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Cloud Storage vs. On-Premises Servers for Surgical Video

Theator on August 6, 2024

3 Critical Considerations for Storing Surgical Video Data

In the digital age, hospitals increasingly rely on data to enhance patient care and streamline operations. A critical decision for hospitals, especially when dealing with sensitive surgical data, is choosing between on-premise storage and cloud storage.

Each option has its own set of advantages and disadvantages, particularly in terms of security, accessibility, and cost. Which option is a better fit for health systems?

Spoiler alert: It’s the cloud! (At least in our opinion). But want to find out why? Keep on reading!

How much could your hospital save by storing surgical videos on the cloud?  Free Savings Calculation! 

1. Security

Security is paramount when it comes to storing surgical data. Hospitals must ensure that patient information is protected from breaches and unauthorized access. On-premise storage offers a sense of control, as data is stored within the hospital’s own infrastructure. However, this control comes with the responsibility of maintaining robust security measures, including physical security, encryption, and regular updates to guard against cyber threats.

Cloud storage, on the other hand, leverages the expertise of specialized security teams employed by the cloud service providers. These providers invest heavily in security technologies and practices, often exceeding what individual hospitals can implement. Data stored in the cloud is encrypted both in transit and at rest, and providers comply with stringent regulations and standards, such as HIPAA, to ensure the protection of sensitive health information. 

While some may have concerns about the perceived vulnerability of storing data off-site, cloud providers offer advanced security measures, such as multi-factor authentication, intrusion detection systems, and continuous monitoring. The distributed nature of cloud infrastructure also adds a layer of redundancy, protecting data against local hardware failures or disasters.

2. Accessibility

Email, texts, music and more are always accessible via our phones on-demand. Your surgical videos can be accessible, too, but it is a lot more likely that is true if they are stored on the cloud.

On-premise storage systems typically require users to be on-site or use a VPN to access data remotely, which can be cumbersome and slow. This limited accessibility can hinder the efficiency of surgical teams and the ability to make timely, informed decisions.

Cloud storage offers unparalleled accessibility. Data can be accessed from anywhere with an internet connection, using a variety of devices, including smartphones, tablets, and laptops. Need to check on something but you are already home from the hospital? No problem. Real-time access to data can enhance coordination and improve patient outcomes.

3. Cost: On-Premise vs. Cloud

One of the most significant considerations in the decision-making process is cost. On-premise storage requires substantial upfront investments in hardware, software, and infrastructure. Hospitals need to purchase servers, employ IT staff to manage the system, and regularly update the technology to keep up with advancements. Budget also needs to be set aside for maintenance and also the energy costs for running and cooling the servers.

In contrast, cloud storage operates on a subscription model, where hospitals pay for the storage capacity they use. This model eliminates both the need for large initial capital expenditures and ongoing maintenance costs. Cloud providers like Amazon Web Services, Google Cloud, and Microsoft Azure offer scalable solutions that adjust to a hospital’s changing storage needs. Moreover, cloud storage can be more cost-effective over time, as the costs of infrastructure, security, and updates are spread across many users and managed by the cloud provider.

Why Theator Chooses Cloud Storage

Simple – it’s secure, always accessible, and comes at a lower cost.

How much can storing videos on the cloud save a hospital compared to on-prem? Fill out the form below and we’ll email you your custom savings. If you’re unsure of the exact numbers, an estimate will be sufficient to give you an idea of potential savings.

How much could your hospital save by storing surgical videos on the cloud?  Free Savings Calculation! 

Surgical Spotlight: Robotic vs. Laparoscopic Sleeve Gastrectomy

Theator on July 23, 2024

Robotic vs. Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy, also known as gastric sleeve surgery, is a frequently performed weight loss surgery that removes 80% of the stomach, leaving a much smaller organ that holds less food and liquid. A further advantage of this procedure is that the portion of the stomach that produces a hunger-inducing hormone is removed, leading to a decreased appetite and improved metabolism.

 

While this procedure was traditionally performed laparoscopically, in recent years more surgeons are performing robotic-assisted sleeve gastrectomies.

 

What’s the difference between laparoscopic and robotic-assisted sleeve gastrectomies? We’re glad you asked. In general, the main benefits of robotic-assisted surgery include a clearer view for surgeons, high accuracy of movement, and reduced trauma, meaning less tissue damage, bleeding, and pain. 

 

Does this mean that robotic-assisted sleeve gastrectomy is the better choice? Not necessarily. Read on to find out what we learned from analyzing 505 surgical videos across a health system.

Longer Operative Times

While many aspects of surgical care affect patient outcomes, longer operative times have been associated with increased chances of complications. In the case of sleeve gastrectomy, you likely won’t be surprised to learn which approach is associated with longer operative times (*cough* robotic *cough*). But it may surprise you which procedure step is the biggest contributor to that increase in median operative time.

 

Download our Spotlight report to learn more.

 

This is just one of many data points that Theator’s Surgical Intelligence Platform automatically recognizes, analyzes, and delivers back to to health systems in digestible formats so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care. 

 

Curious to know more about the differences in operative time between the two approaches? We have the answer. Download the full report here.

Surgical Spotlight: Robotic vs. Laparoscopic Hysterectomy

Theator on July 16, 2024

Robotic vs. Laparoscopic Hysterectomy

Gynecologists were among the second specialty of surgeons to widely adopt a robotic-assisted approach. One of the first robotic-assisted hysterectomies was performed by Dr. Advincula in 2001. Fast forward to 2020, and robotic adoption for hysterectomies has jumped to 30% for benign cases and 65% for oncologic diseases. 

So, is laparoscopic “better” than robotic? Or vice-versa? Or, does it depend on the type of case?

We aren’t here to answer that. But, in reviewing 1,795 cases, we did spot a few differences, empowering hospitals and surgeons with real-world data to inform their own, data-driven decisions. Download the report here.

Variability in procedure time

Overall, robotic hysterectomies take 39% longer than laparoscopic cases. In particular, one step accounts for the majority of that increased time adding a median of 18min to cases.

Variability in Surgical Practice to Enhance Quality (SPEQ)

Identification of critical anatomic landmarks is an essential step in preventing surgical complications associated with laparoscopic hysterectomy. For example, one SPEQ –  identification of the bilateral ureters – can prevent injury to these structures. And, interestingly, view of ureter was achieved significantly more frequently.

Despite an overall increase in achievement of view of ureter in robotic cases, that wasn’t necessarily true in all of the health systems included in this analysis.

Check out the full report to see variability across and within health systems. 

Surgical Best Practice Spotlight: Vaginal Cuff Closure in Minimally Invasive Hysterectomy

Theator on July 11, 2024

Extreme surgical variability exists in minimally invasive hysterectomies

About 600,000 hysterectomies are performed annually in the US, making it one of the most commonly performed surgical procedures, but the surgical practices performed within the procedure are anything but common. 

For example, a previous Spotlight analysis surfaced that bilateral view of the ureter, a common surgical practice, is only achieved 54%f of the time. That got us thinking, what additional surgical practices should we be looking at in this procedure? 

 

The answer? Vaginal cuff closure. 

Vaginal Cuff Closure: A Surgical Best Practice

Vaginal cuff closure is a surgical best practice in hysterectomies, and multiple techniques and materials can be used to complete this step. Both a one-layer and two-layer technique are used in clinical practice, however, multiple studies indicate that the two-layer technique is associated with lower rates of complications, including:

    • Infection
    • Hematoma
    • Need for blood transfusion
    • Cuff complications (biggest contributing factor)

We analyzed 1,767 minimally invasive hysterectomies to find out which vaginal cuff closure techniques surgeons are using today. Download the report here.  (It’s free!)

Vaginal cuff dehiscence after hysterectomy

Of the cuff complications noted above, vaginal cuff dehiscence is of particular concern. This refers to the partial or complete separation of previously sutured vaginal cuff edges, a rare but potentially fatal complication following hysterectomy. Importantly, vaginal cuff dehiscence occurs more often with one-layer than two-layer vaginal cuff closure.

Given that the two-layer technique results in decreased rates of vaginal cuff dehiscence, you may think this approach is favored in clinical practice and widely employed by gynecologists. However, our data shows, spoiler alert, that this occurs far less often than bilateral view of the ureter.  

Theator’s Spotlight database compiled 1,767 hysterectomy procedures from 170 surgeons at 5 different health systems to investigate how often a two-layer vaginal cuff closure was achieved.

Curious how vaginal cuff closure techniques vary across health systems? How about within the same health system? Us too. We have answers – download the report here. 

Video annotated. Value extracted

Theator on June 17, 2024

Simply capturing surgical video isn’t enough

Surgical video capture is not new. It’s been around for quite some time, and as expected, many surgical camera vendors have their own capture solutions. They have varying levels of automation and widely varying technological capabilities, but they all serve a similar purpose – to help sell more cameras. Meaning most of these solutions are not compatible with hardware other than their own This problem can be easily solved, by moving towards one vendor-agnostic software to capture all video, automatically, and with advantage technological capabilities. 

Surgical videos need to be structured to make sense

Do surgeons have time to review hours of surgical video after performing hours of surgery? Of course not.  But if the video is structured, surgeons can review key moments in minutes, not hours.

Do hospital administrators analyze surgeries based on written operative reports to surface trends to drive improved safety or operational efficiency? Likely so, but  misalignment between written operative reports and surgical video is a widely known reality. 

Leveraging the power of advanced artificial intelligence (AI) and computer vision, hundreds of procedures can be automatically structured with procedure steps, intraoperative events, surgical practices, idle time, instruments, and more. Saving surgeons time, and providing more accuracy to administrators.

Turns out, we can learn a lot from structured video alone

Structuring and analyzing surgical video drives clinical, operational, and educational value, but surgeons and hospital administrators don’t have the time or resources to dive through tons of data. They need it to be presented to them in a digestible format. How does this actually work in the real-world?

 

Let’s take a look at one example for each of these value drivers:

Want to skip to the good part? Download the summary here

Clinical and operational value: Safer procedures, performed more efficiently

Most procedures have surgical best practices (SBPs) and surgical practices that enhance quality (SPEQs). Adoption of SBPs and SPEQs are now being understood for the first time, thanks to automated identification with the power of AI and computer vision. Not surprisingly, adoption is lower than surgeons and hospitals expect. Several examples across multiple specialties show an increase in adoption to just one SBP or SPEQ consistently reduces operative time by 12-25%. Yes, you read that right. Higher quality procedures, performed faster. A win-win. 

Specifically, in laparoscopic cholecystectomy, one hospital saw a 77% increase in SBP adoption while reducing operative time by 28%, in just 8 months. That’s just one procedure, in one specialty, in one hospital. Imagine this compounded across specialties, across hospitals all over the world. A global win-win.

Educational value: A 3x increase in surgical video feedback

A large US-based academic medical center with 1,400 beds across 18 hospitals wanted to accelerate training for their urologic surgery residents. The residents also wanted more regular and actionable feedback. With surgical videos now automatically captured and, importantly, structured (surgical steps, intraoperative events, surgical practices, and more), the department saw a 3x increase in surgical video review over the course of six months.

Next up: outcome data

With structuring, there is a lot we can learn from videos alone. And then, we layer on patient outcome data so we can understand how different surgical techniques/tools/approaches impact the recover of a patient. Stay tuned for what’s next. 

Procedure Step Detection… On Steroids

Theator on June 10, 2024

Can we skip to the good part?

Have you ever recorded an entire concert with your phone? Or a fireworks show? No one goes back to look at the whole thing, you want to fast-forward to the meaningful moments. Fast-forward to your favorite part or when something interesting happens. 

It’s the same with surgery. Surgeons don’t have the time to go back and review hours of surgery after scrubbing out from a long day in the operating room.

The two longest surgical videos in our database are (hours:minutes:seconds):

    • Robotic anterior resection: 9:52:28
    • Robotic whipple: 8:30:19

Even procedures this long, are automatically structured. With more than 3,000 procedures captured by Theator every week at a median duration of 42 minutes, that is a lot of data. A lot. 

The video is yours, we just make sense of it

Surgical videos need to be structured to be useful. Not just with tools and time, but with all procedure steps, intraoperative events, surgical practices, and more. Structuring with procedure steps is the first step to extracting value from surgical video capture. A deep tech stack enables this to be possible and importantly, enables scalability. 

When a procedure is structured, surgeons can easily navigate to meaningful moments, trainees can quickly review interesting clips, surgical teams can quickly get answers to questions (read how one hospital confirmed no foreign body was left in a patient using quick video review), and so much more. 

