and slow OR turn over between cases
Respondent 42: Lack of flexibility in workflow techniques
Respondent 45: Too much time spent prepare and transport patient for surgery and recovering patient from surgery. Knowing current status of operation and predicting time course surgery
Question 2: What other factors are relevant for Operational Efficiency and Workflow?
Respondent 1: Training, training, training and the will by administration to DEAL with this issue in the real world, not an accounts ledger!
Respondent 3: The new technology does not find its way into the operating room often because it increases time needed for surgery, needs too much interaction, it is not well integrated into the workflow and does not consider all players (e.g. anesthetist) in OR.
Respondent 8: Culture of technology acceptance
Respondent 10: Doesn’t really matter how efficient you are unless you perform more cases during the saved time or reduce overtime. Small increments of saved time that doesn’t result in increased throughput are of limited utility.
Respondent 16: Paper records are bad news
Respondent 17: Culture of OR (analogous to old heirachy in airline industry)
Respondent 21: Ontology and interdisciplinary communication
Respondent 25: Management of unplanned events.
Respondent 27: Visualization of all the information in OR.
Respondent 28: Visualization of surgical flow
Respondent 29: Historical data about patient factors that caused previous complications or delays should be flagged early in process to permit accomodation.
Respondent 32: Usability
Respondent 41: Lack of communication concerning pt information and planned schedules.
Respondent 42: Due to less flexibility of system, user non-compliance is a major issue
Respondent 45: Benchmarking and quantifying workflow and resource usage. Reduction in patient turnaround time. Predictable duration of activities in patient flow process to optimize staff & resources
Question 3: What procedures could benefit most from advances in Operational Efficiency and Workflow?
Respondent 1: Every procedure that goes through the OR, but especially routine procedures such as LC where times wasted can be reduced to a minimum.
Respondent 3: The time critical, complex procedures such as heart surgery.
Respondent 8: Many of these answers fit the repetitive queries
Respondent 10: 60-80 minute similar surgical procedures performed by a surgeon who is motivated to be efficient and who performs surgery with limited variability. Example, a day of gall bladders and hernias with a general surgeon who is predictable.
Respondent 16: OR procedures of all types
Respondent 21: Most, i.e. bone and soft tissue procedures
Respondent 23: All.
Respondent 25: Patient Safety
Respondent 27: Management of Risk and Benefit of treatment (Reducing risk/ High-quality surgery)
Respondent 28: Reducing and assessment of surgical risk and quality control of therapy
Respondent 29: Short duration procedures with rapid OR cleanup and setup.
Respondent 32: All
Respondent 41: All procedures. These issues are such time waister. OR time costs $56/min in our institution and the costs are out of control.
Respondent 42: Simple and most routine procesures, such as biopsies
Respondent 45: Ambulatory surgery
4.3.2 Working Group Questions--Systems Integration and Technical Standards:
Question 1: What are the major technical problems related to Systems Integration and Technical Standards?
Respondent 3: The use of different software and hardware interfaces by different providers make the integration quite difficult. It is not enough to have a common imaging format such as DICOM. One needs a higher level of standardization.
Respondent 10: Agreeing on a common standard and having it take effect
Respondent 16: Proprietary communications standards
Respondent 20: Lack of an accepted standard for device integration
Respondent 21: A clear understanding of surgical workflow and its modeling tools
Respondent 23: Lack of standards between devices. Industry does not want to come to a standard to allow the surgeon to chose the devices in the OR and control them all seamlessly.
Respondent 25: There are none. Manufacturing has been doing this for years with proprietary and non proprietary systems.
Respondent 26: Providing open interfaces while ensuring safety, security and patient confidentiality.
Respondent 29: Integrated control and communication systems require that manufacturers must be motivated by economic drivers, and must feel secure from legal and FDA repercussions.
Respondent 32: Lack of standards in validation in a clinically meaningful way, and visualization (from acquisition to reconstruction. To interpretation)
Respondent 41: Lack of technical standards make integration of equipment very difficult and time consuming.
Respondent 42: Lack of universal evaluation and verification techniques
Question 2: What other factors are limiting advances in Systems Integration and Technical Standards?
Respondent 1: A lack of understanding (too simplistic or overly complicated) of how systemsintegrate and the issues that impinge on integration.
Respondent 3: The commercialization of the integrated systems is quite difficult because the number of partners and complexity of the market, this discourages the researchers to put effort in finding solutions.
Respondent 10: Proprietary interests.
