The Operating Room of the Future
Richard M. Satava, MD FACS
Professor of Surgery
University of Washington School of Medicine
and
Program Manager, Advanced Biomedical Technologies
Defense Advanced Research Projects Agency (DARPA)
and
Special Assistant, Advance Medical Technologies
US Army Medical Research and Materiel Command
Medicine Meets Virtual Reality MMVR - 12
Newport Beach, CA
January 15, 2004
September , 2003
Operating Room of the Future
An Operating Room without people
September , 2003
Problem
Operating room is not integrated and uses
industrial age tools which do not meet the
needs of advanced technologies
The OR size is huge, personnel are many,
management is fractured, tempo slow, supply
& inventory requirements redundant and realtime quality assurance non-existant.
September , 2003
Result
An operating room which is dirty
maladapted, slow, inefficient,
kluged without quality improvement
and not cost effective.
September , 2003
Current Technology
What technology is available
today off the shelf that we can
adapt to the OR of the Future?
September , 2003
The LSTAT
• Defibrillator
• Ventilator
• Suction
• Monitoring
• Blood Chemistry
Analysis
• 3-Channel
Fluid/Drug Infusion
•Data Storage and
Transmission
• On-board Battery
• On-board Oxygen
• Accepts Off-Board
Power and Oxygen
September , 2003
Courtesy of Integrated Medical Systems, Signal Hill, CA
LSTAT Deployment – Air, Land and Sea
LSTAT Deployed at Operation Brightstar
LSTAT Deployed on
Naval ship Tarawa - 2002
September , 2003
Courtesy of Integrated Medical Systems, Signal Hill, CA
LSTAT Deployment to Kosovo
212th MASH Deployed with LSTAT - Combat Support Hospital
September , 2003
Courtesy of Integrated Medical Systems, Signal Hill, CA
LSTAT in Battlefield Configuration
September , 2003
Courtesy Matt Hanson, Integrated Medical Systems, Signal Hill, CA
Next Generation LSTAT – Civilian version
Courtesy Integrated Medial Systems, Signal Hill, CA
September , 2003
We can adapt from industry…
• Clean room technology and standards
(today’s OR cannot even meet Class 10,000 standards)
• Implement “robotic cell” methods
(integrate collaborative robots - below)
• Replace humans interacting with robots (scrub, etc)
(tool changer for scrub, parts dispenser for circulator)
• Miniaturize for mobility and efficiency
(tool changer for scrub, parts dispenser for circulator)
• Just-in-time billing, supply and inventory
(do in millisecs with +100% efficiency what takes hours today)
September , 2003
We can adapt from industry…
• Pre-operative planning and surgical rehearsal
(rehearse [edit] individual patient for “perfect” procedure)
• Provide continuous monitoring for performance improve
(record/store hand/robot motions to analyze surgical procedure)
• Integrated training through patient-specific simulation
(embedded training – “train as you fight, fight as you train”)
• Record procedure for privileges and credentials
(eliminate cramming for periodic examinations)
• Become autonomous, single soldier (SurgiPod)
(remove surgeons and medics from the battlefield)
September , 2003
Why robotics and imaging
• A robot is not a machine . . .
it is an information system with arms . . .
• A CT scanner is not an imaging system
it is an information system with eyes . . .
. . . etc
• An operating room is an information system with . . .
September , 2003
A scenario
• Preop holding with smart table
and anesthesia (suspended animation)
•Total body scan on smart table
•Pre-operative “asepsis”
(not part of this phase - ? SLIME)
•Entry-docking of table to robot
•Surgeon plans/rehearses
Procedure while waiting for patient
September , 2003
A scenario (continued)
• Edit procedure and operate in minutes
(Surgical prototyping)
• Robot cell with tool changer
and supply dispenser
• Automatic billing, re-ordering
• Continuously monitor assess
(error reduction, proficiency credentials,etc)
• Miniature, self-contained, autonomous
(mobile, robotic systems on battlefield of FCS)
September , 2003
The Challenge
Make smart table CT compatible
“Sterlization” procedure
Integrate robotic “cell”
Realtime data acquisition of tools/supplies
Integrate pre-op simulation, rehearsal, editing and exporting
September , 2003