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AANS Neurosurgeon | Volume 28, Number 2, 2019


Soccer-to-Surgeon Paradigm: Why is there Better Technology at the World Cup than in the Operating Room?

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Technological advances often occur in technical arenas, such as the aerospace sector, before finding a role for personal use. By contrast, the medical sector is frequently an area of technological lag, with delays in implementation attributable to a range of factors, including:

  • Regulatory and safety concerns;
  • Cultural attitudes; and
  • Long-standing traditions within the profession.

Interestingly, professional athletics has become a hotbed for innovative testing and application of technologies that may ultimately have a significant impact in medicine. In fact, technology has become a critical component of major sports around the world — notably soccer, where a number of new applications are benefitting spectators and players alike.

Key areas of recent advancement

  • Player development and training;
  • Goal line technology;
  • Video-assisted replay (used in recent Women’s World Cup and Men’s Copa America debates); and
  • Numerous machine-learning applications ranging from concessions to video feeds and event security.

Figure 1: Athlete wearable monitoring performance technology. Images obtained from Playertek and Catapult systems.

Player Monitoring Technology: Are Doctors Next?

Perhaps the most notable technological innovations in soccer relevant to the neurosurgeon are the major advances seen in player monitoring. A wearable athletic tracking system was featured at this summer’s FIFA Women’s World Cup. These systems are comprised of dozens of sensors to track all aspects an athlete’s function, including speed, distance covered, level of fatigue, changes in direction, acceleration and many others, amounting to more than 1,000 data points per second per player, all available in real time. This immense volume of information provides players and coaches with instant insights into individual and team performance, responses to training and trends over time that may indicate meaningful improvements or deteriorations. These data are used to inform decisions related to training goals and ultimately execution during matches. Algorithms in these wearable athletic tracking systems can even identify periods where a player may be at increased risk of injury or approaching a threshold that may be associated with decline in performance.

The operating room, a neurosurgeon’s performance venue, is among the more technologically advanced niches within medicine, with an increasing number of operations becoming dependent on technological marvels like robot-assisted surgery, microscopes and endoscopes and pharmacologic agents that enhance intraoperative visualization of vascular or neoplastic pathology. In spite of this, little progress has been made to formally assess surgeons and trainees as the performance athletes they are. This is particularly surprising in light of the almost innumerable (and readily measurable) actions we think about and discuss during every case, ranging from number of instrument exchanges to smoothness of movements, timing of fatigue, trends in micro-error rates, physiologic tremor patterns and overall ergonomics efficiency.

The incorporation of performance monitoring into the operating room would not only provide invaluable, immediate, objective feedback for expert surgeons, but it would also inform surgical training, mentorship and competency assessment. Accruing information related to a trainee’s performance would provide regular, standardized information allowing progress to be tracked across both time and procedures. One can easily imagine the benefits of highlighting areas of a particular skill early in training as well as opportunities to seek out individualized, task-specific feedback from mentors at the first sign of a possible deficiency. Perhaps even more importantly, both present and future patient safety would be enhanced, as individuals requiring supplemental training could be identified prior to the critical portion of a particular operation. Similarly, monitoring systems incorporating the entire surgical suite would provide further feedback on team integration and efficiency, potentially providing key insights for improving the efficiency of activities such as room setup and turn-over, intraoperative instrumentation requests and anesthesia or medication delays, among others.

Technology has become an important factor in the professional soccer athlete’s performance, both in training and match play. Although at first glance it may seem improbable that neurosurgical performance would benefit from the application of technologies developed in professional sports, many aspects of neurosurgery have parallels to high-level athletics that warrant further consideration. As hospital systems, insurance companies and regulatory bodies continue to integrate flawed performance metrics throughout healthcare, there may be considerable value in neurosurgeons pioneering novel approaches to objective, meaningful and pertinent surgeon assessment. The operating room has the potential to simultaneously showcase human achievements both as technological masters and as performance athletes. Monitoring systems may offer an innovative solution to several pressing concerns, including trainee assessment and benchmarking, tracking of meaningful outcomes and improving efficiency within the OR. Rather than waiting for technological advances to go from bench-to-bedside, perhaps it’s time to trial a soccer-to-surgeon approach to innovation.   


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Saul Balagura, M.D.,Ph.D. | October 8, 2019 at 5:25 pm

As suggested, computer-monitoring of neurosurgeons performing surgery does appear to have many advantages; however, now one would benefit more than the medical-liability lawyers I presume would be monitoring the monitors.