Most of us would expect that a book dedicated “to all innovators and visionaries-past, present, and future” would provide provocative and challenging insights on its chosen topic. In large part, The Operating Room for the 21st Century, edited by Michael L.J. Apuzzo, MD, delivers on that expectation.
A Look at the Past and the Future
The first of three sections offers an interesting and entertaining trip through history, describing the evolution of the operating room from the introduction of anesthetics to modern-day concerns about the environmental impact on personnel working in the operating room.
The authors share lessons they learned from having been involved in the design of an “ideal” operating suite more than a decade ago, describe what a state-of-the-art current suite might be, and speculate on what the future holds. Some of the trends they mention are: progressive minimalism, based on molecular nanotechnology; molecular and quantum computing; intraoperative and advanced visualization (scanning probe microscopy, for example); robotics and bionics; and great advances in information access, accrual, analysis, and exchange.
Technologies That Hold Great Promise
In the second section, many of the leaders who in recent years have collaborated in the introduction of new methods for imaging, robotics, monitoring, communication, visualization, and data presentation offer their perspectives on the 21st century operating room. Others discuss the role of telemedicine and telesurgery, novel concepts in lighting, magnification, and image integration, and the future of noninvasive surgery.
An engineer provides his perspective on the future of robotics in the practice of neurosurgery: “We believe that controllable nanorobots can and will be built. If such devices can be injected…into the brain, would it be possible for them to detect the presence of a tumor and destroy it?” The answer seems to be that yes, such a scenario is likely to be realizable within 10 to 20 years.
Use of computer power and robotics is stressed as well. The authors of chapter nine put it very well: “The overwhelming amount of information now available to the neurosurgeon must be seamlessly integrated and coupled with intraoperative machinery capable of exchanging information in a fashion that assists neurosurgeons and their staff in delivering their skills faster, safer, and more accurately than that attainable by human cognition alone.” The authors go on to propose building a DOTELL (DO what the surgeon asks and TELL the surgeon what he or she needs to know). They describe the DOTELL as “a single, obedient assistant capable of integrating and processing all data input as well as coordinating the output to all necessary instrumentation.”
The New OR
The third section includes several chapters that discuss functional operating room design geared to accommodate these new technologies and to meet goals such as improved efficiency for the institution and its medical staff, as well as improved outcomes for patients. The first chapter in the section describes how integrated interventional facilities that combine imaging, passive image-guided localization, monitoring, modular design, redesign of the operative work space, monitored transport, and integration with intensive care facilities can go a long way to meet such goals.
Other chapters point out that the dramatic changes that might ensue also will require surgeons to change, in both attitude and skills. Surgeons will be partners with scientists and will possess a better understanding of the molecular and biological events that cause tumors and other conditions requiring treatment, and will use this information for patients’ benefit.
General Themes Emerge
Despite the broad scope of the book and the extensive speculation its topic has engendered, several subthemes run through much of the content. One subtheme relates to the economics of advanced technologies. Great progress is feasible, but many contributors to the book believe that any such progress will depend more on financial and political decisions than on technical bottlenecks. The most overriding subtheme is that neurosurgeons must embrace new technology for its positive impact on their practice.
Time invested in reading The Operating Room for the 21st Century is very well spent. Consider a statement from the authors of chapter 11: “Not only keeping up with the technology but also helping to push it forward and expand its possibilities are challenges to all of us who choose to practice in a field as dynamic, and as likely to benefit from improved technology, as ours. Should we choose to meet this challenge, and selectively and judiciously incorporate these sophisticated, powerful technologies into our operating rooms, there is a potential for great benefit to our patients.”
Cheryl A. Muszynski, MD, is a neurosurgeon at Children’s Hospital of Wisconsin and associate professor of neurosurgery at the Medical College of Wisconsin.