In order to familiarize myself a bit more with the medical domain in preparation for the DISA project, I decided to attend the lectures of the “Medical Informatics” course given at the IT department at Uppsala University. The course comprises several study visits, the first one of which consisted in attending a live-streaming of an open-heart surgical intervention at the Uppsala University Hospital.
The live-streaming, which consisted of a high-quality video feed without sound, was orchestrated and commented by a clinician. Before and throughout the three hours that lasted the streaming session (which, unfortunately, ended before the end of the actual operation), the clinician provided us with some background on the ongoing procedure and explained to us how the main machinery and tools in use during the operation worked – showing us real-life examples of what these tools look like.
Throughout the streaming session, we had access to three different cameras located at different places in the operation theatre and capturing different angles of the intervention. As such, there were three different “views” available:
- the operation theater as a whole, where we could see who was present in the room and how the medical staff was standing around the patient;
- the “surgeon’s view”, where we could see the (opened) chest of the patient, as if standing above the patient’s body;
- the vital signs monitor.
The main view used during the streaming session was the second one, the “surgeon’s view”. However, we switched several times to the general, operation theatre view, though for shorter amounts of time.
The live-streamed intervention revolved around placing an artificial valve inside the patient’s heart. In order to do this, the clinicians needed to:
- Open the patient’s chest (including the chest bone);
- “Connecting” the patient to the heart-lung machine (described in more detail below);
- Stop the heart;
- Open the heart;
- Fix (with stitches) the artificial valve inside the heart;
- Close the heart (with stitches);
- Restart the heart (a defibrillation was needed);
- Make an ultrasound of the heart (in order to check that the valve was working and well-adjusted);
- Set up draining tubes (in order to allow for the bleeding within the heart cavity taking place during the next few hours after the operation to be drained out of the body without re-opening the chest);
- Close the patient’s chest – a last step that we were unfortunately unable to witness.
To me, one of the most fascinating aspects of the surgery was the heart-lung machine. Its first function is to cool the patient’s blood (and, ultimately, the patient’s body) in order to minimize the risk of brain damage during the operation (which can be quite long). Its second, and probably main, function is to act as a substitute to the patient’s heart and lungs so as to enable the heart to be stopped while maintaining the patient alive. The heart-lung machine is handled by a specially trained nurse (called “perfusionist” in Swedish and “perfusion technologist” in English), who disposed of a screen (in addition to the machine’s two interface screens) with a specific MetaVision layout fitted to her particular needs.
Beyond the perfusion technologist, sitting at the heart-lung machine situated at some distance from the foot of the patient’s bed, the medical team actively taking part in the operations was composed of a main surgeon, an assistant surgeon, an operating nurse (notably in charge of handing instruments to the surgeons), an assistant nurse (notably in charge of handing equipment and instruments to the operating nurse) as well as an anesthetist and an anesthetic nurse. Interestingly, the anesthetist and the anesthetic nurse, standing at the head of the patient’s bed, were separated from the surgeons by a sort of curtain placed vertically between the chest and the head of the patient.
I noted two further interesting facts from the streaming. First, all team members except for the main surgeon are replaced at some point during the operation in order to prevent the risk for distraction- and tiredness-induced errors. As such, good “transfers of duty” seem to be an essential part of such complex and long interventions. Second, the surgeons and operating nurse did not seem to use any screen as support, and it is the anesthetist who is responsible to look at the result of the ultrasound in order to assess whether the result of the operation is satisfactory.
In summary, this was a truly fascinating and instructive “class”, though I was a bit disappointed by not having any sound – I had hoped to be able to hear how the medical team communicates and to understand when and how they use the different screens and computerized tools they are surrounded with. Hopefully I will get the opportunity to attend another operation within the next few years in order to answer those questions!
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