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Codifying Surgery with Surgical Practices

Measuring high-quality surgery, while it is occurring

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

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

What are surgical practices and why are they important?

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

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

85 Surgical Practices and Counting

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

Download here.

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

The Benefits of Fully-Managed Surgical Intelligence

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 Intelligence: A New Frontier of Surgery

What does AI have to do with the operating room?

Multiple innovations have struck the surgical world. These technologies offer an eclipse into the future of surgery, each attempting to revolutionize the way operations are performed today. In the past, surgical innovation spurred around medical devices: a better stapler, more advanced monitoring equipment, or a versatile surgical robot. All these advancements are hardware. 

While these devices start to mature, there has been a clear shift toward software-based innovations. The new buzzword is Artificial Intelligence. So what is AI, and how is it related to the OR?

The Oxford dictionary defines AI as: “the theory and development of computer systems able to perform tasks that require human intelligence, such as visual perception, speech recognition, and translation between languages.” 

It is clear that technology for the sake of technology is useless; therefore, it is imperative to determine the pain points these innovations attempt to address. AI alone is merely a technological advancement; the question is what value it brings to the table. 

Until now, surgical software companies have been divided into four categories:

#1: Telesurgery​

The world went virtual as the covid-19 pandemic erupted. Employees began working remotely, and many technologies were developed to enable efficient work from afar. If remote video calls can substitute presence in a conference room, why can’t they replace physical presence in the operating room? Companies in this space are essentially creating zoom or facetime for the OR. Despite being a novel technological solution, this platform doesn’t use artificial intelligence. While telesurgery may help to improve access to surgical care, it’s unscalable. Telesurgery is a one-to-one solution that relies on subjective surgeon experience and surgical experts’ availability when needed. 

#2: Enhanced Visualization​

Innovations within this category are developing anatomical enhancement systems that improve visualization of the operative field.

While these solutions may make it easier to perform the next step in surgery, they do not necessarily inform what that step should be or how it should be performed. They address a specific element of surgery but not surgical practice as a whole and therefore don’t address surgical variability. 

#3: OR Performance Monitoring​

Surgical treatment is a sophisticated process and, therefore, vulnerable to human error. Periodically, news reports cases where surgery was performed on the wrong body part. Surgical safety is a well-documented issue and the cause of significant morbidity and mortality. As a result, OR teams are required to implement tools such as checklists, timeouts, and preop labeling – all adopted from the world of aviation.

Solutions within this category are solely focused on implementing current guidelines and improving teamwork and visibility within the operating room.

#4: Video Content Management​

Conventional companies within this category have developed platforms that capture and store procedure data, empowering more surgeons to review and comment on one another’s performances. Essentially these platforms are replacing mountains of thumb drives, the modern version of a cloud-based library. But these platforms provide limited value to OR teams without unbiased, objective data analysis and integration of patient outcomes.

Finding a new way to solve surgical variability

Now we still ask ourselves, what can be done to improve surgical quality of care and efficiency on a wider scale? How can we change the sad reality of  “where you live determines if you live”? How can we continuously improve surgical performance in rural hospitals and top-tier medical centers? How can we tackle surgical variability and democratize access to the best care? 

Surgical variability alone is a complex challenge with many influencing factors. But those factors essentially boil down to one problem: A lack of meaningful data that allows surgeons to link specific aspects of their performance to patient outcomes. 

 

Here’s where Theator and Surgical Intelligence come into play

Surgical Intelligence is a new field focused on data-driven insights that improve surgical outcomes. Connecting intraoperative performance with clinical outcomes on a large scale can unearth surgical best practices. Once surgical best practices are obtained and verified, they can be disseminated and implemented worldwide.

By improving decision-making, all healthcare stakeholders understand what leads to better clinical and financial outcomes and have actionable pathways to achieving them.

At Theator, we have created the Surgical Intelligence platform.

The outstanding platform captures surgical video, annotates the procedure, and analyzes it, all in real time. We’ve partnered with leading medical institutions and professional societies and continue expanding rapidly. Theator has been consistently recognized as a leader in this space, winning awards such as CBInsights top 100 AI companies and Fast Company’s top 10 most innovative companies in data science.  

