Dr. James Suliburk, Associate Professor of Surgery and Chief of Endocrine Surgery, Baylor College of Medicine
The COVID19 pandemic has refocused society’s attention towards the need for rapid and scalable research in healthcare. With medical research rising up as a priority, there is no better time to be involved in translational research and development to improve our delivery of care. Teams who are able to combine multi-disciplinary expertise are the ones who will make the greatest impact towards the improvement of care.
An extraordinary revolution in technology has occurred before our eyes, bringing with it improvements in the delivery of surgical care. With the advanced development of biomedical sensors, portability, and miniaturization of computing power and enhanced techniques of large data processing using machine learning or artificial intelligence-based analysis surgeons are now able to plan and prepare for high complexity operations better than ever. This allows procedures to be performed utilizing state-of-the-art minimally invasive techniques facilitating improved patient recovery and outcome.
Innovation in surgical care has occurred along many fronts including enhancements in robotic technology and endoscopic instrument design, high-fidelity imaging which can provide real-time navigation to the surgical field, development of percutaneous techniques to eliminate the need for invasive incisions, and real-time tissue diagnostics to provide a microscopic level of detail from tissue on the surgical field.
For example, I collaborated with scientists and engineers at the University of Texas at Austin and the University of Texas MD Anderson Cancer Center to test a handheld device, the MasSepcPen, that would rapidly and accurately identify cancerous tissue during surgery, delivering results in about 10 seconds. This is more than 150 times as fast as existing technology. This device gives surgeons precise diagnostic information about what tissue to cut or preserve as they are performing surgery, helping improve treatment and reduce the chances of cancer recurrence.
"An extraordinary revolution in technology has occurred before our eyes, bringing with it several improvements in the delivery of surgical care"
I worked with the scientists and engineers to design the MasSpec Pen in a way that is efficient and comfortable to use by surgeons during operations.
In addition, Dr. Bijan Najafi, professor and director of clinical research in the division of vascular surgery and endovascular therapy, recently published a paper on a test that uses a wrist-worn sensor to measure frailty in vascular surgery patients. Najafi, a biomedical engineer, is the director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at Baylor.
Frailty is a good indicator for which surgery patients may develop adverse outcomes following their procedure, but current frailty screenings are underutilized. Researchers at Baylor College of Medicine and University of Southern California found that a 20-second repetitive elbow flexion-extension test is a feasible tool in evaluating the risk of major adverse outcomes following vascular surgery procedures.
The test measures frailty using a wrist-worn sensor that quantifies weakness, slowness, rigidity and exhaustion. In their study, published this week in JAMA Network Open, researchers tested 152 vascular surgery patients one week prior to surgery and followed them one month post-surgery to document any adverse events. They found that baseline demographic information and clinical information were not good predictors of adverse events, but those who were identified as frail using the sensor-based 20-second test were 2.1 times more likely to have an adverse event following surgery, independent of the type of surgery, location of incision or surgery site (Baylor College of Medicine or University of Southern California). This data can be used to better inform surgeons and patients/families about the risk of adverse events so that they can take measures to reduce the risk of adverse events ahead of surgery. Future research will be done to determine whether the 20-second test can be used to predict adverse events in other types of procedures outside of vascular surgery.
Historically, good surgical outcomes were felt to come from high-quality surgeons who had excellent surgical technique and judgment. We now know that a good surgical outcome is the result of an expertly coordinated team effort. Technology is indeed part of that team and through the digital revolution, we can now scale that technology to put it into use in a variety of settings providing the potential to improve outcomes for all patients undergoing surgery.
Collaboration has become the new competition and centers which provide the organizational infrastructure to foster the intellectual mixing of engineering, computer science, molecular biology, chemistry, and materials science alongside anesthesia, nursing and surgery will be well-positioned to innovate and design treatments and surgical interventions to help patients in the future.