Marilou Jansen, MD1, H.A.W. Meijer, MD1, T.P. Grantcharov, Prof2, M.P. Schijven, Prof1. 1Amsterdam UMC, location AMC, 2St. Michael’s Hospital
Objective: Interaction with electronically controlled operating room (OR) systems embedded in modern surgical environments is everyday practice for surgeons performing Minimally Invasive Surgery (MIS). While there is a non-sterile operating nurse available in the OR, capable of interacting with these systems upon request by the surgeon, this indirect control is mostly slow, prone for error and disrupting surgical workflow. When indirect control causes an unanticipated and unwanted outcome this may result in frustration and eventually even anger, both examples of distress emotions. Distress emotions are undesirable when performing surgery, since they may impact available cognitive workload. Furthermore, they may result in negative communication, hampering OR-team empowerment and effective leadership. Both factors are known to negatively influence quality and safety in the OR.
The aim of the TedTrial is to investigate what setup best enables surgeons to interact with the endoscopic operating room setup during surgical procedures. As a result, disruptions of workflow, delays and errors may be reduced.
Project description: The TedCube© system is a plug-and-play device enabling wearable sensors to act as a wireless alternative for a regular computer mouse, therefore enabling direct hands-free and sterile control of the OR. The study is an observational trial with three different arms: intervention group 1) direct interaction by surgeon with OR environment using TedCube© and Myo™ armband, intervention group 2) direct interaction of surgeon with OR environment using Tedcube© and Plantronics© wireless microphone headset. The third arm is the control group using indirect interaction of surgeon with OR environment using third-person computer interaction. All study procedures will be performed in a medical data recorder (MDR) augmented OR. Surgeons in both intervention groups and the control group will wear a special t-shirt (Hexoskin©) equipped with multiple sensors registering biometric parameters known to reflect distress. The MDR derived output and biometric analysis using Hexoskin© is used to objectify communication patterns, workflow disruptions, errors and delays.
Preliminary results: Main endpoint of study is the number of workflow disruptions due to the operation of laparoscopic OR equipment. Secondary endpoints are error rate, delay, team communication, subjectively reported frustration and satisfaction with the system and objectively measured stress as symptom of frustration and anger as distress emotions.
All surgeons will be asked to complete a questionnaire post-operatively about experienced levels of frustration. In parallel, any system failure or not-executed command during control-procedures is registered. Satisfaction with the way of interaction is evaluated with a questionnaire after each surgical procedure. Subjectively reported parameters on frustration and satisfaction are compared between groups and correlated to objectively measured parameters.
Conclusions and future directions: System feasibility has been tested in a prior pilot study. It is anticipated that reduction of miscommunication, error and delay may result in a reduction of distress emotions and hence may improve surgical safety. The trial will start first quarter of 2019. During the conference preliminary results are expected. When positive results using the TedCube© system are obtained, the system can be implemented in daily care upon individual request.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98769
Program Number: ETP768
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster