The one-second delay is unacceptable: Andrey Kobets — about domestic developments and advanced technologies in operating rooms

— How to adjust modern technologies for doctors? Should systems, monitors and cameras be customized for a specific specialist, or should they still be universal?

— To answer this question, you need to break it into blocks. To begin with, I would like to note that surgeons as doctors have been studying for a very long time. Russian universities have their own traditions, schools, and healing rituals. All this affects how a particular specialist works, the choice of his tools, methods, and so on. In addition, the specialization of the surgeon himself plays an important role — in orthopedics, traumatology, in the treatment of childhood diseases, etc. I emphasize that the entire infrastructure of the operating room should be configured specifically for the doctor. He is here as a conductor — everything necessary is located under his hand, everything is accessible and convenient.

At the same time, it should be understood that the operating room is a sterile area, access to which is strictly limited. Even for other doctors. Establishing contact between the clean zone and the external circuit, even in the mode of a regular videoconference, is a difficult task, the solution of which depends on the information and infrastructure capacities of the hospital. And here comes another task — obtaining and transmitting online high-quality images, which are so necessary for doctors. Just imagine: the second delay of the video by an ordinary person is practically not noticeable, and for the operating doctor it is unacceptable. Every fraction of a second is important, incorrect configuration of systems can turn into a fatal error, so it is important not only high image quality, but also stable data transmission at high speeds. That is why the “heart” and “brain” of innovative operating rooms must work clearly and harmoniously. These include: monitors that display video and audio in real time, endoscopic racks, ultrasound machines, angiographs, CT, MRI, other devices and video cameras. All together, it should work like the most reliable watch: clear, simple, understandable. Moreover, each of the listed pieces of equipment may have several pieces. Once we worked with an operating room where 18 video cameras were placed.

— Are we talking about external cameras?

— Not only about them. There are also cameras that are putted inside the human body when performing minimally invasive operations. They are built into the so-called endoscopic racks. Thanks to them, the doctor can look at the organs and their condition from different angles. Ultrasound machines, angiographs, X-rays, and tomographs also help doctors. The latter, by the way, produce more than 12 images during operations. The number of sources varies depending on the surgical intervention. Among them there are sources of augmented reality.

— What is it about in the latter case?

is a device similar to special glasses. After putting them on, the doctor receives an additional image on the patient’s body. The picture shows the location of the internal organs. The innovation is more often used in traumatology and neurosurgery. The image is “assembled” in advance — based on CT and MRI data, which will then form the basis of a specific model for the doctor. Doctors receive additional navigation through the patient’s body. This is important for promoting tools during complex interventions. For example, in neurosurgery, every millimeter is important, and the success of the entire operation sometimes depends on the entry point and the trajectory of the instrument. To avoid mistakes, a kind of “road map” of the patient is compiled. Thanks to it, the doctor gets a complete understanding of how to use the tools in the best way, without unnecessary incisions.

— Is the surgeon the only one who sees all the information?

— The necessary information is received not only by the surgeon, who can be called the commander-in-chief of the entire operation, but also by the entire team. It can consist of 3 to 12 people. Most of the doctors are involved in organ transplantation. And each of them monitors certain indications. Thus, the anesthesiologist monitors the patient’s vital signs so that during the intervention he remains in anesthesia, was in the right phase. He has his own monitors. Nurses monitor the position of the instruments so that the doctor has everything at hand, in a clear sequence. Access to the body, closing of incisions, suturing — these data are also in the field of view of doctors. And the monitors located in the operating room are available to the entire team. There are three, four, and eight screens, depending on the type of operations performed. It is important that they do not interfere with doctors and are located in the most convenient way. Special consoles are also used, the so-called long arms to control them, as well as microscopes that display information on the screen. There are monitors designed only for the chief physician of the hospital. During his rounds, he can view the progress of the operation, its specific phases, rewind the video to the desired stage, while not distracting the operating surgeon. The chief physician has access to different angles and sources of information — the same microscopes, endoscopic racks, angiographs, etc. Data from each installation is accumulated on the screens.

— You were talking about image quality. How is it configured?

— It must be genuinely high. And here contrast depth settings and color rendering play an important role. It is important to understand that surgeons have to work a lot. He can stand on his feet for eight hours. As a human being, of course, he gets tired. Comfortable conditions are created for doctors to support them. We are talking about the so-called practice of different colors and their correction. The lighting of the operating room plays its role, as well as the internal color rendering settings. For example, when wearing 3D glasses, the surgeon never chooses the blue scale. The white color begins to shine especially brightly in it. This reflection puts a very strong strain on the surgeon’s eyes. It is removed by choosing the right color scheme.