Jordan

Theator Takes the Gold in Critical View of Safety Challenge at MICCAI 2024

Jordan on December 5, 2024

SAGES Critical View of Safety Challenge

A leading organization in surgical innovation, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), challenged industry and academics alike to test their algorithms on 1,000 surgical videos from a SAGES-curated dataset. The challenge was centered around the automatic identification of a surgical best practice, Critical View of Safety (CVS), in cholecystectomy procedures. (CVS) Challenge? Accepted.

SAGES CVS Challenge Winner

Theator won first place in the global competition for best overall performance, highlighting Theator’s best-in-class and cutting-edge AI technology. In this competition, Theator beat out 12 other participants, including industry leaders and academic participants, such as Stanford University. This exciting accomplishment was announced at the Medical Image Computing and Computer Assisted Intervention Society (MICCAI) conference in October 2024.

Critical View of Safety: Explained

It is widely published in literature and agreed upon by surgeons that achieving CVS greatly reduces the risk of a bile duct injury during gallbladder removal surgery, which is a devastating complication for patients. After identification of the CVS, surgeons can safely proceed with the procedure with reduced risk of complication. Successfully identifying the CVS requires three components to be viewed by the surgeon to achieve CVS:

1. Two and only two tubular structures are seen connected to the gallbladder
2. The hepatocystic triangle is cleared from fat and connective tissue so that an unimpeded view is obtained
3. The lower part of the gallbladder is dissected off the liver bed to expose the lower ⅓ of the cystic plate

Leveraging advanced computer vision technology, all three components can be identified and analyzed to determine whether or not CVS was achieved. In looking at a subset of our own dataset, we found that (spoiler, alert), CVS was achieved far less often than what you’d expect.

4 Considerations When Evaluating Surgical Intelligence Vendors

Jordan on November 5, 2024

Evaluating surgical intelligence solutions

There is no one-size-fits-all surgical intelligence solution that will solve all challenges for surgical departments. Intracorporeal-focused surgical intelligence solutions are focused on the surgery itself, as opposed to the room workflow, compliance, or integration of existing digital systems. That narrows down vendors to evaluate, but there are still a lot of varying capabilities that need to be assessed to ensure any new technology introduced to the health system satisfying the current need and can scale with the system’s expected growth.

4 important considerations when evaluating vendors

Patient information, surgical video, hospital staff – these are just a few of the sensitive data points that surgical intelligence vendors are capturing and analyzing. Significant responsibility goes along with handling this data. That’s why the following topics are critical to asses during any evaluation process:

- Technology infrastructure and setup
- Data capture mechanism and use
- Data analysis and delivery of information
- IT and security

Specific questions to ask, and why each are important are detailed in our comprehensive evaluation template along with an easy-to-use guide. The built-in guide highlights which questions should be asked during early-stage conversations with vendors to determine if future conversations are worth pursuing. For example, “what software integrations are required?” and “how are the vendor’s AI models built and maintained?” and “who pays for and manages video storage?” and the list goes on. Check out the template for these and more.

Getting started with AI in surgery

Jordan on October 28, 2024

AI is all the buzz across industries, and healthcare is no exception. There is so much information out there about AI in surgery, and it can be overwhelming to know where to start. Here, we break it down into a three-step process to guide any health system considering adopting a new technology through implementation.

But first, what is surgical intelligence?

AI technology applied to operating rooms is more than just algorithms. It’s turning that data and analysis into digestible information that stakeholders across a healthcare system can use and act on, providing a data-driven path to improving patient care. That’s why we call it “surgical intelligence”.

Step 1: focusing on a surgical intelligence category

Health systems are in different geographical areas, treat different patient populations, offer different levels of care, have different in-house expertise, and the list goes on. That’s why a one-size-fits-all approach rarely works. With so many vendors focusing on different areas of surgical intelligence, it is difficult to know where to start. We’ve categorized available solutions into three buckets: intracorporeal, extracorporeal, and ecosystem.