Respondent 16: Proprietary hardware configurations
Respondent 20: Medical device manufacturers need to look beyond short term profits. Also don't fear compatibility with other companie's equipment.
Respondent 21: Awareness in the surgical community
Respondent 23: Lack of hospital financing.
Respondent 25: Cultural change.
Respondent 26: No large institution/corporation seems to be pushing for standardization. Also, the regulatory environment generally discourages integration – company quality systems make it hard to provide “hooks” into their medical device; also FDA clears devices for specific “indications for use”.
Respondent 29: Confusion about clinical needs. Turf battles in "ownership" of standards. Manufacturers fear of providing opportunities for competition.
Respondent 32: Lack of common terminology, lack of accountability (mainly industry), and lack of enough government and FDA initiatives to address these issues
Respondent 41: Slow speed of introducing technology advances into equipment.
Respondent 42: Lack of international standards and coorporations
Question 3: What procedures could benefit most from advances in Systems Integration and Technical Standards?
Respondent 1: Training
Respondent 3: From my non medical point of view, the minimally invasive therapies such as endoscopic and laparoscopic ones need advances in systems integration, because they are many different players providing imaging and navigation tools.
Respondent 10: Minimally invasive surgery of all kinds
Respondent 16: All OR procedures
Respondent 20: Experimental cases in which many decisions may have to be made on the spot. Also hospitals that have very limited inventory of devices and must make efficient use of them.
Respondent 21: Image guided procedures
Respondent 23: All.
Respondent 26: Any procedure that could benefit from the integration of more than one vendor’s device.
Respondent 29: Numerous self-evident improvements in data communication and device integration, remote device actuation, closed-loop control systems, decision support, etc. Safety example: Surgeon should be unable to tilt table head-up if patient hemodynamically unstable.
Respondent 32: ALL (with exception of 2D imaging related projects)
Respondent 41: All minimally invasive and guidance procedures.
Respondent 42: Any routine procesures performed in most large hospitals internationally
4.3.3 Working Group Questions--Telecollaboration:
Question 1: What are the major technical problems with Telecollaboration?
Respondent 1: Willingness to participate in everyday practice and the lack of clinical trials on every-day practice that clearly demonstrates the value of tele-collaboration (and how much easier it makes life!)
Respondent 5: Bandwidth, Latency
Respondent 7: Not enough installed equipment to make it feasible. Poorly trained support staff to operate and maintain equipment. High cost and unreliable nature of broadband telecommunications.
Respondent 16: Cost of equipment (still), Cost of infrastructure to support suitable image quality, Setup time (not possible to do it impromptu yet)
Respondent 20: Successful and widespread telecollaboration hinges on an accepted standard for device integration.
Respondent 21: Latency and bandwidth in networks
Respondent 23: Lack of networking capabilities in most Ors.
Respondent 25: None.
Respondent 41: Speed of network paths.
Respondent 42: Lack of precision telepresence technologies that can remotely extend major human senses such as touch, force, and smell
Respondent 43: Not enough installed equipment to make it feasible. Poorly trained support staff to operate and maintain equipment. High cost and unreliable nature of broadband telecommunications.
Respondent 47: Limited use of multimedia and information technology
Question 2: What other factors are limiting the use of Telecollaboration?
Respondent 1: Ignorance, lack of standardization and clinical trails demonstrating the power of this medium
Respondent 5: Legal Issues, Security Issues, Pattent Issues
Respondent 7: Legal aspects of medical liability , licensure, and availability of mentoring personnel. No practical way of financial compensation for telementors, time-zone differences.
Respondent 10: Often requires special scheduling – not all locations have the infrastructure, requires bringing technology in and booking expert users.
Respondent 16: Social inhibitions, Credentialing issues, Medicolegal liability
Respondent 20: Ease of use. Specialized equipment.
Respondent 21: Attitude of professionals
Respondent 23: Hysteria over HIPPA; every time someone suggests a collaboration they are shut down by the HIPPA Nazis.
Respondent 25: Funding
Respondent 41: Lack of acceptance by third party payors and state licensing agencies.
Respondent 42: Difficult scheduling of the collaborative physicians, lack of compensation system, and lack of obvious benefits etc.
Respondent 43: Legal aspects of medical liability , licensure, and availability of mentoring personnel. No practical way of financial compensation for telementors, time-zone differences.
Respondent 47: Outdated computational and display facilities in the OR
Question 3: On a scale of 1 to 5 (5 being very widely used), how widely used do you think Telecollaboration will be used in advanced procedures in the next 5-10 years?