The part of this journey we are most proud of is hearing the positive feedback we receive from our users. Many have told us they couldn’t imagine their surgical practice without surgical intelligence. Others have improved the surgical quality in their department, positively affecting the treatment patients receive. 

This is the Surgical Intelligence revolution. It’s the ideal application of “AI in Surgery” — one with immediate, practical value that empowers and supports surgeons. It’s the key to finally eliminating variability and disparities in surgical care. And, most exciting of all, it’s happening right now.

From Concept to Creation: The Path to Surgical Intelligence

Challenging the status quo of surgical care

Bringing a new idea to life is all about the four ‘P’s: purpose, persistence, (the right) people, and a solid plan. At Theator, our purpose was clear — challenge the status quo of surgical care. And by applying these principles in pursuit of that goal, we developed a first-of-its-kind product, transforming how surgery is performed today and improving quality of care for generations to come. Here’s what it looked like – from concept to creation. 

We started with the end user (surgeon) in mind

Any great product solves an unmet market need, even if the end user is unaware they have one. Theator was founded based on the realization that there is significant variability in surgical outcomes today — not only in different parts of the world but even within the same hospital. We ultimately knew what needed to be solved, now it was a matter of how to best solve it

Theator Technology Advisor and former Netflix Chief Product Officer, Neil Hunt, emphasized the importance of understanding our end users’ real habits, needs, and motivators. We needed to ask the right questions, in a non-leading way, to gather unbiased input that would illuminate our path forward. For example, “what frustrates you about being a surgeon? or “what do you hope to accomplish within the next 2-3 years?”. Based on their responses we discovered there’s a world of untapped surgical data, that if unlocked and leveraged properly, could aid in providing the highest level of care without the extra burden. 

We focused on the features that add value

Surgical video contains a ton of invaluable data, yet surprisingly it isn’t being routinely captured today. 

So we started with the low-hanging fruit: enable touchless, automatic video recording for every procedure where a camera already exists. This includes all laparoscopic and robotic procedures. Next, you have to structure the data in a way that simply highlights only the moments that matter. Otherwise you’re just left with a mountain of raw footage and manual, time-intensive work. And the last thing we wanted was to add to a surgeon’s overflowing workload. Thanks to our advanced AI and computer-vision technology, this information is automatically presented to you in an easily digestible format. But it doesn’t end there. You still need to be able to link specific actions and techniques to outcomes. We are able to connect the dots along the entire patient’s journey (pre-operative, intra-operative, and post-operative) in order to, for the first time ever, draw actionable insights and disseminate best practices. This is Surgical Intelligence in a nutshell.

We knew our tech needed to standout from the rest

In order to deliver on all the above, we needed superior AI-technology. Conventional AI-capabilities were not suitable for delivering both real-time and accurate results that could scale across multiple surgical specialties, so we set out to do something different. 

Our first aim was to develop an algorithm that could accurately detect, structure and annotate procedures in real-time. This was achieved through our proprietary VTN approach, which allows for immediate, end-to-end action recognition within the surgical domain. This is critical given that conventional technologies are only capable of capturing individual frames or brief clips, lacking long-term context of what happened before or after. 

Next, we wanted to quickly scale this across the majority of procedures and specialties. So we became the first to apply a proven machine learning concept, called Transfer Learning, to surgery. This enables us to train new procedures, using less videos. The more information the algorithm is fed, the more knowledgeable it becomes, and the more transferable that knowledge is. Then, applying multi-task functionality enables simultaneous predictions across these various procedures and specialties. So not only can it detect what’s happening, it can also predict what’s going to happen.

An algorithm that is fast, accurate and scalable provides real-time functionality which you can trust. Theator is proven to be the only company that can do this across hundreds of procedures, spanning five specialties and rapidly growing!

Never stop improving.

Our product team’s work is never done. We continuously challenge ourselves to test, optimize, refine, and re-evaluate. Is our solution still aligned with our users’ needs? What is the usability of our application? This ensures we continue to deliver a high-quality, high-value product versus just flashy features. This is only the beginning for Surgical Intelligence and we’re excited for what’s next – stay tuned!