Traditional operating rooms are being transformed as new technologies and paradigms are being introduced into the clinical environment, and hospitals are putting substantial investment into updating the infrastructure of their ORs.

Anyone who has ever worked in an operating room (OR) knows how complicated they can be. Because they are used for all kinds of different surgical disciplines, from general surgery to orthopedic, cardiac, and others, the equipment and setup required to meet every need can become incredibly complex and varied. Lighting, tools, equipment, and how patients are oriented in the OR space should be changeable at a moment's notice to accommodate different kinds of surgical procedures.

Present-day ORs are inefficient and overcrowded, and the turnover between cases is often lengthy and variable. Patient data and images are not well-integrated or displayed in a timely fashion. This lack of integration of technology and information strains the system, resulting in further reductions in efficiency. This, in turn, potentially impacts patient safety and costs. The OR drives 60 percent of revenue in the average hospital. It is critical not just that avoidable human error be eliminated, but that heightened efficiency and quality of surgical care be driven more broadly. While technology has begun to enter the pre- and post-operative realms, little technology has been applied intraoperatively.

The traditional OR is being transformed as new technologies and paradigms are being introduced into the clinical environment. The good news is that hospitals are putting substantial investment into the physical infrastructure of their ORs. Having a modern OR is more critical than ever to create consistent quality across a variety of operative circumstances. Recently, some hospitals have upgraded their facilities with more sophisticated software for imaging and documentation, as well as hardware to enable robotic and minimally-invasive procedure. For instance, the state-of-the-art operating theatres at Apollo Hospitals and Yashoda Group of Hospitals are equipped with one of the most advanced robotic platform for minimally invasive surgery.

Technology has much to offer the surgical disciplines. There is an ongoing migration from invasive to less invasive and even noninvasive procedures. Minimally invasive surgery, image-guided procedures, robotic surgery, and tele-surgery continue to replace traditional surgical procedures. Improved design of ORs and more efficient logistics are being developed using a multidisciplinary approach with close collaboration among clinicians, technologists, scientists, and industry. New devices and technologies with improved attention to ergonomics will improve the surgeon–tool interface, improving the ability for the surgeon to safely complete the tasks required, thus transforming surgical care in the future.

An Impetus to Other Related Product Segments

The growing popularity of modern hybrid ORs is expected to prop up other related products, for instance the OT tables and lights market.

OT tables. In 2015, the Indian OT tables market was valued at 240 crore with sales at 3000 units. The quality of Indian tables has improved over the last couple of years, resulting in better unit realization, albeit cost of manufacturing has also increased. However, compared to imported tables, they remain competitive on pricing.

Cosmetic surgery and bariatric high-load-bearing tables continue to see an increase in demand. Other high-end tables for neurology and cardiac surgery are also gaining share.

The newly set up private hospitals have provided impetus to this market with major investments. For instance, Aster DM Healthcare, with six hospitals at Kochi, Calicut, Bangalore, Hyderabad, Pune, and Kolhapur expanded operations in 2015–2016. It invested 550 crore in Aster Medicity at Kochi, and 230 crore in its Greenfield hospital project at Bangalore. Medanta spread to tier-II cities, with new hospitals and operation theaters, as many as 30 in each facility at Lucknow, Indore, and Jabalpur. Government buying too was good in 2015, with new hospitals being set up across the country. Schmitz, Famed, and Surgdent had some success with bids invited by government hospitals.

Continued demand was exhibited as when customs duty was hiked by 7.3 percent for other items, OT tables continued to enjoy 22-percent duty.

Under the current scenario, this segment is poised to grow over the next few years, with Indian brands gaining traction.

OT lights. In 2015, the Indian OT lights market was valued at 185 crore with sales at 4300 units. This was an increase in the number of lights as compared to 2014, and yet a declining market in value terms. Overall unit prices have decreased, resulting in a smaller price differential between imported and Indian brands; the market is thus seeing a major increase in imported lights.

The imported lights have been classified as premium lights and regular ones. About 200 units of top-of-the-line lights, including camera systems are procured from Maquet, Steris, and Martin.

It is roughly estimated that the replacement market would account for about 33 percent of the total market. On a similar note, it is estimated that the government procurement, a discerning buyer, would account for
30 percent of the market.

Till last year, variable color temperature was a sought-after feature. However, now almost all lights are equipped with this feature. Color differentiation helps the surgeon to determine where and what to cut. Lower-color-temperature lights, which appear yellow, have more of their energy toward the red end of the color spectrum, overshadowing the blue and purple tones, producing a washed-out appearance. High color temperatures, which appear white or blue, are more balanced, mimicking the true white light of the noon-day sun, giving surgeons the subtle contrasts they need to distinguish one structure from another.

There has been a distinct shift from SD cameras to HD cameras.

Although LED lights have become the norm, there is a distinctly casual attitude observed in Indian vendors and buyers, both. Applications as for cardio, neuro, and cosmetic surgery could have 25 separate LEDs, as against the desired 100 separate LEDs.