Respondent 1: 7
Respondent 5: 2
Respondent 7: 2
Respondent 10: 5
Respondent 16: 1
Respondent 20: It will become routine as long as the equipment is widely available and EASY to use.
Respondent 21: 2
Respondent 23: If HIPPA folks have their way, -10. If people with rational minds prevail, 3.
Respondent 25: Limited use in the USA medical model. 1-2
Respondent 40: Telecollaboration has little applicability in the surgical suites. Given the nature of surgery, extra hands are welcome, but extra opinions are not. Senior level training conditions, however, may well be enhanced by these applications.
Respondent 41: 5
Respondent 42: 3
Respondent 43:
Respondent 47: 4
Question 4: What procedures could benefit most from advances in Telecollaboration?
Respondent 1: Everything from basic procedures in community practice where the physician would ‘like’ the benefit of an expert observer to very advanced difficult, novel procedures where an expert would like the support of national or international experts whilst they are doing the case
Respondent 5: The first few of any procedure
Respondent 7: Image guided therapies, laparoscopic and robotic-aided surgeries.
Respondent 10: Those seldom performed by most practitioners, those that are rare or just emerging into prime time. Interventional procedures that require collaboration across disciplines eg cardiology, vascular procedures etc.
Respondent 16: Rare cases
Respondent 21: Exotic procedures
Respondent 23: Unusual cases like deep brain stimulation; it would be fantastic to have another set of ears listen to the recordings coming from the patient’s brain during surgery.
Respondent 25: Psychology and therapy compliance.
Respondent 41: Those requiring realtie collaboration.. all high risk neurosurgical procedures.
Respondent 42: Time sensitive procedures such as emergency trauma procedures, and cardiac procedures etc.
Respondent 43: Image guided therapies, laparoscopic and robotic-aided surgeries.
Respondent 47: Complex neurosurgical procedures
4.3.4 Working Group Questions--Robotics and Surgical Instrumentation:
Question 1: What are the major technical problems with Robotics and Surgical Instrumentation?
Respondent 1: Less expensive robots, smaller footprint and better training
Respondent 3: Steep learning curve, often the large size and high price.
Respondent 5: Too big, cumbersome. Lack of Haptics.
Respondent 9: For MIS: Placement and navigation of the instruments, multi-modal (multi-sensory) on-line sensitive control of the instruments, integrated view of all relevant navigation and physiological data during the operation
Respondent 10: Voice recognition is still not where it needs to be for real world use.
Respondent 16: There are not many operations that actually benefit from it, Huge costs, Productivity dis-abler
Respondent 20: Improvement needed for equipment fault tolerance
Respondent 21: Not being adapted to the surgeon’s working needs and the patient’s bodily needs
Respondent 23: For most specialities no one has clearly indicated what the robot should do. Most commercial entities do not see where a profit can be made. What can be done with a robot that is clinically useful that cannot be done now?
Respondent 26: Difficult to use. Generally require more setup time, especially when registration and/or fixation are required.
Respondent 27: Sterilization, Size, Reliability
Respondent 28: sterilization, size and reliability
Respondent 32: Reducing the size while maintaining reliability, lack of IGS integration
Respondent 40: Cost of tool development and regulatory processes
Respondent 41: Two different areas. Robotics is mostly working on non-problems. Instruments are not being approached innovatively.
Respondent 42: Lack of flexible enough control technologies, and lack of miniature technologies
Respondent 46: Tissue movement and deformation.
Respondent 49: Size and reliability
Question 2: What other factors are limiting the use of Robotics and Surgical Instrumentation?
Respondent 1: Most surgeons don’t really know how to use them
Respondent 3: Resistance of the surgeons to the use of robotics devices and lack of full integration into the existing workflow.
Respondent 5: Cost. Lack of refinement. Lack of teaching console or simulator.
Respondent 9: Cost, size of the instrument, required training of personnel
Respondent 10: Cost and demonstrated benefit for mainstream use.
Respondent 21: Need for retraining of physicians
Respondent 23: The tenuous financial ground that most surgical robotic companies find themselves.
Respondent 25: Funding
Respondent 26: High cost (both initial cost and recurring cost).
