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Safer and More Precise Surgery with the Aid of Digital Technology

- MRI system and surgical instruments are integrated with IoT.
Smart operating room realizes next-generation surgery -

A variety of data, such as MRI images obtained on site and the patient’s biological information are integrated and aggregated to be shown on the monitor.
How is a cutting-edge operating room where the surgeon and staff can share information on a real-time basis to make decisions and perform surgery?

Smart operating room

Operating room evolving to realize safer and more precise surgery

Dr. Yoshihiro Muragaki
Professor of Faculty of Advanced Techno-Surgery / Neurosurgery
Institute of Advanced BioMedical Engineering and Science
Tokyo Women’s Medical University

Composition of smart operating room (360° panoramic image)

In general, neurosurgery operating rooms have many cutting-edge medical devices and equipment. Surgeons and staff treat the patient while assessing a vast amount of information generated from these devices within a limited amount of time. However, the devices function independently and information on medical practice for treatment and the resulting patient’s biological information are only recorded individually and separately.

Tokyo Women’s Medical University and Hitachi, which installed an MRI system in the operating room in 2000, have continued research to achieve more accurate surgeries. The results have led to the development of the smart operating room to improve the accuracy and safety of surgery by sharing and understanding the progress of surgery and the patient’s condition aided by IoT, which coordinates a variety of medical devices and equipment centering on the MRI system.

According to Dr. Muragaki, the smart operating room continues to evolve further.

“Currently, the smart operating room is evolving into a next generation treatment room project called Smart Cyber Operating Theater (SCOT), based on the planning and support of AMED(*1). Clinical studies have already started at Hiroshima University Hospital(*2), Shinshu University Hospital(*3), and Tokyo Women’s Medical University Hospital. At Tokyo Women’s Medical University, among others, we are developing Hyper SCOT, the final goal of SCOT.

*1 AMED (Japan Agency for Medical Research and Development): Organization that supports research conducted by universities, research institutions and similar so that their achievements in research and development in the medical field, from basics to practical use, can be smoothly utilized. It also conducts research and development, and creates an environment for R&D.

*2 Hiroshima University Hospital: Affiliated hospital of National University Corporation Hiroshima University.

*3 Shinshu University Hospital: Affiliated hospital of National University Corporation Shinshu University.

Data accumulation and AI enable you to predict even a patient’s prognosis after surgery

Data sharing through the surgical strategy desk

The concept of SCOT is to realize precision medical treatment that can achieve a highly therapeutic effect with less risk with the integration of medical information. For example, Hyper SCOT uses IoT to integrate about 20 kinds of devices from different manufacturers. Information that has been recorded/laid out again is shown on a large display called the surgical strategy desk. Surgeons and staff can share information organized, displayed and saved in chronological order, such as surgical field videos, MRI images, biometric information monitor, use of electric scalpel and robots for the surgeon.

In addition, the large display can be installed wherever users want. At Tokyo Women’s Medical University, for example, it is located in the medical office. It allows them to receive advice from experienced surgeons’ broad perspective, while young doctors can watch actual surgeries performed by skilled surgeons.

Fewer residual tumors greatly influence the postoperative outcome

MRI images obtained during surgery

*Open MRI: MRI system that offers patients an open test space, instead of a conventional cylindrical space, focusing on patient-friendliness.

One reason for utilizing an MRI during surgery is to visualize a brain shift, which is a phenomenon where spinal fluid is lost after an incision during brain tumor surgery, resulting in a depressed brain deformation. This phenomenon causes a deviation in the brain from the preoperative position that can be seen on MRI images obtained before surgery. Taking MRI images during surgery allows surgery to be performed while confirming accurate information about the brain position.

Another role is to help determine the area to be resected. A brain tumor is an infiltrative disease in which the lesion gradually spreads and its characteristics include difficulty in recognizing boundaries between the tumor and normal tissue. Additionally, the brain has many areas essential for living, such as the motor area and speech area, which means that a brain injury can also cause complications. We have relied on surgeons’ experience and skills to determine the tumor area to be resected, but intraoperative MRI scans have visualized the exact area to be resected. While checking the MRI images, the surgeon determines the area and performs the resection.

