| The NSF-funded Engineering
Research Center for Computer-Integrated Surgical Systems and Technology,
headquartered at Johns Hopkins University (JHU), is collaborating with
the JHU Department of Surgery, the JHU School of Engineering, and the JHU
Applied Physics Laboratory to develop the Automated System for Surgical
Instrument and Sponge Tracking (ASSIST). This system automates the
error-prone manual counting procedure for surgical instruments and sponges
used during surgery to ensure that no surgical item is left inside a patient.
The immediate goal of the research is to develop a prototype that can serve
as proof-of-concept.
A dangerous medical error
that can occur during surgery is unintentionally leaving a surgical instrument
or sponge inside a patient. Commonly known as a “retained foreign
object,” this error can lead to inflammation, obstruction, perforation,
sepsis, and sometimes death. By some estimates, the incidence of retained
foreign objects may be as high as one in every 1500 surgeries. While the
problem is highly avoidable when stringent manual counting guidelines are
followed by operating room personnel, the problem nevertheless persists.
Moreover, manual counting requires nurses to focus on accurately counting
sponges, so they are unable to provide support for the surgeon for several
minutes during each sponge count. When miscounts occur, time spent
in the operating room is increased and an additional x-ray of the patient
is often required.
The ASSIST system increases
the safety of surgical procedures by utilizing Radio Frequency Identification
(RFID) technology to detect and identify each surgical item at various
stages during surgery, even when in the vicinity of metallic objects, soaked-in
body fluids, or inside a patient’s body. The working prototype of the ASSIST
system accounts for 100% of tagged sponges during surgery. This high level
of reliability is attained by RFID verification at a check-in station –
a process that requires just two seconds to verify the contents of a package
and register each tagged item in an inventory database. Detecting
used sponges is accomplished in under five seconds via multiple antennae
at a check-out kick-bucket (see figure). Preliminary tests in pig
models also show that missing sponges may be reliably detected in vivo.
The research team has presented
their ASSIST system research at conferences, and are in the process of
patenting the technology. Future endeavors aim to develop a system
for detecting every type of surgical instrument that could be retained
during surgical procedures. |
