With countless components going into surgery, it comes as no surprise there are numerous ways to make surgery more efficient. Any element between signing up the patient for surgery and postoperative care can be optimized to reduce unproductive time and, most importantly, medical errors.

In the operating room, we often discuss efficiency when reviewing surgical tools, and for good reason: improvements in surgical instrumentation in the past decade have allowed surgeons to increase the precision of their surgeries with enhanced safety (Sidebar). Still, innovation in instrumentation is not the only means by which we can improve efficiency intraoperatively.

Software in surgical vitrectomy platforms and microscopes have grown more sophisticated, allowing for the ability to aggregate new data points previously unrealized. After data are synthesized into coherent and relevant reports, they can aid retina specialists in identifying areas of inefficiency, measuring improvement, and determining which efficiency metrics are linked to better patient outcomes. This article will discuss the possibilities of surgical software in relation to vitreoretinal surgical efficiency.

SPACE FOR PREOPERATIVE STREAMLINING

Surgeons must pull data from several sources when planning for surgery. Depending on clinical practice, ophthalmic imaging may be stored in different software and not necessarily integrated with the patient’s EMR. What’s more, some surgeons prefer tangible printouts of all the clinical data for each patient. All this aggregation is performed manually and is either not stored at all, compiled in surgical notebooks, or scanned into the EMR.

Electronic surgeon profiles that integrate all the preoperative data sources may obviate this manual labor. This cloud-based, surgeon-centric software will need to automatically communicate with the EMR system and imaging software to pull all the data seamlessly. When the surgeon posts the case for surgery, the software could auto-populate the procedure details based on surgeon preferences and prior cases, with the opportunity to add needed instrumentation. Ideally this would then be relayed to the surgical scheduler and/or surgery center for planning. The surgeon could then access the patient’s surgical plan any time prior to surgery either through a desktop or mobile application, with opportunities to add surgical notes and drawings. By automatically aggregating multiple preoperative sources, this software could reduce the number of applications the surgeon would need to access prior to surgery.

INSIGHTS INTO INTRAOPERATIVE METRICS AND VISUAL OUTCOMES

There are several ways in which a surgeon profile may be useful to retinal surgeons in the operating room. Surgeons are already familiar with having their profile on the vitrectomy machine to access their vitrectomy and foot pedal settings. Certain vitrectomy platforms take this a step further with a cloud-based surgeon profile to log cases and track intraoperative metrics. Storing intraoperative data could provide insights into particular surgical behaviors.

SUCCESS IN OTHER AREAS OF HEALTH CARE

Clinicians in the robotic surgery space have started tracking intraoperative data to improve surgical efficiency. The Da Vinci Surgical System (Intuitive Surgical), for example, is a surgical platform used by several surgical specialties, including gynecologic, urologic, and otolaryngologic specialties. Specifically, the system provides a software application called “My Intuitive,” which helps surgeons access case history and case times, and it provides a timeline of the surgical instruments used during the case and for how long.

Additionally, surgeons can track their case times and compare them to case times by other surgeons performing the same procedures. This gives the surgeon the ability to look back on a case and see how much time is spent on each surgical step to compare with colleagues, offering opportunities to adjust surgical approaches if safe to do so. Vitrectomy machines, particularly those that have cloud-based surgeon profiles, already have the capability of storing and uploading intraoperative metrics. These metrics include a variety of information, such as case time, infusion amount, time spent on each vitrectomy setting, laser settings, and number of laser spots, among others.

At the present time, it is unclear whether analyzing any of these metrics translates to improved surgical efficiency or patient outcomes in vitreoretinal surgery. For instance, a faster surgeon does not automatically equate to a better or more efficient surgeon. That said, there is significant potential in identifying surgical trends once enough data are captured and curated. We won’t know which elements of the surgery are relevant to real-world outcomes until we begin to examine the data. These intraoperative data could become more valuable if properly tied with both preoperative characteristics and postoperative outcomes via the cloud-based surgeon profiles. It is possible that, by automatically extracting objective, intraoperative data from each case and correlating it with patient outcomes, retina specialists may start to discern which surgical techniques are more effective and efficient. Also, researchers may wish to look at regional or global data on particular surgeries to understand broader trends in the field.

TYING IT ALL TOGETHER

Cloud-based surgeon profiles are just one way to begin linking the multiple steps of surgical care, and this likely will evolve in tandem with “smarter” vitrectomy machines and surgical microscopes. Further insights into intraoperative decision-making and simplified organization of surgical data may not only improve patient outcomes but also aid surgical educators in teaching novice surgeons. Industry leaders have recognized the value of data aggregation in ophthalmology and have worked with data-minded surgeons to craft software solutions that integrate with surgical platforms to produce reports relevant to everyday surgical practice. In the age of data aggregation from new sources, retina specialists have opportunities to embrace new technologies that allow us to collect data efficiently and accurately. This will complement the engineering innovations that will emerge in the coming years and will ultimately enable retina specialists to improve surgical care for their patients. RP

REFERENCES

1. Srivastava SK, Karthik N, Kolesnitchenko V, et al. The impact of gauge size, surgical volume and cutter probe design on surgical efficiency. Poster presented at: EURETINA annual meeting; September 5-9, 2019; Paris, France.
2. Karthik N, Kolesnitchenko V, Srivastava SK. Evaluating surgical efficiency measures of hypersonic vitrectomy cutters and guillotine cutters. Poster presented at: American Society of Retina Specialists annual meeting; July 26-30, 2019; Chicago, IL.