Another Way to Keep Brain-Surgery Patients Alive

One of the people you’ll meet in SuperFreakonomics is a remarkable physician at Washington Hospital Center (WHC) named Craig Feied. He has had a hand in many technological innovations that are pushing medicine, hard, into the future (or at least the present).

Check out, for instance, the video below. It was taken in an operating room at WHC, using software developed by the Institutes for Innovation in Medicine and the Medical Media Lab. As you’ll see, the surgeon, who is preparing to take a brain biopsy, is able to manipulate the MRI images without touching a computer screen or controls. It is risky enough to perform brain surgery; the idea is to not add the risk of bacterial infection by having a gowned-and-gloved surgeon have to manipulate a bacteria-ridden computer mouse or screen. As we’ve written before, hospital bacteria are a serious problem. (Here‘s a paper on this innovation, co-authored by Feied.)


hmmm...

I bet it would be cheaper to buy a cheap keyboard before surgery, sterilize it roughly (gamma/hot nitrogen/UV) and then throw it away after each surgery.

Seriously.

Michelle

It might be cheaper now (using discardable keyboards and mice), but not in the long run. Ultimately technology like this becomes cheaper as the components do. Using technology like this is a great idea, and probably also has many carry-overs to the fields of disability adaptive assistance.

aj

There is no such thing as anything cheap in the OR. Everything has to packaged, sterilized, tested, etc. You cannot buy any product, just sterilize it, and use it in the OR. An OR keyboard would cost $500, and be used only once. And would be incredibly easy to contaminate during use.

Brad

Yeh Michelle, you are so right about the economics, because the costly manned space missions ultimately produced a success like Tang. Remember, don't get the data in the most cost-effective manner, the long way around the block is always best!

In the OR...

The BrainLab and similar imaging devices triangulate the location of a probe in real space and display it in the context of preoperative imaging.

In cases where these devices are not used, it's common to cover a touchscreen with a sterile drape and use a sterile pointer to manipulate images. The latter is far less annoying than gesturing at a computer that probably takes an inordinate amount of effort to set up and is likely to misinterpret commands.

Tim

This is an interesting application of computer vision technology, but it doesn't seem particularly groundbreaking. Maybe I'm missing something but it looks like it just tracks obvious hand movements to flip through a few different screens.

I wrote some very simple face/object recognition software as an undergrad that could probably be adapted to do something similar (i.e. determine if the hand is moving left, right, up, down, etc. and act accordingly).

One of the research groups in our computer science department developed software allowing severely disabled people to move a pointer on the screen with head movements, and "click" by blinking their eyes. Another project was some software that could recognize subtle facial expressions or gestures. The only equipment needed was a $20 webcam.

Dave

I don't think operating rooms are particularly price-sensitive. The MRI machine that generated those images likely cost upwards of $3 million, so using this system vs. a keyboard was not really an economic calculation.

I think the idea is that surgery, and medicine in general, is quickly heading toward a model that integrates the patients and surgeons themselves seamlessly with robotics, therapeutics, and massive amounts of data and information (which will soon include artificial intelligence),

Tyler Coolbear

I think that this new technology is really cool because it decreases the risk of the patients brains being contamanated

Patricia

Bravo the less you touch in a hospital the better.

MT

Dave (#7) writes: "using this system vs. a keyboard was not really an economic calculation."

And people wonder why health care costs are increasing faster than inflation.

Why bother with a low-cost, low-tech effective solution (e.g. sterile drapes and sterile pointers) when we can throw all sorts of money down the drain on high-tech boondoggles such as this?

I think "comparative effectiveness" studies need to be done not only on competing medicines, but on medical devices, technologies, and procedures as well.

rishi

Are there sterile gloves for a mouse or a keyboard, that can be changed for each surgery?

Eric M. Jones

I agree with those who don't see the wonderfulness of this device. How about installing a human being to follow the surgeons instructions in the OR? It's not high-tech but it works well.

Does this surgeon want to get rid of assistants so he can do it all himself? Foolish use of resources at best. Megalomania at worst.

Kirilius

What is shown on the video is nice but how does that support the idea of keeping the patents?

The fact that a good technology is hidden under a patent only makes it more expensive and less accessible to humanity.

hmmm...

"There is no such thing as anything cheap in the OR. Everything has to packaged, sterilized, tested, etc. "

Sort of true, sort of not. Watch surgeries on science channel some times. Those are ordinary home depot power tools wrapped in plastic when they drill. They even reuse them.

A keyboard wrapped in plastic would work fine. This sort of flaunting of high tech is great for egos and publications, but doesn't necessarily give the best outcome per dollar. And it's never going to be cheap because of the number of expensive people needed to maintain it. Having this system means hiring someone at $100K/yr, guaranteed.

And don't get me started on all the marble foyers and piano lobbies in our hospital. Then we have a donation drive so we can "provide low cost care".

Martin O'Neill MD

As a retired CV surgeon, it is hard to imagine that any surgeon would manipulate a keyboard or mouse without at least changing his gloves in the middle of an operation. As has been pointed out there are many other alternatives which are both simple and inexpensive.
The more important reason for this note is that my son recently had neurosurgery at WHC-a cervical discectomy with the implantation of an artificial disc. Since he is a type 1 diabetic, I was quite concerned about infection involving the prosthesis so I stayed with him and closely followed his care.
What I found was of great concern to me. Now, while doing cardiac surgery over a 35 year period, the most important innovation in controlling surgical infections was keeping the blood sugar of the patient in the normal range with an IV infusion of insulin. This has been well noted and documented in the cardiac surgical literature. The importance of maintaining normal blood sugars has not made it to the neurosurgical dept at WHC. Despite my best efforts to influence my sons care, his blood sugars remained too high. My only recourse was to see that my son had an early discharge and manage his blood sugars at home. I find it ironic that a high tech and impractical solution is being suggested for WHC when there are other therapies of known utility, which are not being employed.
Fortunately, he has done well and had no infections.
MJO

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Q

Might be cheaper to have a tech in a control room reacting to physician verbal orders as in a Cath Lab