But, don’t just take it from us. A few abstracts and publications examples, written by our customers, have shown the ability of our AI tech to automate procedure step annotations (which, is just one element we structure). Check them out for yourselves below:

Urology

Gynecology

    • Hysterectomy – published in the International Journal of Gynecology and Obstetrics 

General Surgery

Want to check these out all in one place? Download the cheat sheet here.

Get The AI-Powered Step Detection Cheat Sheet

Captured automatically: robotic, laparoscopic, and endoscopic surgical video

Theator on June 3, 2024

One operating room, dozens of surgical hardware vendors

Operating rooms are filled with hardware from dozens of vendors – different camera vendors, device vendors, consumable vendors, the list goes on. Take camera systems, for example. You have robotic systems (with many more coming to market), straight-stick laparoscopic towers, and flexible endoscopic towers. Sometimes, all in the same OR. 

Can one of those existing camera vendors automatically capture all of those video feeds? Nope. Not today, and likely not ever. 

Leveraging software from these hardware companies means that some videos are being captured today, but not routinely and definitely not automatically. 

Theator Robotic company Medical device company
Automated capture of robotic surgery
Automated capture of laparoscopic surgery
Automated capture of endoscopic surgery

Why? That’s because existing hardware vendors are not set up to do this. In fact, surgeons often still use thumb drives to capture and store videos. Rewind a few decades and it’s how people used to burn songs onto a CD to play in their car, instead of streaming millions of songs at the click of a button.

Theator Robotic company Medical device company
Identify tools used
Track overall procedure time
Annotate procedure steps across hundreds of procedures
Annotate surgical practices
Annotate intraoperative events
Connect to patient outcomes
Individual and enterprise-wide analytics

Download our guide to start turning video data into valuable data ➡

Theator: One software for all your hardware

Simple. It’s already here. 

How can we bring video capture into the 21st century? 

To automate routine video capture – robotic, laparoscopic, and endoscopic – you need a deep-tech, hardware-agnostic solution. Enter: Theator.

Whether your hospital uses a daVinci robot, a Stryker camera, or an Olympus endoscope, Theator’s Surgical Intelligence Platform records, de-identifies and stores all of these surgical videos, automatically – without even pressing a button. 

Robotic Laparoscopic Endoscopic
Automatic video capture
Identify tools used
Analyze overall and per-step procedure time
Annotate procedure steps across hundreds of procedures
Annotate surgical practices
Annotate intraoperative events
Identify in-body and out-of-body idle time
Connect to patient outcomes
Analyze individual and enterprise-wide data

Better yet, you can access all of your videos, on-demand, at any time, in our app. Capturing the video is just the beginning. From there, so much value can be extracted, if, and only if, videos are structured and connected to outcomes. Spoiler alert: we do that, too.

Download our guide to start turning video data into valuable data ➡

Surgical Spotlight: Right Hemicolectomy

Theator on May 22, 2024

One colorectal procedure, and the postoperative complications that can happen

Right hemicolectomy is a common colorectal surgical procedure to treat both benign and malignant conditions, including inflammatory bowel disease, colon cancer, and diverticulitis. While surgery is often a necessary step in a patient’s treatment plan, these cases don’t always go as planned.

What do we know about postoperative complications with right hemicolectomy? We know they can occur shortly after surgery or later in the postoperative course. We also know that early complications include:

    • Anastomotic leaks
    • Infections
    • Bowel obstruction
    • Bleeding
    • Cardiopulmonary complications

Many factors can impact whether or not a patient experiences a complication. When looking at the right hemicolectomy surgery itself, there are 6 surgical practices Theator automatically identifies and annotates, all associated with reducing the risk of one or more postoperative complications.

Reducing anastomotic leaks in right hemicolectomies

Let’s dive into one complication, in particular. Anastomotic leaks occur in 6.4% to 8.8% of cases and can contribute to postoperative mortality and the need for revisional surgeries. Anastomotic leaks also increase healthcare costs and can lead to worse functional and oncologic outcomes for patients. Surgeons and hospital administrators want to reduce these, first and foremost to help patients.

What can surgeons do during surgery to reduce the risk of postoperative leaks? 

Some literature suggests that performing the anastomosis in right hemicolectomy intracorporeally instead of extracorporeally is associated with several improved outcomes. This includes potentially lower rates of anastomotic leak and reduced rates of incisional hernias, open conversion, reoperation, blood loss, and incision length. 

So, we asked the question – how often is intracorporeal anastomosis performed across health systems? The answer is less than you think.

Download our Spotlight report.

How often is intracorporeal anastomosis performed in right hemicolectomies?

We did an analysis of 389 right hemicolectomies, how often do you think intracorporeal anastomosis was performed? Flip this card to find out...

Intracorporeal anastomosis was only performed in 54% of cases.

In spite of its reduction of risks, intracorporeal anastomosis was performed in only 54% of the 389 right hemicolectomies analyzed.
Get our right hemicolectomy report >

Theator’s Spotlight database has compiled nearly 400 right hemicolectomy procedures from 6 different health systems to investigate.

This is just one of many surgical practices that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care. 

Curious to know how the adoption of this surgical practice varied between the 6 health systems? What about between hospitals within the same health system? We have answers. Download the full report here.

Surgical Spotlight: Cholecystectomy

Theator on May 14, 2024

Cholecystectomy Insights

Over 500,000 cholecystectomies are performed each year, making it one of the most common surgical procedures. Notably, most cholecystectomies are performed laparoscopically. The most common indication for laparoscopic cholecystectomy is cholelithiasis, but there are additional indications for the procedure in both symptomatic and asymptomatic patients.

Surgical complications occur in some patients who undergo cholecystectomy and include:

    • Bile leaks
    • Common bile duct injuries
    • Hemorrhages
    • Retained gallstones
    • Wound infections

Although rates of bile duct injuries have decreased during the three decades that laparoscopic cholecystectomies have been performed, they remain a potentially significant and life-threatening complication. 

Importantly, the effects of bile duct injuries can be long-lasting and include biliary strictures, cholangitis, cirrhosis, and portal hypertension. In addition to these outcomes’ physical and emotional burden, a substantial cost is also associated with this potentially avoidable complication.

For more laparoscopic cholecystectomy insights, download our procedure spotlight report. 

How often is the critical view of safety achieved in cholecystectomies?

We did an analysis of 5,298 cholecystectomies, how often do you think the critical view of safety was achieved?
Flip this card to find out...

ONLY 34%

Achieving the critical view of safety (CVS) in laparoscopic cholecystectomies is widely documented in peer-reviewed journals to reduce the risk of bile duct injury. Despite this, it’s achieved in only 34% of cases.
Download our cholecystectomy report for more insights.
Get the Cholecystectomy Report >

Surgical Practice in Laparoscopic Cholecystectomy

A surgical best practice for preventing bile duct injuries includes the Critical View of Safety technique, which involves purposeful identification three components, one of which is the view of the cystic duct and cystic artery to avoid injury to these structures. The median success rate using this technique for the prevention of bile duct injuries is 95.8%. 

Despite utilization of the Critical View of Safety being recommended for over 20 years, Theator’s Surgical Intelligence database of over 5,000 cholecystectomies performed at 15 health systems indicates this is only achieved 34% of the time. Furthermore, there is significant variation across healthcare systems and even within healthcare systems in the adoption of this surgical best practice.

This is just one of many surgical practices that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know what other insights we’ve seen in our database of cholecystectomies? Download the full report here

Surgical Intelligence and Gynecologic Surgery

Theator on April 29, 2024

What Are The Advantages of AI in Gynecologic Surgery?

As the role of AI-enabled tools in surgical care expands, clinical research continues to validate the benefits of integrating streamlined AI technologies into operating rooms. In gynecology, surgical AI integration has the potential to improve quality of care and patient outcomes. A win-win.

What is Surgical Intelligence?

Surgical Intelligence is the analysis of surgical video data using AI that can surface insights that aren’t possible with manual data analysis alone. Its ability to identify specific and actionable measures to improve patient outcomes is why this technology is the future of surgical care.

Why Surgical Intelligence for gynecologic surgery?

Surgical Intelligence offers a number of advantages for clinicians and patients related to gynecologic surgeries. 

Surgical step identification:​

The ability of AI to identify the steps of a surgical procedure by analyzing video data is the first step toward harnessing this data to support clinicians and improve outcomes.

Specific to laparoscopic hysterectomy, available AI technologies demonstrated a 92% concordance between human and AI-directed annotation of surgical steps in one study, while a separate study found a similar 93% concordance rate between humans and AI-enabled technology in annotation of surgical steps. 

The ability of AI to detect surgical steps significantly cuts down on the amount of time that would be required for humans to manually perform this task. This, in turn, allows for recorded surgical videos to be used more effectively to bolster the knowledge base and skill set of trainees.

Surgical Spotlight: Laparoscopic Hysterectomy

Continuous quality improvement:​

AI demonstrates a high rate of accuracy in identifying the surgical steps of a laparoscopic hysterectomy. This is notable because when AI is able to correctly identify these steps and landmarks in real time, it can then be trained to provide clinical decision support at the point of care.

For example, identification of the ureters is a critical step to avoid ureteral injury in laparoscopic hysterectomy. However, this step isn’t universally performed during this procedure. By surfacing this information to a hospital’s gynecology department, a proactive, data-driven quality initiative can be implemented to drive adoption of this surgical practice—therefore increasing the safety of laparoscopic hysterectomy procedures.

Outcomes assessment: ​

Because Surgical Intelligence integrates with patient outcomes data, it offers the opportunity to link what happens in the OR to outcomes such as infections, readmissions, reoperations, and increased length of stay. This allows healthcare organizations to identify systemic and individual areas for quality improvement.

Surgical Intelligence represents the future of care in all surgical specialties. By effectively and efficiently identifying procedural steps, AI-enabled tools have the power to assist clinicians with making evidence-based decisions at the point of care. Furthermore, they can link this data to patient outcomes to identify how intraoperative events affect what happens after surgery. The potential benefits of this technology for gynecologic (and all other) surgeries are significant, and staying ahead of the curve with Surgical Intelligence will benefit surgeons and patients alike.

Surgical Spotlight: Laparoscopic Hysterectomy

Surgical Spotlight: Laparoscopic Hysterectomy

Theator on April 17, 2024

Laparoscopic Hysterectomy Insights

Laparoscopic hysterectomy is performed for a variety of indications, the most common of which is symptomatic uterine fibroids. In just over two decades, hysterectomies in the US went from being performed via an open abdominal approach in 70% of cases to being performed laparoscopically 70% of the time. 

The laparoscopic approach to hysterectomy offers a number of advantages over open abdominal hysterectomy, including reductions in:

    • Recovery time
    • Pain
    • Blood loss
    • Costs

However, like all surgical procedures, laparoscopic hysterectomy has a risk of complications including:

    • Urinary tract injury 
    • Bowel injury
    • Vascular injury
    • Bleeding

Readmission within 30 days following laparoscopic hysterectomy occurs in 2.6% of patients, with most of these occurring within the first 15 postoperative days. Surgical site infection (28.3%) is the most common reason for readmission. Notably, 51.9% of complications following laparoscopic hysterectomy are related to infections, surgical injuries, and wound complications, which are all potentially preventable outcomes. 

These complications can affect patients both physically and emotionally, as well as increase the cost of care.

For more laparoscopic hysterectomy insights, download our procedure spotlight report. 

Surgical Practices in Laparoscopic Hysterectomy

Identification of critical anatomic landmarks is an essential step in preventing surgical complications associated with laparoscopic hysterectomy. For example, identification of the bilateral ureters can prevent injury to these structures. 

However, this step isn’t universally performed by all surgeons, and rates of bilateral ureter identification vary by institution. Theator’s Surgical Intelligence database has compiled more than 1150 laparoscopic hysterectomies to date from 9 different health systems, and we’ve found rates as low as 37% and as high as 72% for identification of both ureters at different institutions. 

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care. 

Curious to know what other insights we’ve seen in our database of laparoscopic hysterectomies? Download the full report here

How AI is Transforming Surgical Quality

Theator on April 8, 2024

Quality Improvement Then and Now: How AI is Transforming Surgical Quality

The concept of quality improvement in the medical field is not new. In fact, Florence Nightingale herself was an early pioneer of the practice. Of course, times have changed immeasurably in healthcare since the 19th century. Given the advanced technologies that are now widely available for surgical care, most notably AI, the opportunity exists to take quality improvement to the next level. But how?

