Integration of Recent Technology in the Operation Theatre Enhancing Patient Outcomes

Valarmathy1, Gayathri2

1Nursing Supervisor, Kauvery Hospital, Tennur, Trichy

2Senior Scrub Nurse, Kauvery Hospital, Tennur, Trichy

Introduction

Operating rooms are a one of the most critical part of health care system where often complex surgical procedures are performed. Surgical procedure like Transplant surgeries, Thoracic surgeries, Complex cancer surgeries were once considered as high risk cases associated with very high mortality and morbidity. Expertise in surgical technique and the advancements in technology has helped us perform these complex procedures safely and achieve a good clinical outcome. This technological advancement includes advancements in administration of anesthesia and monitoring systems; technologies used during the surgical procedure and the monitoring systems used post operatively that help us make clinical decisions. In this article we have reviewed some of the technological advancements that are being used in kauvery hospital in the recent past that has helped us improve the surgical outcome.

Review

Some of the Technological advancement recently included into our surgical armamentarium that has made a major impact on clinical outcome are,

  • Activated clotting time machine (ACT)
  • Indocyanine dye (ICG) and near infra-red imaging system
  • Cryo probe
  • Video Bronchoscopy
  • Bipolar TURP Diathermy.

Activated clotting time machine (ACT):

  • The ACT machine measures the time it takes for a blood sample to clot after being exposed to a substance that activates the intrinsic pathway of coagulation. It’s crucial for monitoring heparin therapy during interventional cardiac and endovascular procedures where rapid clotting is undesirable like in dialysis , cardiac catheterization and angioplasty.
  • The machine uses a whole blood clotting assay to determine the ACT value which is the time in seconds it takes for the blood to clot.
  • There are different models including the Helena Actalyke mini II and the Medtronic ACT plus.

Applications:

  • Dialysis: Monitoring heparin during dialysis procedures.
  • Cardiac procedures: Monitoring heparin during cardiac catheterization, angiography and angioplasty.
  • Endovascular procedures in vascular surgery.
  • It helps to monitor the therapeutic level of anticoagulation bedside intra operatively, based on which the decision on dosing of anticoagulation can be made to reduced the risk of post operative bleed.

Clinical application:

  • To confirm the optimal level of anti-coagulation before Vascular stenting.
  • After procedure before sheath removal-ACT monitoring is useful
  • Persistent low ACT value for 10mg per hour helps to adjust the dose of therapeutic anti-coagulant level
  • Helps prevent bleeding manifestation by monitoring ACT value.

Indocyanine Green Dye and NIR Imaging:

  • ICG is a near infrared fluorescent dye used in oncological surgeries, gastrointestinal surgeries and plastic surgeries at various situations helping to perform more precise surgery and reduce complications.
  • After injecting the ICG dye using Karl strorz NIR imaging system, the fluorescent dye can be visualized to assess perfusion of the particular organ or in case of injection into the tissue the sentinel node of the particular organ can be visualized.
  • Based on which precise surgical procedure can be performed resulting in good oncological outcome and reduce complications.

ICG in sentinel node biopsy:

  • After conventional axillary dissection most patients develop lymphedema of arm which can be debilitating and leads to a poor quality of life. We use ICG guided sentinel node biopsy of axilla for patients with carcinoma breast, there by avoiding axillary dissection and helps to avoid lymphedema.
  • ICG guided sentinel node biopsy is also commonly performed in carcinoma endometrium where pelvic lymph node dissection can be avoided and thereby the risk of lower limb lymphedema.

ICG for perfusion before bowel anastomosis:

  • Conventionally before bowel anastomosis after bowel resection or stomach or esophageal resections the vascularity of the bowel ends before anastomosis is assessed by colour and bleeding form the edge which can be subjective, and many times will not be accurate.
  • When ICG is injected intravenously and where the bowel ends are assessed with NIR imaging it gives an objective way of assessing the perfusion in real time and the ends can be revised, avoiding the risk of catastrophic anastomotic leakage.

Clinical scenario:

During radical cystectomy for carcinoma urinary bladder and after tumour, before ileal conduit reconstruction the vascularity of the ileum was doubtful and, in that situation, ICG was used to confirm vascularity after which anastomosis was performed and the patient improved clinically and discharged home safely.