Respondent 27: Cost, Surgeons are not familiar to Robot, Training/Education of surgeons for Robotic Surgery
Respondent 28: training and education of surgical procedure (including management of manipulator and tool)
Respondent 32: Expense.. steep learning curve
Respondent 40: The need to integrate image information into the telerobotic modules
Respondent 41: Lack of technical input
Respondent 42: Dislike by patients, lack of physician experiences, and FDA restrictions
Respondent 46: Definition and implementation of real value applications.
Respondent 49: Suitable advance materials for microrobots, patient/surgeon’s confidence on robotic surgery, cost and size of the robots
Question 3: On a scale of 1 to 5 (5 being very widely used), how widely used do you think Robotics and Surgical Instrumentation will be used in the next 5-10 years?
Respondent 1: 4 (I would like 5 but I just don’t see it unless there is a breakthrough in the near future)
Respondent 3: Master slave robots à 8, Small surgical robotic instruments à 8, fully automated large robots à 3
Respondent 5: 5
Respondent 9: 4
Respondent 10: 2
Respondent 16: 2
Respondent 21: 1
Respondent 23: Some form of robotics is already being used – see the Cyberknife. The use outside the OR will quickly grow, and the OR may finally come along.
Respondent 25: 1-2
Respondent 26: 3
Respondent 27: 4
Respondent 28: 4
Respondent 32: 1
Respondent 41: 4
Respondent 42: 4-5
Respondent 46: 2
Respondent 49: 2
Question 4: What procedures could benefit most from advances in Robotics and Surgical Instrumentation?
Respondent 1: Any minimally invasive procedure that is currently expensive to do (instrument wise or OR time) and is very demanding or it can make difficult procedures doable for the ‘average’ surgeon
Respondent 5: Any procedure requiring complex reconstruction
Respondent 9: All procedures which – due to the small size of the organ to be manipulated – need a “scaling barrier” to be overcome, e.g. neurosurgery and heart surgery
Respondent 10: Long procedures or procedures that demand prolonged or exact motor control. Image guided surgeries.
Respondent 16: Any procedure that actually uses robots to advantage. Robots should be passing instruments, picking, delivering and opening supplies, etc. Robots can do this now, but it’s not sexy. Robots are the ‘Mercury’ space capsules of 2004. Forty years from now, operating robots will have space-shuttle like capabilities relative to their potential…
Respondent 21: Bone-oriented procedures
Respondent 23: High dexterity small cases – clipping intracerebral aneurysms.
Respondent 25: Neurosurgery, Cardiac surgery
Respondent 26: Minimally-invasive procedures, assuming that registration and fixation difficulties are solved.
Respondent 27: Recording all the surgical procedure (-> Risk management)
Respondent 28: pin point surgery, medical traceability
Respondent 32: Minimally invasive procedures where Robotics can add dexterity.
Respondent 40: The low hanging fruit has been picked. The regular integration of robotic into moré and more procedures will occur when the benefit of doing so outweighs the cost and inconvenience
Respondent 41: Remote surgical procedures
Respondent 42: Any procedures that need precision targetings such as biopsies and neurosurgeries
Respondent 46: Procedures that can be changed to minimally invasive through the use of robotic or surgical navigation tools.
Respondent 49: Minimally-invasive procedures, percutaneous applications, remote surgery
4.3.5 Working Group Questions--Intraoperative Diagnosis and Imaging:
Question 1: What are the major technical problems with Intraoperative Diagnosis and Imaging?
Respondent 3: They are still mostly two dimensional and only anatomical (non-functional)
Respondent 6: Poor quality intra-operative images, lack of 3D real-time. Lack of adequate models to represent virtual representations of internal organs
Respondent 11: Acquiring three or four dimensional images of very high resolution
Respondent 12: Biochemical sensitivity, spatial resolution, knowing what tracers are appropriate for a particular clinical task, equipment size, other special environmental needs,
Respondent 13: Lack of integration of molecular imaging methods into intraoperative diagnosis. Need for better molecular tracers, both in intensity of marker and specificity of marker. Need to develop improved methods for image processing of color and NIR images.
Respondent 19: Designing imagers for interventional needs. Efficiently moving images out of imagers designed for diagnostic purposes. Real-time computation for deformable registration and reconstruction. Real-time updating of image models.
Respondent 20: Interfacing with interventional devices: Image file formats are *STILL* an obstacle
Respondent 21: Appropriate hardware and software
Respondent 23: Radiologists refuse to come to the OR, leaving surgeons with the need to figure out how to work the equipment. A perfect use of teleconsulation, but it is still not happening.