The Continuous Quality Improvement Process

Enter continuous quality improvement (CQI). This modern approach to quality improvement encourages medical teams to continuously ask:

    • How are we doing?
    • Can we do it better?
    • Can we do it more efficiently?
    • Can we be more effective?
    • Can we do it faster?
    • Can we do it in a more timely way?

In healthcare, the Plan-Do-Study-Act (PDSA) method is often employed to achieve CQI. By completing iterative cycles, the PDSA approach aims to continually build knowledge and institute changes that improve quality on an ongoing basis over time. 

However, the traditional approach to PDSA quality improvement yields only marginal results. Although many projects report successful quality improvement, low adoption to the methodological features of this approach calls the legitimacy of this method into question.

Automated Analytics Throughout the Patient Journey

This is exactly where AI is poised to disrupt the CQI landscape. While the standard approach to PDSA cycles involves collecting and analyzing data manually, the key advantage of AI is its ability to perform these tasks automatically and quickly. 

In the surgical realm, AI can provide particular value by linking what happens in the OR to patient outcomes following completion of a case. For example, Theator’s Surgical Intelligence platform is capable of recording cases, identifying best practices, scoring case complexity, mapping key procedural steps, detecting instruments, noting operative events, and measuring idle time.

Real world examples demonstrating improved quality based on Surgical Intelligence insights have already been documented. One institution improved achievement of surgical practices related to anatomic identification in laparoscopic cholecystectomy from 39% to 69% in just 3 months. 

Furthermore, better intraoperative technical performance, as documented by intraoperative video recording, has been linked to improved patient outcomes, including fewer postoperative complications, reoperations, and readmissions.

Actionable Insights for Improving Patient Outcomes

By harnessing the power of AI technology at each stage in the care of a surgical patient, healthcare organizations and surgeons can acquire a substantial amount of data that can then be analyzed to link intraoperative performance and events to individual patient outcomes. This information can then be leveraged to inform clinical surgical practice and make continuous improvements over time. 

Importantly, this exponential increase in available data comes without additional effort by team members. In addition, the nature of AI-based surgical intelligence reduces the risk of bias that is inherent in manual data collection. 

The results to date on this growing application of AI to improve continuous surgical quality improvement speak for themselves. The days of Florence Nightingale and PDSA cycles are over. The modern approach to CQI is driven by AI; innovative organizations are rapidly adopting this approach, and their patients are benefitting from the results. Check out our Beginner’s Guide to AI in Surgical Care to learn more!

Surgical Spotlight: Sleeve Gastrectomy

Theator on April 2, 2024

Sleeve Gastrectomy Insights

Obesity is a public health crisis in the US, affecting more than one third of adults. In addition to diet and exercise, medications and surgical procedures are effective obesity treatments for eligible patients, and laparoscopic vertical sleeve gastrectomy is the most commonly performed weight loss surgery in the world.  

 

Theator’s Surgical Intelligence database has compiled more than 700 sleeve gastrectomy procedures to date from 10 different health systems.

 

Like all surgical procedures, sleeve gastrectomy has potential complications, including:

  • Bleeding (1.16 – 4.94 %)
  • Leakage (1 – 4%)
  • Acute pancreatitis (1.04%)
  • Venous thromboembolism (0.06 – 2.20%)

30-day readmission occurs in 3.89% of patients following sleeve gastrectomy. The most common reasons for readmission after bariatric surgery include:

  • Nausea/vomiting (14.05%)
  • Abdominal pain (12.14%)
  • Dehydration (10.78%)

 

Importantly, international best practice guidelines for sleeve gastrectomy note that a lack of standardization can lead to poor outcomes, and if surgeons consistently followed surgical practice techniques, surgical outcomes would be better.

 

For more sleeve gastrectomy insights, download our procedure spotlight report.

Surgical Practices in Sleeve Gastrectomy

Guidance on surgical practices for sleeve gastrectomy continues to evolve as the body of research on this topic grows. This is excellent news for patients, as the more practices are standardized based on clinical evidence, the better outcomes will be.  

For example, staple line reinforcement may reduce the risk of bleeding along the suture line and other perioperative complications. Notably, there is no current evidence to support one staple line reinforcement technique over another, so techniques vary by surgeon and across institutions. 

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care. 

Curious to know what other insights we’ve seen in our database of gastric sleeve surgeries? Download the full report here.

De-Identification in Surgical Video: What You Need to Know

Theator on March 26, 2024

De-Identification in Surgical Video​: What You Need to Know

As recording surgical procedures quickly becomes the standard of care in the field, maintaining patient and staff privacy within recordings is an issue that all institutions should carefully consider to ensure regulatory compliance and ethical practices. 

 

For video footage, maintaining privacy means de-identifying those who are recorded. If you’re wondering what this involves and how to make sure your institution follows best practices, we’ve got you covered.

What is De-Identification?

The concept of data de-identification arose with the implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The Privacy Rule considers individually identifiable health information to be protected health information. This includes information such as names, birthdates, or social security numbers that are attached to health information, including electronic health information such as recorded surgical videos.

The HIPAA Privacy Rule contains a de-identification standard, which states that health information is considered de-identified if 18 types of identifiers are removed. These include items such as names, dates, medical record numbers, biometric identifiers such as finger and voice prints, and most importantly for video recordings, full-face photographs and any comparable images. 

How To De-Identify Surgical Video

Although it may sound daunting to de-identify an entire surgical video, there are important points to keep in mind that can make the process simple and automated. This was outlined in a recent JAMA Surgery article, in which the Mayo Clinic, in partnership with Theator, set the standard for use, analysis, and de-identification of intracorporeal surgical videos:

1. Obtain consent

Even though obtaining signed consent prior to a surgical procedure is second nature, in the age of recording surgical video it’s important to make sure this process is specifically covered in your surgical consent. Patients should be made aware that their procedure will be recorded, assured that their privacy is protected, and informed about how the recorded footage will be used. Although obtaining consent does not actually de-identify surgical video, it’s a critical first step to ensuring ethical and compliant practices. 

2. Remove identifying information

While it may seem like a good idea to include information such as a procedure date or patient medical record number on a recorded video, since these are considered identifiers, it’s best not to do so. This reduces the risk of a surgical video being traced to a specific patient if it is used for educational or other purposes.

3. Automate removal of out-of-body frames

Luckily, the technology already exists to automatically remove out-of-body video footage, which poses the highest risk for identification. By identifying out-of-body video with greater than 99% accuracy, Theator’s surgical platform technology significantly reduces the risk of accidentally including images of patients or staff that could result in identification of protected health information. Automation of this process is the key to success in de-identification, as manual removal of identifying footage would be prohibitively time consuming.

De-Identification in Surgical Video

Although it’s valid to be concerned about the privacy of recorded surgical video, it’s important to know that solutions already exist to overcome the challenges of maintaining patient and staff privacy. By initiating updated consent processes, removing identifiers from recorded material, and implementing a system that automatically identifies and removes out-of-body frames, institutions can meet their patient’s needs for privacy and remain compliant with regulatory standards.

The Benefits of Fully-Managed Surgical Intelligence

Theator on February 19, 2024

Ready to Upgrade Your Operating Rooms with AI?

If you’re upgrading your OR to take advantage of the many benefits of AI technology for patients, surgeons, and healthcare organizations, don’t make the mistake of only considering how and what a particular platform records. The question of what happens to all of your recordings is just as (or maybe even more!) important as what and how you record.

Knowing why these considerations are important and how to ask the right questions before investing in technology that isn’t the right fit for your organization can save a lot of headaches and money down the road.

    • Where will recorded data be stored?
    • Will this sensitive data be secure?
    • Will storage be onsite, or can it be cloud based?
    • Will data storage cost extra, or is it included in your platform?

Data Storage

Before investing in technology to record and analyze surgical video, it is essential to consider all aspects of data storage. Surgical video is not only needed for immediate review of cases and association with post-operative outcomes, it will also be part of a patient’s medical record and stored indefinitely for record keeping and legal purposes. 

This means significant storage space is needed, especially if you will be recording high-quality video. Investing in on-premises servers and managing your own storage requires considerable space and is extremely costly—averaging about $500k per year. In contrast, cloud-based storage is more secure, and eliminates the need for those costly investments. 

As you can see, the question of where and how to store surgical video is going to affect the all-in price of the technology you choose. Some platforms, such as Theator’s Surgical Intelligence platform, offer unlimited cloud-based storage as part of our package. No hidden fees or need to upgrade once you’ve reached a certain point, unlike our competitors. 

Data Security

Like any other identifiable patient information, stored surgical video must meet the highest privacy and security standards. In the case of surgical video, it’s also important to ensure that only the surgical field is captured in recordings to further maintain privacy of patients and staff.

One way to limit recording outside of the surgical field is to use technology that identifies and blurs out-of-body segments of surgical video. This is exactly the technology that Theator uses in our platform—with 99.5% accuracy, the highest in the industry—where privacy and security are top priorities.

Security certifications are a key indicator that a surgical intelligence platform meets industry-leading security standards. Theator is the only platform with both HITRUST and SOC2 Type 2 certifications and we are HIPAA compliant, so patients and staff can rest assured their privacy is protected.

Think Big Picture for Surgical Intelligence

Here’s the bottom line: if you’re making a large investment in a surgical AI platform, be sure to consider every aspect of the product from start to finish first. The platform’s performance in the OR is of course paramount, but it’s also crucial to consider what happens to your recorded content after each case. Otherwise, you may be left with substantial ongoing costs, and challenges that could undermine 

Use our AI Technology Evaluation Checklist​ to help. 

Surgical Spotlight: Robot-Assisted Radical Prostatectomy

Theator on February 5, 2024

Robot-Assisted Radical Prostatectomy Insights

Prostate cancer is the second most common cancer in men, with an estimated 288k new cases diagnosed in the US every year, and an estimated 34k deaths per year as a result of it. 

Robot-assisted radical prostatectomy (RARP) has been a treatment option for men with intermediate to high-risk prostate cancer since 2001. Theator’s Surgical Intelligence database has compiled more than 750 RARP procedures to date, from 6 different health systems. 

Like any surgical procedure, RARP has potential complications, including: 

    • bleeding/vascular complications (1.9-6.8% of cases)
    • urinary incontinence (4-31% of cases)
    • erectile dysfunction (10% of cases)

In the 5 years following RARP, 17% of patients are readmitted. The most common reasons are:

    • Urinary obstruction (73%) 
    • Urinary infection (13.5%) 
    • Bleeding (6%)

In addition to the physical and emotional impact on patients in these cases, hospitals incur significant costs.

For more RARP insights, download our procedure spotlight report >> 

Surgical Practices in Robot-assisted Radical Prostatectomies

You might think a surgery that has been done for decades would be standardized with surgeons from all over the world performing the same steps and same surgical practices. Unfortunately, this is far from the truth. 

Not only are surgical practices not agreed upon, there’s very little data to support which approach or which techniques consistently optimize outcomes. 

For example, one surgical practice, bladder neck suture, is performed 9% of the time at one health system, and 50% of the time at another. Which begs the question: why the variability?

This is just one metric that Theator’s Surgical Intelligence Platform recognizes and analyzes across a health system and connects it to outcomes, so hospital administrators and surgeons alike can take a data-driven approach to improving the quality of surgery. 

Curious to know what other insights we’ve seen in our database of RARP surgeries? Download the full report here

Taking Surgical Quality Improvement to the Next Level

Theator on January 15, 2024

Surgical Intelligence Takes Quality Improvement to the Next Level

There will always be some degree of variability in surgical practice. Every procedure and surgeon has unique characteristics that make this inevitable. However, there are many circumstances in which surgical variability is a red flag that there is room for improvement. If Surgeon A is taking twice as long to complete the same procedure as Surgeon B, this is likely to affect quality of care and surgical outcomes, and interventions to address this discrepancy could improve these parameters.

Luckily, equipping your OR with Theator’s Surgical Intelligence Platform offers a simple and  transformative solution to this complex issue. Only Theator’s state-of-the-art platform provides  the comprehensive tools needed to identify surgical variability, connect this information to surgical outcomes, and offer custom solutions to improve practice and standardize care.

Are you wondering how we do it? Here’s what our technology offers that you won’t find anywhere else.