“How much of the malignant tumor was resected greatly influences the subsequent course of the disease. Tokyo Women’s Medical University Hospital is one of the institutions involved in a large number of surgeries in Japan. For example, in terms of glioma surgery, which is said to be the most difficult brain tumor surgery, the 5-year survival rate for grade 3 (220 patients) was 74% (survey in 2016). I think this is a good result, as the general 5-year survival rate is 40 to 60%,” said Dr. Muragaki.

“SCOT can integrate and analyze all data related to surgery. SCOT is expected to provide data to support the decision-making of surgeons in charge, as well as improve treatment efficiency and safety. In the near future, it will be possible to use AI to support the optimal treatment policy and to predict a patient’s condition after surgery based on the accumulated data,” said Dr. Muragaki.

Accumulating surgical data and aiming to provide support as a new eye for surgeons
Akira Nakanishi
Senior Director
Surgical Treatment Solution Division
Healthcare Business Unit
Hitachi, Ltd.
Accumulating surgical data and aiming to provide support as a new eye for surgeons Akira Nakanishi Senior Director Surgical Treatment Solution Division Healthcare Business Unit Hitachi, Ltd.

Hitachi proposes OPERADA, a digital solution to support surgery that packages an open MRI system, surgical navigation system, video integration and distribution system, and its peripheral equipment installed in the operating room. What kind of support can be provided by integrating a variety of information in the operating room by using digital technology? Mr. Nakanishi from Surgical Treatment Solution Division of Hitachi, Ltd. discussed the prospect of digital solutions to support surgery as follows:

Usage example of OPERADA

Since installing the open MRI system in the neurosurgical operating room at Tokyo Women’s Medical University Hospital in 2000, Hitachi has conducted collaborative research with the hospital and accumulated know-how on surgical support with digital technology. The packaged digital solution to support surgery based on the results is OPERADA. It can provide services, such as support from introduction to practical use and maintenance during actual use.

It is not easy to use an MRI system in an operating room with limited space. Magnetic field leakage caused by MRI system may affect precision instruments and magnetic medical instruments.

Hitachi’s open MRI system is characterized by its use of permanent magnet. Because magnetic field leakage from the permanent magnet affects a smaller area, it can be installed even in an operating room with limited space, without influencing precision instruments and medical instruments. Packaging an operating room, including an MRI system, and enabling it to obtain MRI images in the operating room during surgery can generate several advantages, including the support of decisions during surgery as well as shortening interruption time during surgery with MR imaging and reducing the risk of infectious disease.

Using data to support surgeons’ decision-making under serious conditions

A major reason to propose OPERADA as a packaged solution is to digitize data on surgeries. Information on a surgery performed inside OPERADA is shared with doctors and staff in the operating room on a real-time basis, from the MRI images obtained during surgery, area of tumor resection, to the surgical knife angle at the time of resection, and is directly saved in the database.

For example, brain tumor surgery can last 5 to 10 hours. Under physically demanding conditions where delicate technique is required, surgeons are forced to make a variety of decisions on the area of resection. Nevertheless, they have only relied on their own experience and knowledge to make decisions. Hitachi intends to utilize digital technology to support surgeons to make such decisions under serious conditions. OPERADA has already built this foundation. Accumulating a number of cases and incorporating AI and IoT technologies into the accumulated database, we will provide information that plays the role of a new eye for surgeons and supports decision-making.

In addition, we are developing a concept for providing these technologies overseas. Asian countries, where the scale and environment of hospitals are similar to those in Japan, are attracting great interest in digital solutions to support surgery, which can be installed compactly and has achieved an excellent 5-year survival rate. To improve the survival rate after brain tumor surgery as much as possible, we aim to contribute to healthcare overseas using technologies from Japan and continue to evolve technologies.