Sharpening Surgical Effectiveness

Operation Room X (OR-X), an innovative facility nestled in Zurich, is pioneering change in surgical research, enhancing patient recovery experiences, and driving the future of healthcare with AI. As noted by Sebastiano Caprara, Head of the Digital Medicine Unit and the Health Data Repository project at the Balgrist University Hospital, the success of these endeavors hinges on real-time data analysis and a resilient network infrastructure.

I had the pleasure of chatting deeper with him about this exciting project. This blog is the result of that dialogue.

GY: What is Operating Room X?

SC: Operating Room X, or OR-X, is more than just a facility; it’s an open-access center for surgical research and training. It’s not only recognized by the Swiss government as part of Switzerland’s national critical research infrastructure, but it will also be open to international users.

OR-X combines a highly realistic surgical environment with innovative technology. We aim to provide researchers and developers with the optimal environment for data collection, prototype development, validation, and product demonstrations. Thanks to the integration in the University Hospital Balgrist ecosystem, the paramount exchange with the healthcare professionals is ensured, optimizing the path to clinical translation.

GY: What’s the vision?

SC: Our mission is to improve tomorrow’s surgery by creating and implementing innovative and disruptive technologies.

Most surgical research and education takes place in real operating rooms and practical skills are taught on patients. OR-X is an ideal environment for surgical training using real instruments, synthetic and real human specimens, and the latest surgical technologies, without compromising patient safety, but working on virtual objects using the latest technology.

GY: Why in Zurich?

SC: Balgrist University Hospital, which has created OR-X thanks to the support from the Balgrist Association and multiple partners, has a reputation for innovative orthopedic medicine, where innovation and clinical care come together. Regionally, we’re already part of a dynamic, collaborative ecosystem.

OR-X will create opportunities for researchers from different backgrounds to work together on multidisciplinary projects. We think the work done here will achieve groundbreaking results in surgical research and innovation.

OR-X is integrated within Zurich’s university landscape, including University Medicine Zurich, the Federal Institute of Technology Zurich, and the University Hospitals in Zurich.

Dr. Sebastiano Caprara, Head of the Digital Medicine Unit and the Health Data Repository project at the Balgrist University Hospital; and Dr. Garif Yalak Country Digital Transformation Lead Healthcare, Education & Governance, Cisco Switzerland.

GY: How did the project come about?

SC: My role at the Balgrist University Hospital is the Head of the Digital Medicine Unit. We’re the bridge between the hospital and its IT department and research and digital innovation. We’re on the lookout for digital projects that can add value to the clinical side of the organization; projects that can build our digital infrastructure and enable us to collaborate with new partners.

OR-X presented an ideal opportunity. It involves multiple partners, an upgraded network infrastructure, and has a direct impact on the quality of research.

GY: As you mentioned, there are many different stakeholders, and the OR-X includes a vast range of different technologies. How did you pull it all together?

SC: You’re right, there are all kinds of technology in OR-X, from power tools to 4K (Ultra High Definition) displays, and surgical instruments to augmented reality headsets. We needed to make sure the facility could incorporate today’s technology, and tomorrow’s. We also wanted real-time data processing, which requires the type of network we’ve never built.

Cisco has been invaluable. The in-kind and financial support by Cisco’s Country Digital Acceleration Program not only helped boost momentum but also provided us with a creative sandbox to design the technical concept to test ideas and develop a robust business case.

It was hugely encouraging that a company such as Cisco could see the potential of the project, and help us structure a project delivery plan. The OR-X project has created a unique collaboration opportunity for the Balgrist University Hospital with technology companies such as Cisco, this momentum will be orchestrated to address the development of the surgery of the future.

GY: What about the network specifics?

SC: The implementation of the Cisco Application Centric Infrastructure (ACI) in the data center network with Nexus components ensures efficient configuration, segmentation, and management. For wireless communication, OR-X relies on the latest generation of Cisco Access Points with the Wi-Fi 6E standard. Additionally, transmitter boxes are used to exchange and record audio and video.

OR-X can integrate any device and technology, regardless of whether it is a certified medical device or a brought-in prototype. The network to the HPC (High-Performance Computing) server supports a bandwidth of 100 GB/s, a workload capacity of 30TiB, and a throughput of 100,00 IOPS. As of today, we have 18GB of surgical data, and a flexible infrastructure allows us to be ready for the future demands of all the research projects and surgical courses in the facility.

Flexible ports with standard connections SDI, HDMI, XLR, Ethernet, 3.5mm Audio, and USB (2.0, 3.0) are being developed and will be integrated into the custom ceiling and wall installation.

GY: What are you hoping the impact of OR-X will be?

SC: The impact won’t be seen overnight; the benefits will be long-term. I think the quality of data, and the speed at which we can process and analyze multiple modalities of information, can be transformational. We can refine surgical techniques, test new methodologies, and be faster to deploy new technologies in the real clinical workflow. That can have a genuine impact on patient outcomes.

There is also an Artificial Intelligence (AI) element. OR-X can help train the next generation of surgical AI. AI is going to be huge. We – Switzerland and Zurich – can take ownership of our own AI models. We can become a center of AI expertise and Surgical Data Science.

I also think OR-X is an example of new approaches to medicine. Digital workflows cannot replace all aspects of healthcare, but it can be a transformational tool. I believe that the research conducted at OR-X has the potential to provide practical support to surgeons on a daily basis. We aim to demonstrate that the future of AI in healthcare is a collaborative environment where AI and surgeons can optimally work together, leveraging each other expertise and improving the quality of care and outcomes.

For those just starting a career in medicine, you might expect to see Augmented Reality, wireless connectivity, and live webcasts. However, the healthcare industry has not always been great at embracing the latest technological advancements. Yet, here, at OR-X, we can proudly showcase the best of a modern work environment. I think that younger generations will have very different expectations around technology and ongoing skills development. Places like OR-X will become more common.

GY: And at a personal level? Your role is a new one, what impact can a successful project have?

SC: Leading the digital medicine unit and the healthcare data repository project has been a remarkable journey. Digitalization in the healthcare sector is a great opportunity, but it must be approached strategically. When we demonstrate value to clinicians, we are confident that we have achieved success. More broadly, our vision for OR-X is to establish a framework for accelerating the delivery of surgical data science projects, optimizing their smooth integration in the real surgical environment. A successful OR-X should pave the way to help greenlight more new projects.