Intraoperative Intelligence

Theator’s technology begins recording procedures automatically, eliminating the possibility of human error resulting in missed recordings. Once a procedure begins, real-time feedback and updates are instantly available to those in the OR and other key team members, such as attending physicians and charge nurses. This means faster reaction times when unplanned events occur and increased OR efficiency as staff are kept informed of case progression.

Because Theator’s platform can identify procedural steps as they occur, recorded cases are tagged by key moments, making them easy to review for educational and quality improvement purposes. In addition, our technology is compatible with any device, so you have multiple options for watching and reviewing cases from the hospital or on the go. 

EHR Integration

Identification of intraoperative steps is an excellent first step toward reducing surgical variability. However, without connecting surgical events to patient outcomes it’s impossible to know if practice changes are truly moving the needle on quality of care.

That’s why our platform seamlessly integrates with your EHR system. By automatically connecting surgical events to patient outcomes, our technology can identify disparate outcomes related to surgical variability and easily track changes over time as improvement efforts are implemented.

AI-Powered Analytics

It goes without saying that taking the time to manually review recorded surgical video and connect intraoperative events with patient outcomes would be impossible for any surgeon. That’s where AI tools provide the support needed to harness and analyze the vast volume of data in recorded procedures to generate customized and meaningful insights for individual and systemic improvement.

Our dashboard offers each surgeon analytics about their individual cases and patient outcomes and how their results compare to their peers. By providing granular information about surgical variability, surgeons can then use these insights to adjust their practice and follow changes in their outcomes over time.

Choose Surgical Intelligence That Meets Your Needs

Other surgical AI platforms promise recorded video that will improve surgical care. However, this usually comes with a catch. These other platforms often don’t integrate with all the hardware and software you already have in your OR, don’t connect with your EHR to link surgical events to patient outcomes, or don’t have advanced AI tools to analyze data and offer personalized recommendations for improvement. When it comes to updating your OR to best meet the needs of surgeons and patients, be sure to choose a surgical intelligence platform that checks all these boxes so you can improve quality and optimize patient outcomes instead of just gathering data.

Ready to adopt surgical intelligence in your operating rooms? Make sure to use our AI evaluation checklist when evaluating different technologies. Get the checklist here.

Choose the Product That Captures ALL Your Surgical Video

Theator on January 9, 2024

Theator: The Product That Captures ALL Your Surgical Video

Leaders across the surgical profession are upgrading their operating rooms to incorporate innovative AI technologies that improve surgical care. If you’re among these forward-thinking leaders, you may be wondering how to choose between available technologies and which benefits one solution offers over another. 

 

Here’s what Theator brings to the table that you won’t find anywhere else.

Compatibility With Existing Equipment

Many surgical AI tools on the market are only compatible with their own OR hardware or software. Not only can this mean bigger upfront costs, it can also cause you to miss out on valuable surgical data if all of your hardware and software isn’t compatible with their technology.

 

With Theator, you never need to worry about this issue because our Surgical Intelligence Platform is compatible with any and all hardware and software you’re already using in your OR. When you partner with Theator, you won’t encounter any upfront costs or delays related to compatibility issues. 

Capture ALL Your Surgical Video

Ensuring compatibility of your surgical AI platform with your existing hardware and software is the first critical step toward capturing ALL of your surgical video going forward- not just some of it. You might be wondering why capturing all your surgical video is so important. The answer is simple: more data = more opportunity to improve quality and outcomes.

Recorded surgical video improves care from multiple angles. First, trainees (and even experienced surgeons) can review cases to continuously improve their technique and decrease errors. In addition, a greater volume of recorded surgical video means more data that can be mined to identify patterns and systems issues affecting care. 

Theator provides two key features related to surgical video recording that set us apart from the competition. Our Surgical Intelligence Platform automatically records every surgical case when it begins. No additional steps or room for human forgetfulness. 

Additionally, our AI technology provides real-time updates and feedback to improve efficiency and alert surgeons to critical intraoperative events as they occur. This means no time-consuming manual review of video footage is needed. Our AI-assisted Platform can identify practice variability, support clinical decision making, and immediately provide the information you need to improve patient outcomes.

Bring Your Operating Room Up to Speed

Partnering with Theator to upgrade your ORs using our universally compatible Surgical Intelligence Platform means capturing six times more surgical video than you would with our competitors. That’s six times the amount of information at your fingertips to increase transparency, enhance medical education, identify practice variability, and improve clinical decision making, quality, and patient outcomes. 

 

With so many benefits to surgeons and patients, the choice in surgical AI technology is clear. Reach out today to book a demo and learn more about what Theator can do for you.

Three Benefits of Recording Surgical Videos

Theator on January 5, 2024

Three Benefits of Recording Surgical Videos

Intraoperative video recording is quickly becoming the standard of care across surgical specialties, and with good reason. Recorded surgical videos are a valuable educational tool for trainees and experienced surgeons alike and improve the transparency and quality of care provided in the OR. Let’s take a deeper look at what this means for day-to-day surgical practice and patient outcomes. 

1. Recording Surgical Video Provides More Transparency

Improving transparency regarding surgical practices is important for both surgeons and patients. Patients experience anxiety about undergoing surgery and are interested in understanding what happens when they are under anesthesia. 

 

For surgeons, having recorded surgical video available for review is an invaluable tool for managing postoperative patients. One surgeon whose hospital has been automatically recording all surgical video for over a decade described a patient who had undergone emergency surgery the night before, but was worsening the next day. 

Upon review of the recorded surgical procedure, it was noted that a small bowel perforation was missed the prior night. Without the benefit of recorded surgical video, determination of the cause of the patient’s worsening would likely have taken much longer. A study of recorded bariatric surgeries found similar benefits in identifying postoperative complications by reviewing recorded surgical video. 

Notably, the surgeon mentioned above also reported there were “three or four” instances of recorded surgical video being submitted for legal cases over the decade since they began automatically recording. In each instance, the case was settled in favor of the hospital. 

2. Recorded Surgical Footage Can Be Used For Training & Education

Recorded surgical video provides the opportunity for trainees to gain exposure to exponentially more surgical procedures than they are otherwise able to by only attending procedures in person. Surgical residents with access to recorded surgical videos report accessing them to prepare for upcoming cases, improve their surgical anatomical knowledge, and review cases in which they participated to solidify their skills. 

Importantly, the use of surgical video to prepare for surgical cases has been associated with a decreased procedural error rate when performing the procedure that was studied. Taking recorded video to the next step in surgical training, cases performed by residents that are recorded can later be reviewed by multiple surgeons for feedback and evaluation.

The educational benefits of recorded surgical video don’t end with trainees. Even experienced surgeons benefit from refining and continuously improving their skills, and studies suggest that self-evaluation is not the best method of skills assessment. The objective data provided by surgical video recordings can provide the necessary data for surgeons to make actionable changes.

3. Surgical Video Provides Information Needed For Quality Improvement

The bottom line is that surgical video recordings are enormous sets of data that provide otherwise unavailable information about what occurs in the OR. For surgeons and hospitals looking to improve the quality of care they offer, recording surgical video is the first step in gathering the data needed to do this. 

Consider the current use of patient outcomes to drive quality improvement initiatives. Without intraoperative data, how can a link (or lack thereof) between what happens in the OR and patient outcomes be established? Often, it cannot. 

In this realm, there is an opportunity to pair recorded surgical video with AI technologies to gain deeper insight into practice variability and surgical outcomes than is possible with manual review alone, which is inherently limited by time and cost restraints.

AI tools paired with surgical video recording can identify steps in a surgical procedure, offer suggestions for clinical decision making, and enhance intraoperative diagnosis. The integration of such tools into everyday surgical care provides the specific feedback needed to improve patient outcomes.

Why Aren’t All Surgical Videos Recorded?

Simply put, automation is the key to success with surgical video recording. Without automation, surgeons are unlikely to remember to manually record each procedure they perform when it involves an additional step to everything else they are doing to prepare for a case. Investing in a technology that offers automatic recording is an essential step in collecting surgical data and improving outcomes. 

Failing to Record Surgical Video Leaves Valuable Data on the Table

If your institution isn’t currently recording all surgical procedures, you are lacking a large and essential data set that can be used to improve quality, transparency, education, and patient outcomes. Especially given that video is already used regularly in laparoscopic and endoscopic procedures, integrating software that automatically records video from tools already in use is a simple step that can result in a great leap forward in your institution’s technological, safety, and quality capabilities. Knowledge is power, and recorded surgical video gives your institution the power to create a culture of continuous improvement that benefits patients and surgeons. 

Considering AI in your operating room? Get our AI Technology Evaluation Checklist​:

Get the AI Evaluation Checklist

Do Patients Want AI in the Operating Room?

Theator on December 11, 2023

Do Patients Want AI in the Operating Room?

Short answer: Yes! 

 

In fact, not only do patients place a high importance on choosing where to get surgery based on their innovative nature and adoption of technology, but half of patients believe they will receive better care if that is the case.

 

Much of the literature about implementing AI technology in the OR views the issue from the perspective of the physician or healthcare organization. And while patient outcomes are a key force driving this discussion, patient opinions are rarely part of the conversation. So how do patients feel about the use of AI technology during their own surgical procedures? The answer may surprise you. 

Surgery Is Already A Difficult Decision For Patients

Unsurprisingly, patients do not take the decision to undergo surgery lightly. Furthermore, most have understandable concerns about surgical risks and complications. In our 2023 survey of 200 post-operative patients, 82% of patients reported they were nervous to undergo surgery. Specifically, 65% worried about dying on the table and 66% were concerned their surgery may create more health problems. 

 

 

In fact, our data show that patient preoperative anxiety is not misplaced. While 93% of those surveyed were pleased with their surgical outcomes, 26% of this group experienced post-surgical issues that required further intervention to correct.

Choosing Surgeons and Hospitals

What factors go into a patient’s decision about where to have surgery and whom to trust with their care? A vast majority of patients (87%) trusted their surgeon prior to undergoing their procedures. This trust largely carried through to the post-operative phase, even for those who experienced complications they believed could have been prevented. Interestingly, 21% of patients felt their surgeon did not clearly explain what to expect, yet clearly still trusted them.


In terms of surgical location, access to the most advanced technologies was the most important factor patients considered when deciding where to undergo surgery. This outranked consideration of the hospital where a physician practiced and where the surgeon was trained. Patients see the value in innovative care and are willing to forgo institutional loyalty to access advanced technologies.  

Intraoperative Video Recording and AI

According to our results, a majority of patients (55%) wished their surgical procedure had been recorded and placed high value on the potential uses of recorded surgical data. Of the patients surveyed, 60% would want to watch the recording of their surgical procedure if it were available. Additionally, 38% wish they knew more about what happened in the OR during their procedure and 58% of those who experienced complications (15% of total respondents) felt their complications were avoidable, which may explain their interest in viewing their own procedure. 

Notably, patients are not simply interested in the potential for recorded surgical video to demonstrate what took place during their own procedure — they see the value in using recorded surgical data for quality improvement. In this regard, 76% of respondents believed that surgical video should be captured and used to better understand surgery. 

When asked about the use of AI tools in the operating room, 50% of those surveyed felt they would receive better care if advanced technology like AI was used in the operating room. This means that when patients are selecting a hospital for their surgical procedure, many see the use of AI as exactly the type of high-value advanced technology that would warrant choosing one hospital over another. Rather than being wary of these tools, patients see the potential for them to support surgical decision making.

Surgical Expectations and Outcomes

A majority of respondents believed that surgeons should be measured on complication and readmission rates, as well as length of stay. Of note, 72% of patients surveyed experienced a length of stay that was expected or less than expected. 

When asked how their surgical experience could have been improved, patients cited the following:

    • Knowing my surgeon is using the most advanced technology (47%)
    • Knowing my surgeon is being assessed based on their postoperative outcomes rather than cost (46%)
    • Having more visibility into what happened while I was asleep in the operating room (41%)
    • Being at a hospital known for having the most advanced technology (32%)

Insights for Future Decision Making

Patients are consumers of healthcare and have high expectations for the level of surgical care they receive. Rather than being viewed as risky, technological innovations in surgical care, such as the use of AI tools, are viewed by the general public as not only desirable, but a feature worth seeking out when deciding where to obtain care.

As physicians and hospital administrators make decisions about how and when to integrate AI tools into their ORs, it is essential to keep this patient perspective in mind. Just as those in the healthcare sector see the potential for AI to improve patient care, so do patients, whose interest in advanced surgical technologies is likely to grow as these tools become more widely available.