Cryo Probe:

  • It uses the principle of Rapid freeze – thaw cycles to destroy tissue or remove foreign body within the airways.
  • In conventional bronchoscopy biopsy large tissue samples are not possible because of crushing tissue and many times low yield in pathological results in debulking of large endobronchial tumours are also not possible because of difficulty in retrieval of tissues.
  • By using Cryoprobe larger tissues samples can be frozen by making it smaller and it also adheres to the probe so it can be retrieved without crushing, delivering better pathological yield. It is also useful for retrieving large foreign bodies and debulking of endobronchial tumours.
  • The procedure is performed under deep sedation or general anesthesia.
  • The cryoprobe is advanced through the airway with or without fluoroscopic
  • Compressed nitrous or carbon dioxide gas is used to rapidly freeze the tissue at the tip of the probe.
  • The frozen tissue is then retrieved.

Clinical scenario:

A middle-aged patient was planned for a diagnostic bronchoscope and during the procedure he developed bradycardia and desaturation due to bleeding and clot related airway obstruction. Conventionally Rigid bronchoscopy is used in this condition to remove the clots, but we used the Cryoprobe to clear the airway from right bronchus safely saving the life of the patient.

Bipolar Diathermy in Trans Urethral Resection of Prostate (TURP):

  • Conventionally during TURP using Monopolar diathermy irrigation is done using non-conductive irrigation fluids like sorbitol or glycine to current dispersion which can lead to TURP syndrome manifesting as Hyponatremia or Glycine toxicity leading to Nausea and cardio vascular effects.
  • The key advantage in using Bipolar diathermy during TURP is we can use normal saline (0.9% NaCl) as irrigation fluid reducing the above risks.
  • It also reduces risk of thermal damage at adjacent structures like obturator nerve, lower risk of capsular perforation and burns.
  • It provides a better homeostasis and reduced bleeding compared to conventional Monopolar diathermy based TURP.
  • It is also very useful in special conditions like patients having Pacemakers or implantable cardioverter -defibrillators.

Due to fewer complications and faster recovery, it is the preferred choice in modern urological practices.

Fiber Optic Flexible Video Bronchoscope:

  • Conventional flexible bronchoscope is one of the common instruments used in operation theatre for airway assessment, remove secretion, managing difficult intubation and removing foreign body. But the conventional scopy needs a light source, monitor system and most often heavy and have large diameters.
  • With the introduction of flexible fiber optic bronchoscope which is light weight and attached to a simple monitor, the scopy which can be moved around easily between OT rooms and also into post operative ward. It also comes with variable diameters, especially the smaller diameter scopes can be used to confirm position of double lumen endotracheal tube, Tracheostomy tube placement guidance and in pediatric patients without much difficulty.
  • It is also associated with low risk of Cross contamination, portable and very convenient.

 

Conclusion:

The evolution of surgical technology has greatly enhanced intraoperative precision, safety, and efficiency. Technology such as minimally invasive and robotic-assisted surgery have reduced postoperative morbidity and improved recovery. Real-time imaging, including ICG-guided fluorescence surgery, has expanded intraoperative visualization of vascularity and tumor margins. Single-use flexible bronchoscopes reduce cross-contamination risks and enhance procedural efficiency, particularly in pulmonary interventions.

Cryo probe applications have added value in diagnostic and therapeutic procedures, especially in airway procedures. Improved monitoring systems like ACT have helped prevent bleeding complications. These advancements collectively contribute to improved surgical outcomes, infection control, and patient satisfaction.

References

  • Integration in Operation Theater: Need of the Hour: Vijaydeep Siddharth,2 S Kant, 3 R Chandrashekhar, 4 Shakti Kumar Gupta
  • Trends in Evolving Technologies in the Operating Room of the Future Yael Kopelman 1,✉, Raymond J Lanzafame 2, Doron Kopelman 3
  • Futuristic Trends in Medical Sciences e-ISBN: 978-93-6252-038-8 IIP Series, Volume 3, Book 11, Part 4, Chapter 5 ADVANCEMENTS IN OPERATION THEATRE AND THE ROLE OF ARTIFICIAL INTELLIGENCE: A REVIEW ARTICLE

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