Respondent 32: More reliable and cheaper tracking devices, lack adequate software tools to conduct reliable intraoperative analysis, and lack of consolidation off all the intraoperative information into a comprehensive format
Respondent 34: Lack of integration to disparate information systems. Too much information.
Respondent 36: Devices designed for OR suffer from poor image quality. On the other hand, devices (CT, MRI) that have good image quality were not designed for OR and are too bulky and cumbersome to fit into OR.
Respondent 37: Too many visible seams in integration of components. Current devices too large. Radiation exposure an issue for various x-ray procedures, which are otherwise some of the more practical OR imaging modalities. MR devices just too big.
Respondent 40: Intraoperative imaging is NOT for diagnosis. Nobody wants to undergo exploratory surgery when imaging is available. Barriers to intraoperative imaging include cost, inconvenience, radiation risk, high risk/benefit. It will therefore prevail when it is cheap, easy, accurate and convenient.
Respondent 41: Lack of good 3D visualization techniques; Lack of good sensors for making measurements.
Respondent 42: Lack of real-time and multi-modality all-in-one imaging technologies
Respondent 46: Limitations of DICOM for real time applications.
Respondent 49: Use of Multi-modal imaging techniques, real time 3D imaging
Question 2: What other factors are limiting the use of Intraoperative Diagnosis and Imaging?
Respondent 3: Difficulties for real-time non-rigid registration to pre-operative data. Problems in efficient visualization and interaction with 3D intra-operative data.
Respondent 6: Inability to integrate models based on pre-op images with intra-op images. Limited tracking abilities in site-blind and hostile envrinments.
Respondent 10: Disruptive to the flow of surgery, cumbersome, inconvenient, requires collaboration with other departments to insure technologist available is surgeon cannot operate.
Respondent 11: X-ray exposure
Respondent 13: Important basic science questions have not yet been solved.
Respondent 19: Reimbursement.
Respondent 20: Cost.
Respondent 21: Redesign of surgical workflows
Respondent 23: Surgeon’s in ability to properly control the equipment.
Respondent 32: Lack of automation, and usability
Respondent 34: Sterile Field violation, applications not designed for Surgical OR interactions, applications placed in geographically undesirable locations in the OR.a
Respondent 36: Turf wars among different medical specialties and consequently among the divisions of major imaging companies that cater to these different specialties.
Respondent 37: Who owns and maintains equipment? Who gets reimbursed for its use? Etc.
Respondent 41: Adequate understanding of things like desriptive geometry on the part of clinicians.
Respondent 42: High cost and affordability
Respondent 46: Lack of true integration.
Respondent 49: Interaction with 3D visualization for deformable bodies, integration of data from multi-modal imaging technique
Question 3: On a scale of 1 to 5 (5 being very widely used), how widely used do you Intraoperative Diagnosis and Imaging will be used in the next 5-10 years?
Respondent 1: 3-5
Respondent 3: 9
Respondent 6: 3
Respondent 10: Depends on the specialty. Overall a 3.
Respondent 11: 5
Respondent 12: 4
Respondent 13: Molecular imaging in the OR will change the practice of surgery resulting in fewer complications and less need for re-resection of tumors.
Respondent 17: 5
Respondent 19: 4
Respondent 21: 2
Respondent 23: 5; its already here.
Respondent 32: 4
Respondent 34: 5
Respondent 36: 4
Respondent 37: 4 in 10 years but qualified with the requirement that instruments must be unobtrusive enough such that they don’t require re-invention of the OR.
Respondent 40: Incremental advances may be expected. Cost recovery by hospitals for high price technologies will be a main issue.
Respondent 41: 5
Respondent 42: 4
Respondent 46: 4
Respondent 49: 5
Question 4: What procedures could benefit most from advances in Intraoperative Diagnosis and Imaging?
Respondent 3: Most of the procedures, but in particular the resection and therapy of the malignant tumors. Intra-operative Diagnosis and Imaging would allow the surgeon to remove all malignant tissue and reduce the damage to the neighboring anatomy.
Respondent 6: Prostate brachytherapy and surgery, cardiac interventions
Respondent 11: Neurosurgery, liver surgery, lung surgery
Respondent 12: Cancer surgeries
Respondent 13: All operations involving potential for vascular compromise of tissues; Resection of brain cancer and metastases, resection of breast cancer, axillary node sampling.
Respondent 17: Cancer-related, eg, brain tumor surgery
Respondent 19: Stroke, EP/Cardiac, Orthopedics
Respondent 21: Oncological
Respondent 23: Implants; delicate tissue such as the brain.