Why Automation is the Key to Surgical Video Recording Success

Theator on December 4, 2023

The Key to Surgical Video Recording Success is Automation

Recording intraoperative surgical video and using an artificial intelligence (AI) platform to analyze recorded content is quickly becoming standard practice in operating rooms across the country. If your hospital or healthcare organization is embarking on the quality improvement journey offered by such platforms, it’s critical to understand their features to decide which one is best for your organization.

One such essential component of a high-quality surgical AI platform is the ability to automatically record surgical video instead of counting on surgeons to manually hit the record button.

You may be thinking, “Is it really that hard to remember to hit a record button?” In fact, our experience shows that it is.

Real Life Impacts of Automated Surgical Video Recording

We worked with a urologist who intended to always record his robotic-assisted radical prostatectomy (RARP) procedures. In the 10 years before adopting Theator’s Platform that automatically records all procedures, he managed to manually record 122 procedures. In just one year after implementing Theator’s technology, he recorded 163 procedures — a 1200% increase! 

What does this look like for an entire hospital? When Theator’s Platform was deployed at a hospital that performs 120 cases per week, they went from recording only 8.3% of cases to recording 100%. 

Why Does Automated Surgical Video Recording Matter?

Are you wondering why it’s so important to record every case instead of a select few? Great question! When it comes to actionable data, more is simply better for identifying patterns and trends. 

For example, consider a clinical trial for a new drug. You are far more likely to identify potential adverse effects in a trial with 2000 participants than you are in one with 20 participants. The same goes for recorded surgical data. Identifying practice patterns and variations should be based on all available data from a group or surgeon because a select sample may not accurately reflect true practice.

How Is Recorded Surgical Data Analyzed?

First and foremost, it’s important to know that Theator’s AI Platform will do the analyzing for you. This means there is no need for a busy surgeon to take time out of their day to manually review hours of video footage.

Theator’s proprietary AI technology can identify surgical steps, adverse events, variations in practice, and more – all of which can be linked to patient outcomes. This allows your institution to design plans with measurable goals to improve the quality of care. Patients, hospitals, and surgeons all stand to benefit from automated video recording and data analysis.

Tips for Integrating Surgical AI Platforms

When considering a surgical AI platform for your organization, be sure to understand the ins and outs of how data is recorded, stored, accessed, and analyzed. Some questions to ask are:

    • Is surgical video data automatically recorded?
    • Does the platform software integrate with the hardware already used in your ORs?
    • Does the platform offer storage of recorded video? Is it limited or unlimited?
    • What metrics will be analyzed in recorded video?
    • Does the platform link analyzed data to patient outcomes?

By embarking on the surgical AI journey as an educated consumer, you are more likely to find the platform that best fits your institution’s needs. 

Download The Surgical AI Platform Evaluation Checklist

Recording Surgical Data: What You Need to Know

Theator on November 30, 2023

What Surgeons and Administrators Need to Know About Recording Surgical Data

Recording intraoperative video is not a new concept, especially for those who perform laparoscopic or robotic procedures. However, as the practice of surgery continues to evolve by incorporating advanced technologies, such as AI, into everyday care, the role of intraoperative video recording will need to shift to better accommodate and advance the use of these tools. 

 

How will this change day-to-day surgical care? What are the best ways to protect privacy and security in this new digital age of healthcare? These and other common concerns are addressed in the July 2023 recommendations published by the AI Task Force of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Read on for a breakdown of what they had to say.

Why Record (More) Intraoperative Video?

The idea of recording extensive data to improve safety originated in the aviation industry. Following highly publicized plane crashes in the 1970s, recording in-flight data became standard procedure and the systems that were put in place to address identified issues resulted in the industry achieving a near-perfect safety record. 

 

Applying the same practices to surgical video offers the opportunity to improve patient outcomes and reduce complications in a similar manner. Importantly, recording intraoperative video is an easy process since ORs are already equipped with the necessary tools—meaning little to no valuable OR time is required to implement collection. Furthermore, currently available AI technologies are already adept at analyzing recorded video to identify surgical steps and variations, which means there is no need for surgeons to spend additional time manually reviewing recordings. 

Surgical Data: Who, What, When, Where, and Why

Before implementing large-scale surgical video recording, it’s important to understand the many aspects of using and managing this data that will come into play for an organization. The SAGES AI Task Force breaks these down as follows:

    • Data Use: This refers to the need to address all stakeholders in the use of recorded data, from surgeons to patients to administrators and beyond. What does each group need from the recorded data?
    • Data Structure: How will data be captured, stored, and formatted? This affects how accessible it is to stakeholders.
    • Data Exploration: Once data has been collected, it’s essential to define how it will be used for research purposes to improve care and promote innovation.
    • Data Governance: The ethical and legal aspects of data collection reflected in policies and procedures are key to protecting privacy and ensuring fair and just practices.

As departments, hospitals, and healthcare systems enhance their intraoperative recording capabilities and practices, all of these overlapping concepts should be proactively addressed to optimize outcomes and prevent unintended consequences. 

Data Use: Who Needs the Data and Which Cases Should Be Recorded?

In terms of what and when to record, 58% of task force members felt that surgeries should always or almost always be recorded. Of note, the group pointed out the specific need to record less frequent or more complicated procedures to maximize representation of rare events for educational and quality purposes. If storage capability is a barrier to recording all surgical video, working with a technology program that offers unlimited storage can eliminate the need to pick and choose which procedures to record and simplify the process using automatic recording of all procedures. 

 

Healthcare providers and patients were identified as the two most important stakeholders requiring access to recorded surgical data, and research, educational, and clinical use cases were all noted to be highly valuable roles of recorded data. Legal experts should be included in conversations and policy development regarding data use to ensure HIPAA compliance and address concerns related to discoverability of recorded data in medicolegal cases. In addition, attention to blurring out-of-body video segments can help to mitigate privacy concerns.

Data Structure: What Data Sources Are Most Valuable and How Should Data Be Stored?

In terms of which type of video to record, the task force felt that endoscopic data is a key addition to intraabdominal video to facilitate best practices. While using multiple sources to record intraoperative data increases the volume of available data, it also increases the need for data storage, so these two priorities should be carefully balanced. When planning an institutional approach to video recording, selection of technology that integrates with existing hardware can offer a logistically easier solution than starting from scratch with new equipment.

Quality and storage are main pillars of data structure that will require careful planning by organizations embarking on increasing their surgical data recording practices. Standardization is a vital element of this process to optimize accessibility and usability. In addition, video quality should be balanced with the intended data use, since higher quality data requires more storage. Choosing an unlimited storage platform can allow for consistent recording of high-quality data without the need to worry about running out of storage space.

Data Exploration: Addressing Bias and Furthering Research

It is well-documented that the healthcare system is fraught with bias, and it’s important that recorded surgical data not further contribute to this issue. To mitigate this, the task force suggests collecting additional data such as patient demographics and surgical team information to provide context to recorded data. Because recorded data are used to train AI algorithms, reducing bias in recorded data can ultimately reduce bias in these algorithms.

Planning for surgical data collection and storage should not only consider the current uses for this data, but also the potential future uses for safety and quality improvement, research, and outcomes analysis. This approach can inform forward-thinking practices for data management.

Data Governance: The Laws and Ethics of Data Collection and Storage

Transparency is key to the development of data governance policies that align with the principles of medical ethics. Patients should be informed about the use of video recording and have the opportunity to consent or decline the use of intraoperative recording. 

Related to this, access to recorded surgical data should be managed in a way that protects patient privacy and limits its use to predetermined use cases. Involvement of ethics boards and institutional review boards is encouraged to facilitate best practices in this area. 

Institute Policies Today to Be Prepared Tomorrow

The use of advanced technologies, such as AI tools, in the OR is on track to quickly become the standard of surgical care. The first step in implementing such technologies and their advantages is the collection of recorded intraoperative data. Luckily, ORs are already equipped with the tools to do this, so getting started is easy. However, the storage of large volumes of data, identification of its intended use, and privacy and security compliance are critical areas of consideration that should be planned for—purposefully and strategically that include all stakeholders—before embarking on large-scale data collection.

As Lung Cancer Rates Continue to Rise in Never-Smokers, Theator Expands Surgical Solution into Thoracic Surgery

Theator on November 16, 2023

Theator Now Supports Thoracic Surgery

We are excited to announce that we have expanded our Surgical Intelligence Platform into the field of thoracic surgery. Despite there being over 530,000 thoracic procedures conducted in the US each year, the surgical specialty is facing a major deficit of cardiothoracic surgeons. With lung cancer continuing to be on the rise in never-smokers, Theator’s award-winning technology will help hospitals meet the growing demand for minimally invasive thoracic surgeries by providing surgeons in the OR with the actionable insights they need to not only address but also up-level patient care across the board.

"At Theator, we are focused on generating actionable insights to positively impact patient outcomes and improve the quality of patient care. With the field facing a decreased supply of cardiothoracic surgeons, and thoracic surgery being a highly specialized and multidisciplinary field that involves collaboration among thoracic surgeons, pulmonologists, oncologists, anesthesiologists, and other healthcare professionals, it's never been more important than now to capture and disseminate better information, so patients, no matter where they live, will be assured they are receiving the best care possible."

Tamir Wolf, co-founder and CEO of Theator

With its rollout timed to November’s Lung Cancer Awareness month, Theator’s technology will target the specialized field of thoracic surgery, spanning the treatment of conditions affecting the organs within the chest cavity, including the lungs, esophagus, and other thoracic structures.

“Currently, there are limited ways for surgeons to access actionable and reliable evaluations of thoracic surgical performance,” said Dr. Matthew Ninan, Director of Thoracic Surgery at HCA Florida Healthcare West Division. “Objective benchmarks are yet to be defined as well. By having these measurements at our fingertips, surgeons will be able to meet crucial performance indicators for each specific task throughout the procedure, improving our outcomes and providing much-needed insights into the patient’s recovery.”

 

Despite technological advancements in the industry, many hospitals do not leverage the latest tech advancements in the OR. And, this lack of technology is felt by patients as well. A recent study commissioned by Theator found that while 80% of patients were satisfied with their surgical outcomes, nearly a quarter (24%) of them needed corrective surgery. Of the patients who had complications during surgery (15%), over half of them believed they could have been avoided (58%). And, almost a quarter of patients felt that if their surgeon were able to capture video of their surgery, they likely would have had a different result.

 

Theator’s ability to help hospital systems increase the adoption of evidence-based surgical practices, has helped make it a leading technology in the operating room, with hospitals around the globe signing on daily. 

Introducing Theator Spotlight

Theator on November 13, 2023

Ever wonder if all of the hospitals within a health system are achieving surgical practices? Or how different intraoperative techniques impact patient outcomes? Or why the cost of a procedure is higher at one facility than at another?

Theator Spotlight: Shining a light on surgical variability

Wonder no more! Theator Spotlight offers a window into this void of data. We’ve analyzed thousands of procedures to understand the causes of surgical variability.

We’re excited to introduce Theator Spotlight: shining a light on never-before-seen surgical variability insights and its causes by procedure, and surgical practices to improve outcomes.

We’ll be releasing exclusive insights into intraoperative data drawn from our 6 million+ hours of structured surgical videos.

 

Theator Spotlight highlights the most impactful surgical practices for each procedure and how they affect patient outcomes, as well as how often these practices are followed. It also identifies the reasons behind surgical variability—across and within health systems—and how to reduce it.

The best part?
It's completely free.

Whether or not your hospital has implemented the Theator Surgical Intelligence Platform (which draws insights from your hospital’s own procedures), these updates are an invaluable way to identify key variables that can impact:

    • Patient outcomes and quality of care
    • Profitability of a procedure
    • Institutional transparency
    • Costs to your hospital
    • Operational efficiency

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Surgical Outcome Reports Aren’t Enough

Theator on October 30, 2023

Improving The Modern Surgical Outcomes Report

In recent decades as evidence-based medicine became the standard of care, physicians and hospital systems turned to outcomes reporting as a means of indirectly measuring quality of care. Such information, especially when it is publicly available, allows for the transparency necessary to assuage patient concerns about the quality and safety of medical care and provides a basis for identifying systemic and individual opportunities for improvement. 

No other area of medicine lends itself to outcomes reporting and tracking quite as well as surgery. The universal nature of surgical procedures allows for standardization of outcome metrics, and the inability of patients to provide an account of surgical occurrences reinforces the need for maximal transparency to monitor quality.