There are pros and cons to each type of solution and must-have considerations. One key consideration is that intracorporeal surgical intelligence solutions leverage existing technology in the OR, delivering a big bang for the buck.

Want to skip ahead to the recipe for success? Click here.

Step 2: choosing the right surgical intelligence vendor

Even once a category is chosen, there are more choices to consider, such as which vendor to partner with. While surgical intelligence vendors all have the north star of improving patient care, the approach to making that a reality is ripe with different schools of thought. Asking the right questions at the right time is critical to identify which vendor best aligns with your health system’s needs and challenges. Our comprehensive evaluation template provides must-have considerations, key questions, and an easy-to-complete template to help compare and contrast available options.

Step 3: setting up the partnership for success

Choosing the right vendor takes careful consideration and effort, but the real work begins once the partnership has been established. Just like with any new category, it takes dedicated time and focus to extract value today and work as partners to identify and extract significantly more value for tomorrow. The amount of time and investment from the vendor is also an important consideration; both parties should have some skin in the game. The best way to ensure success is to identify the key personnel (at both the health system and vendor) to track performance, and, set up ambitious key performance indicators (KPIs) that are regularly reviewed, revised, and improved.

The resources you need, at your fingertips

Whether you are at the beginning of your surgical intelligence journey, the end, or anywhere in between, all of the resources for surgical intelligence are at your fingertips. Check them out for free here.

Surgical Spotlight: Gastric Bypass

Jordan on October 4, 2024

Bariatric surgery is growing, but gastric bypass procedures remain stable

Bariatric surgery is growing in volume year-over-year, but the volume of Roux-en-Y gastric bypasses, or ‘gastric bypass’ for short, has remained relatively stable over the past few years. In total, gastric bypass procedures account for approximately 20% of all bariatric procedures. Sleeve gastrectomies make up the majority of that difference and are the most common. Even though sleeve gastrectomies are simpler to perform and more straightforward surgery, significant variability still exists.

A gastric bypass procedure, on the other hand, modifies a patient’s digestive system to consume and absorb fewer calories. It is more complex and surgically challenging than sleeve gastrectomies, but interestingly, many of the surgical practices for Roux-en-Y gastric bypasses have high adoption.

Variability in procedure duration

As we found with sleeve gastrectomy procedures, procedure duration widely varies, and that variability is exacerbated when performed robotically vs. laparoscopically. In reviewing over 300 gastric bypass procedures across 4 health systems, the median procedure time varied from 68 minutes as the shortest, to 133 minutes as the longest. How is surgical practice adoption impacted by procedure time? Fast-forward to our findings by downloading here.

Performing the safest gastric bypass procedure

There are seven surgical practices defined in peer-reviewed literature to increase the surgical quality of a gastric bypass procedure that Theator’s Surgical Intelligence Platform automatically annotates. In this Theator Spotlight edition, two of them are thoroughly analyzed:

1. Closing the mesenteric defect
2. Intraoperative leak test

Closing the mesenteric defect

A common complication that carries significant morbidity after a gastric bypass procedure is a small bowel obstruction. In one study, closure of the mesenteric defects can reduce the incidence of small bowel obstruction by approximately 48%. While overall adoption is high, significant variability exists between health systems, with one achieving this surgical best practice less than 70% of the time.

Intraoperative leak test

Reducing the risk of anastomotic leaks is at the top of surgeons’ minds. A surgical practice to mitigate this risk is performing an intraoperative leak test on the gastrojejunal anastomosis. Three out of the four health systems analyzed performed this practice the majority of the time, yet variability exists in how this practice is performed.

Despite an overall high adoption of these two surgical practices in gastric bypass, significant variability exists across health systems. Check out the full report here.

From Innovation To Impact

Jordan on September 27, 2024

Why value must lead in healthcare

In today’s world, innovations in the healthcare space need to show value immediately. Gone are the days when health systems were willing to adopt new technology that promises value. Rightfully so, health systems today require examples of both short-term and long-term value before adopting a new technology.

