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This AI-powered “black box” could make surgery safer

The first time Teodor Grantcharov sat down to watch himself perform surgery, he wanted to throw the VHS tape out the window.   “My perception was that my performance was spectacular,” Grantcharov says, and then pauses “until the moment I saw the video.” Reflecting on this operation from 25 years ago, he remembers the roughness of… A screenshot of the analytics produced by the black box.


The best hard data thus far is from a 2022 study published in the Annals of Surgery, in which Grantcharov and his team used OR black boxes to show that the surgical checklist had not been followed in a fifth of operations, likely contributing to excess infections. He also says that an upcoming study, scheduled to be published this fall, will show that the OR black box led to an improvement in checklist compliance and reduced ICU stays, reoperations, hospital readmissions, and mortality.

On a smaller scale, Grantcharov insists that he has built a steady stream of evidence showing the power of his platform. For example, he says, it’s revealed that auditory disruptions doors opening, machine alarms and personal pagers going off happen every minute in gynecology ORs, that a median 20 intraoperative errors are made in each laparoscopic surgery case, and that surgeons are great at situational awareness and leadership while nurses excel at task management.

Meanwhile, some hospitals have reported small improvements based on black-box data. Duke’s Mantyh says he’s used the data to check how often antibiotics are given on time. Duke and other hospitals also report turning to this data to help decrease the amount of time ORs sit empty between cases. By flagging when “idle” times are unexpectedly long and having the Toronto analysts review recordings to explain why, they’ve turned up issues ranging from inefficient communication to excessive time spent bringing in new equipment.

That can make a bigger difference than one might think, explains Ra’gan Laventon, clinical director of perioperative services at Texas’s Memorial Hermann Sugar Land Hospital: “We have multiple patients who are depending on us to get to their care today. And so the more time that’s added in some of these operational efficiencies, the more impactful it is to the patient.”

The real world

At Northwell, where some of the cameras were initially sabotaged, it took a couple of weeks for Kavoussi’s urology team to get used to the black boxes, and about six months for his colorectal colleagues. Much of the solution came down to one-on-one conversations in which Kavoussi explained how the data was automatically de-identified and deleted.

During his operations, Kavoussi would also try to defuse the tension, telling the OR black box “Good morning, Toronto,” or jokingly asking, “How’s the weather up there?” In the end, “since nothing bad has happened, it has become part of the normal flow,” he says.

The reality is that no surgeon wants to be an average operator, “but statistically, we’re mostly average surgeons, and that’s okay,” says Vanderbilt’s Langerman. “I’d hate to be a below-average surgeon, but if I was, I’d really want to know about it.” Like athletes watching game film to prepare for their next match, surgeons might one day review their recordings, assessing their mistakes and thinking about the best ways to avoid them but only if they feel safe enough to do so.

“Until we know where the guardrails are around this, there’s such a risk an uncertain risk that no one’s gonna let anyone turn on the camera,” Langerman says. “We live in a real world, not a perfect world.”

This piece has been updated to reflect additional information from Surgical Safety Technologies about pricing.

Simar Bajaj is an award-winning science journalist and 2024 Marshall Scholar. He has previously written for the Washington Post, Time magazine, the Guardian, NPR, and the Atlantic, as well as the New England Journal of Medicine, Nature Medicine, and The Lancet. He won Science Story of the Year from the Foreign Press Association in 2022 and the top prize for excellence in science communications from the National Academies of Science, Engineering, and Medicine in 2023. Follow him on X at @SimarSBajaj.

Published: 2024-06-07T09:00:00

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