While outcomes reporting plays an undeniable role in improving care, as we enter the era of surgical AI augmentation, the time has come to ask ourselves whether outcomes reporting is enough. With so much data now at our fingertips, how can it be harnessed to increase transparency and further improve outcomes?

The Actual Impact of Reporting Surgical Outcomes

The use case for surgical outcomes reporting came from cardiothoracic surgeons in the UK. This formal reporting process was born out of public pressure related to high mortality rates of pediatric patients in the region undergoing cardiothoracic surgery. With all pediatric cardiac units required to participate in outcomes reporting, mortality decreased 75% between 1985 and 2002. 

Following this, the Society for Cardiothoracic Surgery in Great Britain and Ireland began publishing hospital- and physician-specific data in 2005, resulting in a 50% reduction in risk-adjusted mortality. Since 2005, seven additional surgical specialties in the UK started publishing their outcomes data.

This practice has a number of advantages, most especially for patients for whom the transparency of outcomes reports provides trust and autonomy in their healthcare decision making. Surgeons also benefit from outcomes tracking, which allows identification of hospitals and surgeons with the best outcomes who can, in turn, inform best surgical practices. Additionally, publishing outcomes data provides a transparent piece of the complex puzzle that is healthcare costs.

Surgical Outcome Reports Don't Tell The Whole Story

Without an automated means of capturing outcomes data, continued dependence on human reporting will be inherently suboptimal due to incomplete recall and documentation. 

 

Related to this is the fact that outcomes alone do not take into account patient-specific pre-surgical risk and other factors that affect the complexity of a case. In other words, the intraoperative death of an 85-year-old patient with multiple comorbidities is clinically different from that of a 25-year-old previously healthy patient undergoing the same procedure. While some outcomes reporting systems attempt to account for this risk difference with adjusted scores, there is no perfect way of representing these factors. 

 

In addition, outcomes reports are inherently inaccurate to a certain extent due to their dependence on retrospective reporting. One study found that routine reporting by surgeons identified only 62% of adverse outcomes and even medical chart review identified only 78%. 

Without an automated means of capturing outcomes data, continued dependence on human reporting will be inherently suboptimal due to incomplete recall and documentation. 

How Do We Go Beyond Surgical Outcomes Reporting?

Outcomes reporting provides an important level of professional and public transparency that can build patient trust and potentially result in practice improvement. However, the latter is not a guaranteed result of outcomes reporting alone. One study that compared 263 hospitals that participated in The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to 526 that did not found no statistically significant improvement in outcomes across a 3-year period at participating hospitals, leading the authors to conclude that feedback on outcomes alone is not enough to prompt improvement.

 

For outcomes to serve as meaningful tools for improvement, they must be associated with additional information that tells the story behind how and why an outcome occurred. For surgeons, this data lies mainly in the events that occur in the OR during a surgical procedure. Intraoperative video recording offers a goldmine of data that, when paired with information about surgical outcomes, can provide the key to translating these outcomes into improved surgical practices. 

 

The concept of recording all surgical procedures as standard practice has understandably been met with trepidation by some surgeons. After all, as Alexander Langerman, MD states, “no one wants to fall below the bell curve.” This, coupled with the litigious nature of today’s healthcare system, can lead surgeons to disproportionately focus on the risks of transparency while disregarding the benefits. 

 

However, the benefits of intraoperative video analysis are well documented. For example, one study that used AI to analyze hundreds of intraoperative hysterectomy videos in search of practice differences to explain variability in outcomes found that not all surgeons were performing the recommended step of identifying the ureters during the procedure. This critical part of a hysterectomy procedure is key to preventing ureter injuries, and yet it was not being consistently performed. 

 

This is only one example of how AI analysis of intraoperative video can serve as an essential component of the quality improvement process. AI offers the ability to review and analyze surgical video in a manner that is impossible for surgeons to do manually due to time constraints. Without this tool and the transparency it offers, the reasons behind variability in surgical outcomes cannot be easily identified, and the practice modifications needed to improve these outcomes will remain a mystery.

Taking Surgical Transparency to the Next Level

Digital tools, including AI technologies that analyze intraoperative surgical video, are no longer the wave of the future. Instead, they are already present in ORs and being used by surgeons who see the value they offer in increasing transparency, identifying practice variability, and improving outcomes. The takeaway in the dawning of this new era in which medical care and technology are more intertwined than ever is that increasing transparency by embracing these tools will be a defining characteristic of surgeons who strive to continuously improve, and those who do not embrace these technologies will be left behind. 

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Will AI Replace Surgeons?

Theator on October 26, 2023

AI tools have become a hot topic of conversation in healthcare over the past year, and with good reason. Although patients are unlikely to have a visit with Dr. Chatbot anytime soon, AI technologies are now used on a daily basis by a variety of clinicians, including surgeons. This means it’s likely the role of AI in surgical care will grow, leading many surgeons to ask, “Is AI going to replace me?”

 

The short answer to this question is, “No, but…” Let’s dive in to discuss who/what is more likely and less likely to be replaced by AI technologies.

Free One-Page Introduction to Surgical AI

What Can AI Do That Surgeons Can’t?

Although the adoption of digital technologies, including AI, in the healthcare industry lags behind most other professional sectors, currently available AI tools are able to perform certain tasks that are not feasible for physicians, usually because of time constraints.

The crux of all AI technologies, which makes them so appealing, is their ability to process voluminous amounts of data in a short time period and generate useful output about this data. This is possible because these tools are trained on large datasets, which allows them to create algorithms. 

 

There is no shortage of available data in healthcare. In fact, the situation is quite the opposite- we have more data than time to process and make use of it.  This is what AI can do that doctors can’t. It has the ability to mine large quantities of data and generate patient-specific recommendations for management, such as individualized preoperative risk stratification.

What Can AI Do That Surgeons Don’t Want To?

While the idea of AI taking over tasks that physicians currently perform may sound ominous, there are a number of instances in which this is likely to be a welcome change. 

One such example is the use of AI technologies for clinical documentation. Surgeons spend a substantial amount of time on clinical documentation, often outside of normal working hours. Not only do these hours spent on clinical documentation take surgeons away from direct patient care, they also contribute to physician burnout. 

 

Imagine an AI tool that can pair with intraoperative video recording already in use and take what it sees to generate an accurate operative report. Such technology already exists, and its widespread use could greatly reduce the administrative burden for surgeons and, therefore, decrease burnout. 

How Can AI Augment Surgical Care?

Rather than viewing AI as a tool that will replace the work of surgeons, it makes more sense to think of it as a means of augmenting the care that surgeons currently provide, like an additional surgical instrument. 

 

AI technologies being developed for use in the OR have the ability to identify critical anatomic landmarks and steps in a surgical procedure. This information can then be used for clinical decision support and improved workflow efficiency. 

For example, currently available AI tools are able to identify the Critical View of Safety during laparoscopic cholecystectomy with 84% accuracy. Such technologies have the potential to reduce errors and improve quality by encouraging best surgical practices in every case. 

 

Furthermore, these same tools that pair with intraoperative video already being recorded are able to detect surgical case steps, meaning they have the potential to offer feedback to the user about the best next steps while simultaneously providing real-time information to OR staff about the expected time remaining in a case, allowing for streamlined OR workflow.

 

So, will AI replace surgeons? It’s unlikely. However, given that AI tools have the ability to improve patient safety, clinical outcomes, quality of care, and clinical documentation, according to AMA President Jesse Ehrenfeld, MD, “Physicians who use AI will replace those who don’t.”

 “Physicians who use AI will replace those who don’t.”

Free One-Page Introduction to Surgical AI

This sentiment is echoed by Keith Horvath, MD, AAMC’s senior director of clinical transformation, who notes that “AI is not going to replace physicians, but physicians who use AI are going to replace physicians who don’t, and that may be the cautionary tale.” 

 

AI’s inability to quickly evolve or work in a non-linear fashion means that these tools are unable to match the critical thinking skills of surgeons, who perform their roles in this manner on a daily basis. In addition, AI will never be able to offer the key ingredient of medical care: empathy. There will always be a need for human-to-human interaction that cannot be replaced by AI.

 

However, if surgeons experience better outcomes, improved efficiency, and decreased burnout by augmenting their work with AI tools, it makes sense that experts expect those who utilize them will be replaced by those who do not. The key for surgeons in this new era of medical care is to learn and adapt to change, as the benefits AI promises for patients and surgeons alike mean that it is here to stay.

The Role of Artificial Intelligence in Surgical Care

Theator on October 11, 2023

AI in Surgical Care

In recent years, novel AI technologies have become increasingly available in the healthcare industry. From clinical decision support to documentation to diagnostic radiology, one thing is certain: AI in medicine is here to stay. 

While this may sound like a daunting assertion, the benefits that emerging AI technologies can offer to patient care and clinician workflow have the potential to improve outcome measures in ways that are not currently possible. As you can imagine, one area that is primed for process and safety optimization using AI tools is surgery. 

You may be wondering what technologies are waiting in the wings to improve surgical care. And what are the implications of these tools? Read on to find out!

Emerging Surgical AI Technologies

Although there are numerous specific new and emerging surgical AI tools, many can be grouped into broad categories based on their intended function. 

Free One-Page Introduction to Surgical AI

AI Tools For Workflow Optimization

Developing and maintaining streamlined workflows is essential to OR efficiency, and ultimately to providing timely and appropriate surgical care. Tools that predict the duration of a surgical case based on real time data from video streams or surgical instruments can assist with reducing OR turnaround time. 

Another area of workflow optimization using AI includes OR scheduling. One hospital that used an AI tool to identify and automate release of incentivized OR block time used 336 hours more of their block time in one month than they would have without the use of AI.

AI Risk Assessment Tools

Surgeons have long embraced the use of pooled data and risk assessment tools to predict individual surgical risks for patients, an important method for ensuring high-quality care. Incorporating AI technology into risk assessment adds an additional layer of analysis that personalizes risk information beyond that which is currently available.

 

Because AI technology goes beyond data compilation and has the ability to use algorithms to make predictions, tools that are pre-programmed with large data sets can apply what they have learned from this data to individual risk prediction. 

 

Similar tools are already being utilized in the hospital setting. The Epic Sepsis Model, a feature of the Epic electronic medical record, is a predictive model for sepsis that was trained on data from 500,000 patient encounters to identify early signs of sepsis. A single-center study found its use as a screening tool to be associated with a 44% reduction in the odds of sepsis-related mortality.

AI For Intraoperative Guidance

Surgeries are among the highest stakes medical care provided by hospitals. As such, the ability of AI to support surgeons intraoperatively in making procedural decisions offers the opportunity to provide real time feedback to improve patient outcomes. 

For example, use of an AI tool in the form of an overlay on the surgeon’s video screen during laparoscopic cholecystectomies can guide physicians as to which areas are safe or less safe for operating. 

In orthopedic surgery, automated bone registration and tracking tools use depth cameras to identify the surface geometry of a target bone. These can then be compared to preoperative images to assess bone alignment. Such technologies offer the potential to augment physician knowledge and skill to optimize patient outcomes.

AI For Diagnostic Enhancement

Intraoperative surgical pathology is a common source of time consumption and missed diagnoses in surgical cases. What if AI could be used at this critical point of care to save time and increase diagnostic accuracy? 

Such technology already exists and has been used to accurately diagnose brain tumors in under 3 minutes. Furthermore, the same tool was able to accurately distinguish between tumor tissue and healthy tissue, thus aiding with identification of appropriate surgical margins. 

For pediatric patients, AI tools have been developed to identify acute and chronic otitis media using training data from patients presenting for myringotomy tube placement. Early data suggests this technology performs with higher diagnostic accuracy than expert otoscopic examination, a promising advancement for improved diagnosis of a common but diagnostically challenging condition. 

AI Tools For Intraoperative Video Analysis

While the capability to record intraoperative video is not new, the application of AI tools to this technology offers the potential to gain insights from intraoperative surgical video that were not previously available. 

By performing advanced assessment of intraoperative video, AI can extract information that can be used in multiple areas to improve surgical care. Utilizing AI to analyze voluminous surgical video in a manner that time and cost restraints make impossible for surgeons to do personally exponentially advances OR quality improvement practices.

For surgeons, intraoperative video capture and AI analysis offers a novel tool for linking what happens in the OR to patient outcomes. Coupling these tools together means that AI can do the work of annotating surgical footage, giving surgeons detailed insight into how their intraoperative techniques and decisions relate to later outcomes.

