Step-By-Step Surgery

Despite the digitization of the healthcare world, the OR has typically remained devoid of software tools or trendy new apps.

So, instead of determining which instruments a surgeon prefers and in what order, staff often lay more than they need and hope for the best. Instead of having information about the patient at their fingertips, nurses wait to get briefed by the attending surgeon. And instead of collecting data about what happened during the procedure, patients rely on ad hoc recollections by the surgeon.

A new startup called ExplORer Surgical is hoping to change all that.

Launched in 2015, the software company is the brainchild of Alexander Langerman, MD, an ear, nose, and throat surgeon at Vanderbilt University who also directed the Operative Performance Research Institute at the University of Chicago.

Langerman came up with the idea for the software — which gives users step-by-step instructions and equipment cues for every procedure — after encountering widespread waste in ORs.

“I traveled to hospitals around the country to watch how [other surgeons] did things,” Langerman explains. “I learned that ORs had universal inefficiencies around team coordination and the rotation of team members. And there’s no established mechanism to keep them on the same page and answer the question: How do we respond if something happens?”

Langerman says that in ORs where the staff has worked together for years and everyone is familiar with one another, procedures run more smoothly. But that’s not the typical reality.

To help get everyone in the OR working more efficiently, Langerman came up with the idea of software that staff could use to track the whole procedure — from scalpel down to stitch-up.

(Image credit: ExplORer Surgical)

Launching The App

The commercial version of the software application launched in 2016, after years of research and technology development, and is now available to the market.

In 2013, Langerman linked up with Jennifer Fried, a business savvy former consultant with experience as a healthcare venture capitalist. Along with an MBA student, the team then raised over $300,000 in grants from the University of Chicago and the National Science Foundation to build early prototypes of the app and to test it in live operating rooms. In 2016, Fried left her job as a venture capitalist and raised $1 million in private funding to lead business efforts full-time, grow the team, and take the product to market. Langerman and Fried have since implemented the software in four academic hospitals and one community hospital across multiple surgical specialties.

Langerman says one of the ExplOrer Surgical’s main selling points is that their app can help save money by reducing waste. Inefficiencies can be costly, especially in the OR, which Langerman says is one of the most expensive parts of the hospital.

“We can help prevent the opening of unused items,” Langerman says. “All told there’s about $1.5 trillion lost in wasted supplies in the U.S., including OR waste. One study found that the average costs of unused supplies was about $653 per procedure. It adds up to about $2.9 million a year in one surgical department.”

In one study conducted by ExplORer Surgical, the company found that the app reduced waste in the OR by 95 percent.

The software takes OR staff through all the steps of the procedure. (Image credit: ExplORer Surgical)

How It Works

The ExplORer Surgical software can be used on any device — from a computer to a smart phone — that the staff feels the most comfortable with.

The software spells out all of the needed steps and tools of the operation and then moves in tandem with everyone’s individual device as the surgery advances.

Langerman is personally most excited about the feature that allows him to log which tools he needs for an operation and then hand it over to a nurse. This frees him up to focus on his job as a surgeon without getting interrupted by managing the OR.

When looking at studies on “cognitive disruption,” Langerman said he found research showing that it can take 20 minutes to get back on task after being distracted.

“We believe that by preventing disruptions, we’ll allow surgeons to be more focused on the patient and the operation, and maybe even enjoy the operating room a little better,” he says.

(Image credit: ExplORer Surgical)

Unlocking A Treasure Trove of Data

Now that ExplORer Surgical’s app has gone live and is being used in ORs, Langerman said the company has stumbled upon a potentially profitable side effect of the software: a wealth of data about how surgeries are performed.

For example, Langerman says the team is looking at data about how long every step takes in certain geriatric surgeries that could help surgeons know if a patient is at a greater risk for complications or challenges.

“A normally paced procedure that suddenly slows way down when you get into the crux of it might be an indicator of a case that will have postoperative complications,” Langerman explains.

In other words, data about what happened in certain operations could help give surgeons better predictive tools for patients.

So far, Langerman says that the company isn’t selling this kind of data — but it could become a part of its business model down the road.

“Currently we’re focused on getting in the hands of more surgeons and reducing waste,” he says.

But on a big-picture level, Langerman says the software has the potential to have widespread and even global implications.

“We see this as an opportunity to have something in the hands of surgical teams that not only helps them become better, but on a grander scale, helps make surgery better.”