Wednesday, February 26, 2014

How To Find A Great Idea

Some questions to get the creative juices flowing...

 How will this (this = any thing) be different when computer chips cost less than a penny?  Someday  (soon, if you believe in Moore's Law) computing power will be so cheap that processors are incorporated into everything around us. Including the OR.   How will an operating table be different?  Will it sense pressure points and automatically adjust to relieve them? How will operating lights be different?  Will they "see" the surgeon's hands and automatically adjust?  How will surgical drains be different?  What could a "Smart Drain" do? How will sewing an anastomosis be different? Will the suture auto-adjust to tightness? 

How can this problem be solved be done without an OR? The safest surgery is one that you don't have to do. That's also the cheapest surgery.  Surgeons don't like coming up with ideas to eliminate surgery, but we need to (believe me everyone else is... IR, hospitals, payors).  If we don't ask these questions, we cannot control the answers.   How could we do an appendectomy without an OR?  If we could induce controlled apoptosis, could the body naturally seal off and digest dead or infected tissue without systemic sepsis?  How could w edo a lysis of adhesions for SBO without an OR? Could we design an adhesiolytic that could be percutaneously injected into the peritoneum and break up surgical adhesions?    

How can we "hard-wire" safety into surgery?  How can technology decrease human error? Can we decrease thermal injuries in laparoscopy by having the camera "see" which instruments are in the field and only allow cautery to fire when they are visible?  What complications could be avoided if we had real-time monitoring?  If there is a bowel injury during laparoscopy, can we have a "nose" on our camera or instrument that senses a change in the intraperitoneal atmosphere?

Inspired?  Leave a comment or visit our forum for more discussion 

Tuesday, February 25, 2014

Cautery Monitoring

Could we decrease thermal injuries to bowel during laparoscopy if the camera could recognize whether the cautery insturment was present in the visual field or not, and only allow for the cautery to be activated if its in the visual field? 

I could see two ways of designing this 

Option one would be to design a new cautery device (hook, for instance) that has a light sensor on it.  The amount of light that it senses would be used to determine whether or not its in the camera's field (I'm assuming that laparoscopic cameras are calibrated to have their light align with their visual field)  The light sensor would regulate whether cautery can be activated.  If its in the dark, it's probably not on the operator's screen and it shouldn't be activated.  If its in the light, it's probably is the surgeon's field and is safe.  This system might require calibration to be accurate with sensing the limits of the camera, but it has the advantage of only requiring one new piece of technology (a new hook) 

Option two would be to have an in-line video processing unit that the camera plugs into, which analyzes the video in real time and identifies whether or not the cautery instrument is present on the screen.  This unit would communicate with a second unit (on the cautery) to give a GO or NO GO on whether its safe to fire.  This option requires more computing (ie a computer has to recognize what a hook cautery looks like) and requires two pieces (camera piece and cautery piece) that can communicate.  It has the added benefit of increase precision in identifying if the cautery is on the screen. 

Anyone else have thoughts?  Do you think hospitals would invest in a technology like this for patient safety? Are there any other safety mechanisms that we could "hard wire" in to make surgery safer? 

Cartoon red-hot metal droplet with fire

Sunday, February 23, 2014

Safe Surgery

The best thing that we can do as surgeon innovators is make surgery safer. Maybe its a new monitoring device.  Maybe its findings complications sooner.  Maybe its finding new ways to avoid surgery altogether, because the safest surgery is no surgery.

I see ways to make surgery safer everywhere I look.

Let's stop thermal injuries during laparoscopy.  Let's design a laparoscope that recognizes whether cautery is in the field, and only allows cautery to fire under direct vision.

Let's stop enterotomies during re-do surgery.  Let's design an adhesiolytic chemical that dissolves the adhesions, that could be injected into the abdomen before we even open the skin.

Let's stop waiting for patients to "declare themselves" after surgery.  Let's have Smart Drains that do more than drain fluid; let's have drains that tell us there is pneumoperitoneum before the patient gets septic, and tells us there's a leak before the abscess forms.

I know there are answers out there.  I searched for a place to discuss problems like these and find answers, but there wasn't anywhere.  So I made a place. This is the The Surgeon Innovator. It's a place for surgeons who dream, who imagine, who wonder and who build.