Surgical AI: What are the Implications?

Most experts agree that it’s unlikely AI will be replacing surgeons. Instead, AI tools being developed for use by surgeons are intended to augment and automate current processes and procedures. This has the potential to affect multiple areas of patient care and clinician workflow.

    • Quality Improvement: Intraoperative tools that assist with diagnosis and analyze surgical video aim to increase diagnostic accuracy, reduce operative time, and improve patient outcomes.
    • Cost Savings: By streamlining processes, such as OR scheduling, AI tools have the power to improve the efficiency of OR operations and optimize staffing costs. 
    • Medical Education: AI tools that offer intraoperative clinical decision support or detailed analysis of intraoperative video can provide valuable feedback and guidance for training the next generation of surgeons.

As with any new medical technology or device, adoption of AI technologies for surgical care should be subjected to the highest standards of evaluation prior to widespread adoption. Nonetheless, there are new and emerging AI tools in the surgical field poised to enhance care delivery and improve outcomes, and surgeons and hospital administrators should keep a close eye on these rapidly evolving technologies. 

Free One-Page Introduction to Surgical AI

How AI Can Improve Surgical Care

Theator on October 3, 2023

Although the ultimate role of artificial intelligence (AI) in surgical care is still evolving, one thing is clear: AI is here to stay. The potential advantages AI tools offer to process large amounts of data and generate meaningful information that can improve patient outcomes means that its integration into surgical care has myriad potential benefits. Read on to learn what they are!

Free One-Page Introduction to Surgical AI

How Can AI Tools Be Integrated Into the OR?

To understand how AI technology can be used to improve patient care, it’s important to first understand how AI tools can be incorporated into current surgical workflows. Because the power of AI rests in its ability to rapidly process large data sets and produce reasoned output, data that is currently routinely being captured in ORs in the form of intraoperative video recordings can serve as the input for AI tools. These specially trained programs can then process this input and generate feedback for surgeons and OR staff to improve surgical workflow, technique, and quality. 

The first step in generating useful information from surgical video recordings is teaching these AI tools to accurately identify the steps of a surgical procedure. Currently available technologies have already demonstrated the ability to perform this task in different surgeries. One study that analyzed the recognition of surgical steps in recordings of 619 totally extraperitoneal (TEP) inguinal hernia repairs found per-step identification accuracy to be as high as 94%. Another study demonstrated successful real-time annotation of two separate urologic procedures.

What’s Next for Surgical AI Technology?

Now that we know AI tools can identify surgical steps, how does this information benefit patient care? Here are just a few of the multiple ways this data can be harnessed.

Workflow Optimization

By accurately identifying surgical steps and segments of surgical procedures, AI tools can provide real time predictions of factors that affect OR workflow efficiency, such as the amount of time remaining in a case. 

Accurate prediction of such metrics allows staff and anesthesiologists to better plan patient flow and make the best use of daily OR time, an especially valuable proposition in the dynamic environment of busy ORs. In difficult or complicated cases, AI technologies may someday even have the ability to trigger an alert for extra support or surgical backup based on variations noted in surgical segment identification.

Landmark Identification

Correct identification of anatomical landmarks during surgery is key to preventing medical errors. Just as AI tools are able to accurately recognize surgical segments, they can also assist with identification of critical anatomical structures. By doing so, this augmented technology can aid with reducing misidentification and enhance patient safety.

One example of this technology in action is the use of an AI tool to identify the Critical View of Safety during laparoscopic cholecystectomy, a widely agreed upon surgical best practice. After training on 2,000 surgical videos, this technology was able to achieve 84% accuracy in detecting the Critical View of Safety.

Clinical Decision Support​

A natural extension of the ability of AI tools to mark surgical segments and identify landmarks is the processing of this data to offer real time intraoperative feedback and guidance to surgeons. Based on anatomical data, AI technology may be able to provide updated predictions of surgical risk that augment those done preoperatively based on patient characteristics and risk factors alone.

Furthermore, the ability of AI tools to predict next surgical steps means they can offer suggestions on how to proceed based on their previously programmed data. This feature may be especially valuable for trainees who require additional guidance until they reach a sufficient experience level.

Operative Report Creation ​

Operative reports are a necessary part of surgical care. However, they are also a task that takes physicians away from patient care, and they do not always accurately reflect each step that took place during a procedure. This often makes them less than useful as both a medical-legal document and a learning tool.

Given the ability of AI tools to track surgical segments, it follows that these documented steps can then be compiled into an accurate and timely operative report. One study of this technology found that an AI tool reproduced major components of operative reports 91% of the time across 117 cases. This holds great promise for both reducing physician administrative burden and improving surgical transparency.

The Future of Surgical AI Tools

By processing and analyzing intraoperative video recordings, AI tools can assist in detection of  anatomical landmarks, achievement of surgical best practices, and real time clinical decision making, operative report generation, and maintenance of an optimal workflow. However, this is just the tip of the iceberg in terms of what AI is likely to bring to future surgical care. By augmenting the knowledge and experience of trained physicians with the power of large data sets, technologies such as these are poised to improve quality of care, patient safety, and clinical outcomes. 

Free One-Page Introduction to Surgical AI

The Role of AI in Quality & Safety Improvement​

Theator on September 27, 2023

The future of AI-assisted quality improvement

In the matter of a few years, artificial intelligence (AI) has gone from being a topic discussed only by select innovators in the healthcare industry to one of widespread interest and endless discussion. In fact, one study found that the number of publications about AI doubled in the medical literature between 2014 and 2018.

However, it’s always important to remember that quantity does not equal quality. In other words, AI tools are only worthwhile in healthcare if they improve patient outcomes. So what currently available AI technologies improve quality and safety of care? And what does the future of AI-assisted quality improvement look like? Let’s dive in!

Free One-Page Introduction to Surgical AI

Predictive Analytics

While patient safety techniques have traditionally focused on identifying events and near misses after the fact and working to prevent future repeat occurrences, the introduction of AI-powered predict ive analytics flips this concept on its side by allowing identification of potential patient safety issues before they happen.

One example of this is an AI tool used at NYU’s Langone Medical Center to predict hospital readmission rates, a vital patient safety and care quality measure. This technology is able to predict 80% of readmissions and performs 5% better than standard computer tools at calculating readmission risk. 

In the surgical realm, predictive analytic tools can improve patient outcomes by triaging surgical patients to the most appropriate postoperative location more reliably than traditional methods*. This can lead to significant improvements in patient safety, as patient undertriaging to a surgical floor instead of an ICU is associated with a longer length of stay and higher mortality rate, among other poor outcomes.

Clinical Decision Support

AI technologies have the power to offer clinical decision support in a manner not previously possible: at the time of decision making, using personalized and up-to-date patient data. Furthermore, AI tools that support clinical decision making have expanded in availability from a few select specialties to nearly all fields of medicine.

Radiology was an easy early target for AI technologies given the technological nature of the field. And while it’s unlikely that AI will ever replace radiologists, use of AI-powered diagnostic tools to augment radiologist readings has been associated with reduced diagnostic errors, with one study showing a 19% reduction of this metric. This not only improves quality by increasing diagnostic accuracy, it also saves money by reducing the cost of unnecessary tests. 

In surgical care, AI tools that offer decision support using real time intraoperative data can improve patient safety by assisting with the identification of critical landmarks for injury prevention. One study evaluating the use of AI in detecting the Critical View of Safety in laparoscopic cholecystectomy found this method to have an 84% accuracy rate. Similar intraoperative AI-guided landmark identification was evaluated during endoscopic hysterectomy and also associated with improved safety awareness and reduced intraoperative complications.

Medical Education

Creating a safe environment for trainees to gain necessary skills and knowledge for practicing medicine in the real world is an area where many have tried to innovate over the years. From simulation labs with mannequins to online fictional patient case scenarios, computer-assisted technology has undoubtedly enhanced the ability of students and residents to learn without putting patients in danger. 

AI tools take this concept to the next level by providing guidance and feedback using real patient data, rather than simulations, for enhanced learning. For example, AI virtual patient tools analyze large data sets from actual patients to create true-to-real-life cases for medical students to work through. This not only improves the quality of their training, it also saves valuable time previously spent manually generating such mock cases.

For surgical trainees, harnessing intraoperative recordings and pairing them with AI technology offers a new method of learning and feedback on surgical performance. Identifying critical procedural elements and decision points using AI allows surgical residents to learn from the cases they perform after the fact and use this information to improve the quality of their technique and decision making for future cases.

Improving Quality and Safety Into the Future

Free One-Page Introduction to Surgical AI

The promise of AI for improving healthcare quality and safety lies in its ability to operate in real time, using current patient data to provide assistance and support. This greatly contrasts with traditional models of quality and safety improvement that rely on manual reporting of data with analysis after events have already occurred. Therefore, AI has the power to improve patient care and outcomes in real time, rather than simply using past data to prevent future mistakes.

 

* Loftus TJ, Ruppert MM, Ozrazgat-Baslanti T, et al. Association of Postoperative Undertriage to Hospital Wards With Mortality and Morbidity. JAMA Netw Open. 2021;4(11):e2131669. doi:10.1001/jamanetworkopen.2021.31669

 

I. Levin, Y. Gil, A. Cohen, 7722 Improved Safety Awareness and Intraoperative Complication Reduction after Implementation of Artificial Intelligence in Hysterectomies, Journal of Minimally Invasive Gynecology, Volume 29, Issue 11, Supplement, 2022, Page S101,ISSN 1553-4650, https://doi.org/10.1016/j.jmig.2022.09.325.

The Role of Artificial Intelligence in Healthcare

Theator on September 22, 2023

AI's Role in Healthcare

The release of ChatGPT’s artificial intelligence took the world by storm in 2022, leaving most casual users amazed at the type of content it could produce. Want to build a customized workout plan? Check. Want to rewrite your resume? Check. A list of topics for a dinner party or work lunch? Check and check. While it’s clearly impressive that ChatGPT has knowledge on an unfathomable number of topics, its primary awe-inspiring feature is its ability to rapidly create novel content that generally reads as if it was written by a human.

 

This revelation set off ongoing discussions in nearly every field about the opportunities, threats, risks, and benefits of AI technology. Healthcare is no exception to this discussion, especially given the high-stakes nature of patient care. So how exactly can we expect AI to be used (and not used) in the healthcare industry?

What is Artificial Intelligence?

Before jumping into the role of AI in healthcare, it’s important to understand what defines artificial intelligence. The original concept of AI dates back to 1956, when John McCarthy described it as the science and engineering of making intelligent machines. On a big picture level, AI refers to technology that is able to perform tasks that typically require a human level of intelligence and insight.  

All AI technologies have the same foundational mechanisms. They are programmed with sets of data to develop algorithms that allow them to quickly generate output based on pattern recognition. AI tools like ChatGPT are programmed with enormous data sets. This is why they are capable of both generating your grocery list and recommending the next book you should read. Other tools, such as those used in the healthcare industry, are programmed on more limited data sets related only to their intended use. So while the “A” in AI stands for artificial, in reality it functions more as augmented intelligence that helps humans perform all kinds of tasks.

Free One-Page Introduction to Surgical AI

How is AI Used in Healthcare Today?

Although the term “artificial intelligence” still has a futuristic ring to it, the truth is that AI has been used in the healthcare setting for decades. Current uses of AI in healthcare include data analysis, clinical decision support, and disease diagnosis and treatment, among others.

 

Radiologists were early adopters of AI tools, which makes sense given the technology-forward nature of their work. As of 2020, the American College of Radiology reported that 30% of radiologists had adopted AI technologies. AI tools are currently being used by radiologists to detect intracranial aneurysms and pulmonary embolisms. Furthermore, they supplement routine radiologist workflows by tracing tumors and measuring the amount of fat and muscle on a CT.  

Another example of the current role of AI tools in healthcare is the use of natural language processing in clinical documentation. Natural language processing describes the way in which technologies like ChatGPT can interpret typical human language input to generate meaningful output. Tools like Nuance’s Dragon Ambient eXperience are able to transcribe a patient/clinician interaction and use this information to generate appropriate electronic clinical documentation.

What’s the Future of AI in Healthcare?

If you’ve ever used Siri on your iPhone, had Netflix suggest movies you may like, or used Google Maps to get to your destination, then you already know that AI technology is here to stay, and the healthcare sector is no exception to this. So what does this mean for the future of medical care and those who provide it?