Surgical Intelligence in Action

Advanced technology like artificial intelligence (AI) is not new in the surgical field. Surgical intelligence, however, is still in its infancy, and there are multiple schools of thought on what applications and data sources should be leveraged to provide the most value. But, one thing is consistent, examples of how value has been demonstrated is necessary.

Let’s start with just the surgical video alone. Capturing, structuring, and analyzing surgical video unlocks unique insights that set the foundation for larger-scale, comprehensive impact. Leveraging Theator, our partners have improved surgical quality, reduced operating time, and accelerated training. Let’s dive into each one of these.

Want to skip to the good part? Download some of our favorite customer stories here.

Example 1: improving the quality of patient care

We have seen a variety of approaches in surgical-intelligence-driven quality improvement, some proactive, and some reactive. A common place for our partners to start is to surface where low adoption to surgical practices that increase the quality of a procedure exist and create a proactive quality initiative to drive an increase in department-wide adoption. Time and time again, we see significant adoption increase over the course of a few short months.

Example 2: reducing operative time

Operative time can be analyzed in a few ways – total procedure duration, per-step duration, and also idle time (both in-body and out-of-body). All of these time elements are important to driving consistent and predictable OR scheduling, and, managing OR costs as every minute counts. Structuring and analyzing this data has shown our partners where and why significant idle time is contributing to increased operative time, where outliers exist to drive standardization and more.

Example 3: accelerate education for trainees

Have you ever asked a surgical trainee what resource they use to prep for a surgical procedure? The answer is probably not their medical school textbooks. Rather, the answer is likely YouTube. We know video is a valuable learning tool. Now, with surgical intelligence, trainers can specify which videos to review, provide constructive feedback on specific parts of the video in which a trainee operated, and collaborate in so many more ways.

These examples are just the beginning of surgical intelligence. To read even more, download this booklet to read through some of our favorite examples of how our partners are demonstrating value every day with surgical intelligence.

Surgical Intelligence: intracorporeal, extracorporeal, ecosystem

Jordan on September 18, 2024

The TL;DR on surgical intelligence solutions

The introduction of AI in healthcare and specifically, AI in surgical care, has sparked a lot of interest, albeit a lot of confusion, about what value it can deliver today and also long-term. AI can be so broad, with so many different applications. Specifically in surgery, there are also various applications. If you are just getting started on this journey, check out additional resources here. When health systems are looking to improve surgical care itself, what they need is to focus on surgical intelligence.

Where to start

Surgical intelligence can mean something different depending on who is defining it. Health systems and vendors alike. Rarely does a one-size-fits-all approach work, and the same is true with surgical intelligence. Therefore, it turns into a matter of focus for the health system, and understanding what challenges a health system is facing overall. But where do you start? Download our roadmap for choosing the right solution for you.

Intracorporeal, extracorporeal, or ecosystem?

We’ve categorized the available solutions into three buckets: intracorporeal, extracorporeal, and ecosystem.

Intracorporeal surgical video solutions	focus on the surgery itself, and codifying that data to deliver value.
Extracorporeal video solutions	focus on the external aspects of surgery, such as room setup and workflow.
Ecosystem surgery solutions	focus on broader aspects of the digital infrastructure related to surgery.

Refer to page 11 in our roadmap to continue comparing the 3 solution types.

Choosing the right solution for you

There are pros and cons to each approach and must-have considerations when adopting surgical intelligence into your health system. Ready to determine the right choice for your health system? Download our roadmap here.

Codifying Surgery with Surgical Practices

Jordan on September 9, 2024

Measuring high-quality surgery, while it is occurring

What makes a specific surgery “good” or “not-so-good”? This can usually be measured after the surgery itself, as understood by how the patient recovers. Intraoperatively, more subjective observations determine “good” versus “not-so-good” such as the smoothness of the procedure from step-to-step, if the surgeon encounters intraoperative bleeding, or if the patient has unusual anatomy making the surgery overall more difficult. All in all, intraoperative surgical performance can be a bit more challenging to define.