The Indian lights continue to have a glare and shadow, which can contribute to the surgeon's eye fatigue. Surgeons' eyes need to see structures and look deep into cavities. In surgical sites, light is absorbed because tissues are dark and nonreflective. Quality surgical lighting delivers high-intensity lighting to the surgical site without glare or shadow, to assist surgeons to best see and interpret tissue, vessels, etc., with the highest degree of accuracy. Visualization is of critical importance to the surgeon and surgical team. Next to the surgeon's eyes, no other surgical tool is more important than lighting. Many surgeons will do two or three cases a day under high-intensity illumination. Highly intense but soft illumination without glare allows surgeons to get optimal light to the surgical site for long periods without associated eye fatigue.

Indian manufacturers do not spend money on R&D to assist heat sinking. Thermal management of the light must, by design, minimize beam temperature and radiant energy toward the surgical field. A combination of low-energy consumption together with proper heat dissipation guards against tissue desiccation, and just as importantly, provides optimal comfort for the surgeon and surgical team working under surgical lights.

Technology Transforms ORs

In recent years, the medical field has made astounding advances with the help of modern technology. These improvements have saved countless lives and made illnesses that could not be treated a mere few decades ago either curable or manageable. One of the areas of medicine that has most benefited from technological advancement is surgery. There are several advances that are changing the OR and making surgeries safer and more successful.

Surgical robots. One of the most exciting breakthroughs of recent years has been the incorporation of robots into surgical procedures. More and more ORs have begun to use robotic systems to execute delicate surgeries. These robots are still controlled by human surgeons, but with advances in their degree of stability and ability to work in very small spaces, the robots can perform operations with a higher degree of precision than human hands are capable of achieving. Fully automated surgical robots for simple tasks like suturing incisions have also begun to make their way into the surgical theater. Many even believe that fully-robotic surgeries may one day be possible, albeit under human supervision.

Electrosurgical technologies. Far from the comparatively primitive set of hand tools, stitches and sutures that surgeons once had access to, the modern OR contains a plethora of complex pieces of electrical equipment. Among these pieces of equipment are electrosurgical tool, which use electrical energy to perform tasks such as making incisions of cauterizing wounds. While these technologies are of considerable usefulness, they also produce hazardous by-products in the form of smoke. To facilitate their increased use in surgery, smoke evacuation technologies have also been developed. Smoke pencils and other smoke evacuation devices, in particular, are quickly becoming a standard tool in ORs because of their efficacy in eliminating this common environmental hazard.

Virtual reality surgical planning. One side of surgery that most people never get to see is the planning phase, in which surgeons and support staff determine the best methods and approaches for operations on particular patients. This process can be long and labor-intensive, but the use of virtual reality for visualization has improved considerably in the past couple of years. Advances in VR technology, coupled with patient imaging scans, allow surgeons to plan faster by lowering delay times prior to surgery and, in many cases, have become more successful than traditional methods by increasing efficiency of ORs.

Wearable technology. Technological advancements in recent years have given rise to the imminent possibility of pervasive wearable technology in surgery. Current optical head-mounted displays are lightweight with user-friendly interface and potential for hands-free control. Advances in powerful HD cameras capable of capturing precise anatomical detail have brought augmented reality to the OR.

Precision brain biopsy needles. One of the most delicate biopsy procedures has always been the brain biopsy. New so-called smart needles, however, are making this procedure much safer for patients and much easier for surgeons. These needles incorporate imaging technology that allows surgeons to directly see blood vessels and other tissue. When combined with software that is capable of recognizing blood vessels, these needles can substantially reduce the risk of accidental vessel damage during a brain biopsy. Similar technologies have been developed to reduce the risks associated with other internal procedures.

Surgical telementoring. Surgical telementoring is a more advanced telemedical application. Advances in technology and the wide availability of videoconferencing technology allowed telementoring to become cost effective and reliable. Current telecommunication systems allow for dramatically increased transmission speeds, permitting a considerably decreased time delay. In addition, the high resolution associated with modern high-definition cameras has enhanced the remote surgeon's ability to zoom and visualize small anatomic details. Interactive additions to telementoring systems such as telestration, laser pointing capabilities, or increased remote control of the visual field have played a role in enriching the teaching capabilities of the remote surgeon.

Modern workflow management software. Physicians who want things done a certain way have to work with an ever-changing cast of surgical team members. Installation of workflow software in modern OR allows doctors to set their preferences for how the operating theater is set up, what equipment they prefer to use, and how they perform a procedure. No longer relying on analog guides pre-operatively, each member of the team can access a digital guide to those preferences in real-time and with multimedia.

The digital workflow software manages the procedure from pre-op through to getting the patient back to the ward. Information can include everything from videos about assembling equipment to instructions about which personnel will perform what role and when.

Way Forward

Modern ORs will continue to expand as the technology advances and surgeon adoption of new improved systems and technologies increases. Companies developing surgical products should consider the impact of robotics on their marketplace and the compatibility of their devices with robotic procedures. Surgical robotics should not be seen as a threat to the next generation of surgical devices, since the use of next generation devices alongside robots opens up new possibilities for improved approaches. Traditional boundaries of the surgical space will blur. The rapid advance of computational and mechanical technologies will greatly benefit surgeons and the medical professionals who assist them in the OR. As these technologies continue to improve and become more accessible to hospitals, they have the potential to improve surgical performance and save many more lives. The current trends in patient management and developing surgical technologies are likely to continue to impact the OR environment and the OR of the future. The future is exciting, and technology has much to offer.

10 Diagnostic Imaging Trends for 2018



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