Most experts agree that AI will not replace doctors or other healthcare professionals, and it’s unlikely that patients will be scheduling visits with a ChatGPT-like bot anytime soon. Instead, AI technology will be used to enhance processes and workflows, improve quality, and assist with making sense of the massive sets of patient data that exist in healthcare organizations. 

While any new technology used to provide patient care requires meticulous vetting and consideration of its ethical implications prior to widespread use, the benefits that high-quality AI tools can offer in the healthcare industry have the potential to substantially improve care delivery and reduce costs and administrative burden.

Cost Reduction:

It’s no secret that the US spends more money on healthcare than other economically similar countries. AI technologies that automate, streamline, or improve processes can reduce healthcare costs. For example, one healthcare system noted a savings of $3 to $4 per visit when they changed to an automated scheduling system.

Improved Patient Care:

AI-powered patient monitoring tools offer the ability to not only monitor metrics such as vitals signs, but also to take that data to the next level by looking for patterns that may indicate an impending medical emergency. Such tools are being developed for use both in the hospital setting and for home monitoring of patients. 

Reduced Physician Burnout:

Burnout notably affects a significant number of doctors, nurses, and other healthcare professionals, which has the downstream effect of growing numbers of healthcare workers leaving their jobs. Therefore, AI tools that can alleviate pain points that contribute to burnout, such as time spent on clinical documentation, can serve to reduce this threat to the healthcare workforce. For example, an AI tool that collects patient health information in advance of a doctor’s visit and automatically generates clinical documentation was shown to reduce intake and documentation time by 90%.

Enhanced Quality & Safety:

AI’s ability to quickly analyze large sets of data leads to important implications for patient safety and quality of care. Examples of this include AI tools that accurately predict which patients are developing hospital acquired infections and others that monitor hand hygiene practices and provide reminders to clinicians to improve compliance.

AI in Healthcare: The Future is Now

Current trends in the development and implementation of AI in the healthcare setting all point in the same direction: AI is here to stay. AI tools offer the potential to address some of the most pressing concerns in today’s healthcare industry, including rising costs, physician burnout, quality, and patient safety. In particular, one area of healthcare that is ripe for disruption with AI is surgical care. 

While the adoption of AI technologies in healthcare should be held to the same standards the industry uses for other elements of patient care, such as drugs and medical devices, it’s clear that organizations that are slow to adopt AI as it becomes mainstream may be left significantly behind their competitors. Therefore, the time is now for healthcare leaders to explore evolving technologies and the potential solutions they may offer. 

Free One-Page Introduction to Surgical AI

Three steps for hospitals and surgical teams to start reducing surgical variability today

Theator on September 8, 2023

What can hospitals and surgical teams start doing right now to reduce surgical variability?

Short answer – not a lot, at least not a lot without the help of technology.

Hospitals are grappling with variability in surgical outcomes, yet the ground truth, aka surgical video, is not routinely captured. And even if it is captured, surgeons are busy, and don’t have time to analyze all of that raw video data.

So what steps can hospital executives, administrators, and surgical teams start taking now to tackle surgical variability and all of its damaging effects?

Step one: Capture better data

Especially for minimally invasive procedures (both laparoscopic and robotic), where surgery is visually guided and therefore a camera is already there. Simply fostering a “culture of capture” for every procedure, whenever possible.

Automating capture is key to success:​

As creatures of habit, changing institutional culture and habits can be a difficult task. At Theator, we’ve seen this first hand – this is why our Surgical Intelligence Platform doesn’t have a record button, it starts recording automatically.

Before implementing our automatic recording feature we were shocked to see the number of videos that weren’t being recorded. Even though the benefits were clear, and the technology was readily available to surgeons in the operation room. It became clear that automating this function was key to fostering a culture of capture. 

Step two: Mine recorded surgical data

Once hospitals have created a ‘culture of capture’ they can mine the surgical footage to surface where variability exists intraoperatively to identify opportunities for improvement. This will make it possible to set specific goals and monitor adoption to programs put in place to achieve them. This entails reviewing, annotating or structuring the data, and compiling data points to make analysis possible.

Step three: Take advantage of new tech solutions

Hospitals must take advantage of new tech solutions to help. Sifting through all that surgical video manually can be extremely time consuming and resource-intensive, but there are platforms available now that can do it all for you — and connect the data to patient outcomes.

The ability to connect what happens intraoperatively to a patient’s recovery postoperatively, generates hospital- and surgeon-specific insights on how to improve the quality of surgical care.  

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

 

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Surgical Variability’s Impact on The Entire Healthcare Ecosystem

Theator on August 22, 2023

The impacts of surgical variability extends far beyond individual procedures

Simply put, “surgical variability” means not all surgeons perform surgery exactly the same way. Because of the many factors contributing to variability between procedures, reducing variability is a challenge hospital administrators are painfully aware of. Some causations are obvious, like patient factors or healthcare inequity. While others are more opaque—like subjective experiences between surgeons, or a lack of actionable data. 

The effects of surgical variability at every level of the healthcare ecosystem are significant and wide-ranging. It’s no wonder that executives, administrators, and surgical teams have long been in search of reliable ways to reduce or eliminate it altogether.

Variability in surgical care often leads to preventable complications and poor outcomes, but patients are not the only ones feeling the negative impacts of surgical variability…

To patients surgical variability can mean life or death

Obviously the group hardest hit by disparities in surgical care is patients. The worst case scenario for them, of course, is preventable death. But even unforeseen complications resulting in longer hospital stays, additional health issues, or the need for reoperation can take a massive toll. Patients miss work, incur huge hospital bills, have their lives interrupted, endure pain, discomfort, and lack of privacy, and often suffer psychological distress due to these experiences.

The burden of variability also weighs heavy on caregivers & loved ones

Those closest to the patient experience the ripple effects of the events described above. From managing and coping with the death of their loved one to providing assistance that also disrupts their daily lives and drains them of time, money, energy, and mental health, entire communities feel the impact of surgical variability.

The psychological impact of variability on surgeons

Generally speaking, surgeons and surgical staff strive to continuously hone their craft and deliver the best possible outcomes for their patients. But pervasive variability in processes and techniques (and especially the visibility issues that cause that problem) limits their ability to develop professionally — and to help others improve. The resulting complications and negative outcomes also take a psychological toll on them.

The financial, operational, and liability implications of variability on hospitals

The financial and operational impact on individual hospitals is tremendous. Estimated costs incurred due to gastric leak in laparoscopic sleeve gastrectomy are up to $10,000 per incident — and that’s just one complication that occurs in one type of procedure in one specialty. Hospitals also have to contend with liability issues, such as malpractice suits, insurance reimbursement, and more. And operationally speaking, even what may seem like minor efficiency issues, when replicated across thousands of procedures per year, can add up in terms of budget, resources, and patient care. In a system already stretched too thin, these institutions can ill afford the effects of surgical variability.

Health systems carry the consequences of variability at scale

Similar to how the impact on patients ripples outward to their communities, the impact on hospitals ripples throughout health systems, eating up precious resources that could be used to improve care. No one can “afford” to fix the problem, but the problem itself is costing an ever-growing fortune.

Surgical Variability: A problem we can’t afford to ignore.

Surgical variability has significant implications on the entire healthcare ecosystem, it’s clear that this is an issue we cannot afford to ignore. Though it’s unlikely that we can eliminate this issue entirely, there are steps we can take today to reduce avoidable procedural variability by driving standardization in adoption to evidence-based, surgical best practices. Only by capturing, structuring, and analyzing surgical data, we can surface intraoperative variability that impacts postoperative recovery and start to solve variability one department at a time. 

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

Get the Beginners Guide to Surgical Variability

The Role of Surgical Variability in Complication Prevention

Theator on August 11, 2023

The Frequency of Surgical Complications is Alarmingly High

From the earliest days of trepanation to modern minimally invasive techniques, we’ve come a long way in the field of surgery. But we’re still far from perfect. In fact, of the 300 million surgical procedures performed annually, nearly 1 in 6 still involve complications, resulting in around 3 million deaths per year. The subsequent physical, emotional, and psychological effects on patients and their loved ones, as well as the massive financial and operational impact on hospitals and surgical teams, are impossible to overstate.

The Role of Surgical Variability in Complication Prevention

Variability in surgical care contributes to this high incidence of preventable complications and poor outcomes,  and stems from a lack of adoption to data-driven surgical practices. And disparities aren’t limited to less-developed regions. We see variability between hospitals — and even departments — in major metropolitan centers of the most developed countries on Earth.

Administrators are painfully aware of this challenge, but have struggled to find any reliable way of solving it. Many hospitals invest heavily in hiring teams to analyze their own data and/or to participate in The American College of Surgeons National Surgical Quality Improvement Program (NSQIP). While the program is designed to measure and improve the quality of surgical care, participation does little more than confirm variability exists and show how participants measure up against their peer hospital groups. 

You don’t need sample data that’s delayed 6 months (and isn’t actionable) to tell you any of that. You need better ways to understand why this surgical variability exists in the first place, pinpoint specific areas of improvement, set goals, and achieve them. But let’s start with surgical variability: its causes, effects — and what hospitals and surgical teams can start doing about it now.

What causes surgical variability?

In its most literal sense, “surgical variability” means “not all surgeons perform surgery exactly the same way.” When we break down any procedure into its component steps (assuming even these are standardized), there are any number of different circumstances that could arise, techniques that could be employed, or processes that could be followed during each step that influences the outcome. 

For example, during a laparoscopic sleeve gastrectomy, oversewing the staple line has been shown to help prevent gastric leak and bleeding — two of the most serious complications of this common procedure. Yet a recent analysis of 370 sleeve gastrectomies revealed this technique was performed in only 60% of cases.*

The same analysis also revealed significant variability in surgical efficiency, with average time to perform a specific step, the gastric transection, as low as 13 minutes and 20 seconds for some surgeons, and nearly 39 minutes for others. Considering that longer procedure times are associated with poorer patient outcomes and higher hospital costs, this is no small matter.

While all these opportunities for deviation might seem to create an infinite number of un-trackable variations, there are some common threads that can help us make sense of it all:

    1. Healthcare inequity. Unfortunately, socioeconomic factors, inherent bias, and other equality-based considerations often cause disparities in care and outcomes. From limited access to even basic care (let alone advanced technologies) to communication and trust issues, myriad factors put a disproportionate share of the negative effects of surgical variability on historically marginalized populations.
    2. Patient factors. Every patient is different. Some have pre-existing conditions that put them at higher risk during certain procedures or specific techniques. Some have anatomical anomalies that require in-the-moment adjustments or deviations from standard practices. But particularly with common procedures that are performed thousands of times every day across the world, we should be able to account for these factors by now with documented surgical practices.
    3. Subjective experience. Due to the age-old apprenticeship model of surgical training, one surgeon’s career-long experience can be dramatically different from another’s without either ever realizing it. When your training and daily practice are so heavily guided by the subjective experience of one person (who learned many of the same things, the same way, from yet another single person, and so on), your perspective is inherently narrow and biased.
    4. Lack of actionable data. Although many aspects of surgery are tracked and reported, surgical teams often suffer from “DRIP” (data-rich, insight-poor) visibility issues. Sometimes there’s a scarcity of proof to back up new or emerging recommendations, making surgeons more hesitant to adopt them. And sometimes the data that could be most helpful is simply not reliable or accessible. For example, the best record most hospitals currently have of what goes on in the OR is the surgeon’s operative report. These are typically templatized, created after the fact, and (as has been widely reported) often highly inaccurate. In fact, one paper, entitled A Video is Worth a Thousand Operative Notes revealed that while operative reports claimed 85.1% of technical steps were followed, operative video confirmed only 52.5% actually had been.

Surgical Intelligence: The Next Step to Reducing Variability

Because of these factors, completely eliminating surgical variability may not be possible. But we have the resources to start reducing variability by a significant margin. Powered by AI and machine learning, Surgical Intelligence can help us connect the dots between patient characteristics, surgical practices, and post-op results. Because it’s understanding surgical outcomes is not enough, we have to understand how specific decisions and practices impact those outcomes. 

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

 

Get the Beginners Guide to Surgical Variability

 

*References: Theator Surgical Intelligence Platform Data on File: Bariatric Procedure Analysis, 2023.

Dobson GP. Trauma of major surgery: A global problem that is not going away. Int J Surg. 2020 Sep;81:47-54. doi: 10.1016/j.ijsu.2020.07.017. Epub 2020 Jul 29. PMID: 32738546; PMCID: PMC7388795.

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