The term “black box” is synonymous with airplanes, but soon it could be linked with the OR in the same way.
A team of Canadian researchers is working on the so-called surgical black box, promising to create a device capable of monitoring every movement in the operating room that simultaneously analyzes recordings and identifies mistakes. Surgeons, in turn, can get instant feedback – as they operate.
“Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case,” Dr. Chethan Sathya, a surgical resident at the University of Toronto and a fellow in global journalism at the Munk School of Global Affairs, writes in a piece for CNN Health.
“Such a device isn’t far from reality,” Dr. Sathya adds.
Dr. Teodor Grantcharov, a surgeon at St. Michael’s in Toronto who specializes in minimally invasive techniques, is the man behind the device. He tells Dr. Sathya that being able to pinpoint mistakes and notify surgeons if they’re “veering off course” could help prevent major errors.
While the black box in aviation is used after a disaster, the black box in a hospital setting could prevent one from occurring in the first place. A number of hospitals have expressed initial interest in such a device.
One major hurdle, however, is the litigious nature of healthcare – if the video could be used in courtrooms, “they could open the floodgates to a new wave of malpractice concerns,” Dr. Sathya writes, citing Dr. Grantcharov. That would be precisely the opposite intent of the black box.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The box itself includes operating room microphones and cameras to record the surgery and the surgeon’s movements, closely examining everything from a surgeon’s stitching technique to how organs are handled to communications with nurses throughout high-stress procedures. The box includes “error-analysis” software that would detect when surgeons are “deviating” from routine practices or using higher-risk practices.
The device has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.
Despite the accuracy that the device could help ensure during procedures, some surgeons will likely be skeptical, fearing the potential legal ramifications and being overly scrutinized for often minor errors that don’t affect patient outcomes.
“If there was a legal requirement to record every operation, then many surgeons would be resistant,”Dr. Teodoro Forcht Dagi of the American College of Surgeons Perioperative Care Committee told Dr. Sathya. “The black box needs to be used solely by surgeons for their own education, in which case I think it’s a great idea,” Forcht Dagi says.
But perhaps a middle-ground could be reached. William McMurry, president of the American Board of Professional Liability Attorneys, says the litigation concerns shouldn’t stop the black box from moving forward, suggesting that the black box, whether it’s used in courtrooms or not, would be a helpful tool.
“We care about better health care, and the black box will provide surgeons with the information they need to avoid mistakes,” McMurry tells Dr. Sathya. “It’s a win-win situation.”
The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America. Talks are also under way with a number of American hospitals. In the U.S., it could be quickly adopted since it’s not considered a medical device and therefore does not require approval from the FDA.