Surgery, just like other highly-skilled professions, can be codified to provide data-driven insights into optimized performance. This, however, is near-impossible to accomplish without the availability of structured surgical video. And, structured beyond the procedure steps itself to also include surgical practices.

What are surgical practices and why are they important?

Countless studies have been conducted aiming to identify what specific components of a procedure enhance the quality of a procedure. Perhaps the most widely-accepted of these is the Critical View of Safety (CVS), which is a specific anatomical view that reduces the risk of a bile duct injury during a Cholecystectomy procedure (spoiler alert: it is performed far less often than you’d expect). But, this is just one example of one practice in one procedure. And not all surgical practices are as well-researched and well-defined as CVS. That is why we have split up all surgical practices into two categories, based on the level of validation available in peer-reviewed literature: Surgical Practice to Enhance Quality (SPEQ) and Surgical Best Practice.

Surgical Practice to Enhance Quality (SPEQ)	A SPEQ is a practice that is believed to enhance the quality of the procedure, but is not validated through extensive peer-reviewed literature or widely accepted by the surgical community. SPEQs are created by clinicians and surgeons and require studies and data to validate their efficacy.
Surgical Best Practices	Surgical Best Practices are defined as the gold standard of methods and protocols crafted through empirical evidence, and expert consensus through peer-reviewed literature.

85 Surgical Practices and Counting

Want a compiled list of all SPEQs and Surgical Best Practices across seven surgical specialties? Months of clinical research and discussion, all in one nicely packaged pdf. Each of the 85 surgical practices explained, along with the level of validation, and sources for the literature from which they were found.

Download here.

Bonus: each one of these is automatically identified and analyzed through our advanced computer vision technology. We’ve done that research. Check out the TL;DR from Theator Spotlight to understand how often many of these practices are adopted across dozens of health systems and hundreds of surgeons.

Same Logo Means Consistent Care, Or Does It?

Jordan on June 26, 2024

The best brands have a logo that elicits a positive, consistent response. Coca-cola? You see the fizz and your mouth begins to water. McDonalds? Those golden arches represent a burger and fries, delivered fast and tasting the exact same, whether you’re in your city or 1,000 miles away.

Brands signal consistency and as consumers we have come to expect that.

Healthcare, in some senses, is not all that different from fast food. As hospitals all over the US are consolidating, and well-recognized, big, bright logos are replacing smaller ones, patients will expect the level and standard of care that comes with the brand of the new logo. Whether it is the flagship hospital or a satellite campus, when those “golden arches” are on the front of the building, a patient is expecting the same high quality care.

Not all hospitals are created equal

Variability in surgery is inherent – patients don’t present the exact same anatomy, tool availability varies, and surgeon and staff experience varies. Driving consistency in how surgery is performed seems near impossible, at least without the help of technology.

Routinely and automatically capturing and analyzing surgical video is the first step in identifying variability, with actionable ways of how to standardize care. Multiple health systems across multiple surgical specialties have already identified specific sources of variability.

Read on to see a few examples.

Variability in adoption of surgical practices

In laparoscopic cholecystectomies, one health system (comprising three hospital sites) averaged a 40% adoption of Critical View of Safety, a widely-accepted surgical best practice that reduces the risk of bile duct injuries. When diving into each of the three hospital sites, variability was uncovered in average adoption:

- Hospital 1 = 33%
- Hospital 2 = 45%
- Hospital 3 = 70%

Want more details behind this analysis? Click here!

There’s a similar story here for Right Hemicolectomies in Colorectal Surgery, Robot-Assisted Radical Prostatectomies in Urology Surgery and Hysterectomies in Gynecology Surgery. Despite being under the same healthcare system, separate hospital sites within the system have wide variability in adoption to surgical practices, median procedure time, and more. With the power of AI technology, these insights, for the first time, are surfaced and proactively addressed.

Download the full report here >>