Respondent 32: Neuro, spine, ortho, and ENT are current markets, but the biggest growth will be in the soft-tissue MIS procedures
Respondent 34: Cardiology: Cath Lab, Neurosurgery, Orthopedics
Respondent 37: Although there are many modalities that can benefit various procedures, in the specific case of x-ray CT, probably some of the more immediate are spinal, skull-base, and sinus procedures.
Respondent 41: All intracranial minimally invasive cases
Respondent 42: Complicated procedures such as neurosurgeries and cardiac surgeries
Respondent 49: Most of the procedures
4.3.6 Working Group Questions--Surgical Informatics:
Question 1: What are the major technical problems with Surgical Informatics?
Respondent 1: Using informatics! Understanding the capability of informatics and applying them appropriately
Respondent 3: Building sound anatomic atlases (other than for the brain, where some preliminary solutions exist), building patient specific biomedical and simulation models.
Respondent 12: The bioinformatics field has provided many useful tools for this type of work, but it should be expanded to fully include images, techniques, and situational searches. By situational searches I mean something that could examine the ongoing operation and tailor data to assist it.
Respondent 13: Integration of disparate types of information into a coherent “message.” Need for decision support methods to integrate these types of information.
Respondent 17: Major systems available are cumbersome; Most are beneficial to hospital operations but les so or not at all to needs of surgeon or anesthesiologist
Respondent 21: Lack of ontology and standards
Respondent 23: Surgeons’ attitude that they don’t need any information to complete an operation
Respondent 25: Bad surgical information systems.
Respondent 41: Lack of available tools
Respondent 42: Lack of reliable content-based search techniques and lack of application of high performance computing
Respondent 47: Currently, the information from database is mainly in the textual form. A multimedia form is more suitable for the OR
Respondent 49: Need for Pre- and intraoperative physiological and biomechanical simulations integrated with imaging capabilities
Question 2: What other factors are limiting the use of Surgical Informatics?
Respondent 1: Lack of validation studies to convince the leaders in surgery of their value
Respondent 3: This requires a total change of the intra-operative procedure, different workflow and most of all additional cost in time of the surgery.
Respondent 13: Surgeons are successful because they know what they are doing and have done it many times. Need research OR to problem solve and surgeons willing to be involved.
Respondent 17: Expense, Issues in above
Respondent 21: Awareness of surgeons
Respondent 23: HIPPA concerns.
Respondent 25: Nursing turnover.
Respondent 42: Lack of inter-institution data accessibility and related regulations
Respondent 47: Lack of a wide band wireless data integration/display/interaction system within the OR
Respondent 49: Validation of simulations, familiarizing surgeons with engineering/scientific concepts used in simulations
Question 3: On a scale of 1 to 5 (5 being very widely used), how widely used do you think Surgical Informatics will be used in the next 5-10 years?
Respondent 1: 10
Respondent 3: 5
Respondent 12: 3
Respondent 13: I think it will be used widely, but minimally considering its potential.
Respondent 17: 5. Absolutely critical to future for safety, efficiency, effectiveness, documentation
Respondent 21: 1
Respondent 23: It already is. See the Stealth station. That is surgical informatics.
Respondent 25: 3-4
Respondent 40: Approaching the treatment of a disease via modeling presupposes the inability to adequately obtain patient specific information, i.e. modeling a neural pathway because it can’t be visualized on MR; modeling plaque behavior because intervening in the real thing risks infarction, etc. As risk is encountered, modeling takes over until a better intervention is available.
Respondent 41: 5
Respondent 42: 3
Respondent 47: 5
Respondent 49: 2
Question 4: What procedures could benefit most from advances in Surgical Informatics?
Respondent 1: Intraoperative pathology, tele-mentoring, tele-surgery, training with VR, mission rehearsal with VR
Respondent 3: Orthopedics applications where the mechanical models could be easily used. Neurosurgery where atlases can be better used.
Respondent 12: Procedures with difficult or unusual complications, complex procedures with a need for much preplanning
Respondent 13: Tumor resection in critical organs. Lymph node biospsies and resections.
Respondent 21: Bone procedures
Respondent 23: Low volume cases in which the surgeon has little experience.
Respondent 25: Trauma care.
Respondent 40: Vascular interventions, neural interventions, tumor ablations
Respondent 41: Everything
Respondent 42: Any procedures that require knowledge of long patient histories
Respondent 47: Almost all procedures
Respondent 49: Vascular and Orthopedic applications