Surgical Suite Research Articles

Detection and isolation of brain tumors in cancer patients using neural network techniques in MRI images

MRI imaging primarily focuses on the soft tissues of the human body, typically performed prior to a patient's transfer to the surgical suite for a medical procedure. However, utilizing MRI images for tumor diagnosis is a time-consuming process. To address these challenges, a new method for automatic brain tumor diagnosis was developed, employing a combination of image segmentation, feature extraction, and classification techniques to isolate the specific region of interest in an MRI image corresponding to a brain tumor. The proposed method in this study comprises five distinct steps. Firstly, image pre-processing is conducted, utilizing various filters to enhance image quality. Subsequently, image thresholding is applied to facilitate segmentation. Following segmentation, feature extraction is performed, analyzing morphological and structural properties of the images. Then, feature selection is carried out using principal component analysis (PCA). Finally, classification is performed using an artificial neural network (ANN). In total, 74 unique features were extracted from each image, resulting in a dataset of 144 observations. Principal component analysis was employed to select the top 8 most effective features. Artificial Neural Networks (ANNs) leverage comprehensive data and selective knowledge. Consequently, the proposed approach was evaluated and compared with alternative methods, resulting in significant improvements in precision, accuracy, and F1 score. The proposed method demonstrated notable increases in accuracy, with improvements of 99.3%, 97.3%, and 98.5% in accuracy, Sensitivity and F1 score. These findings highlight the efficiency of this approach in accurately segmenting and classifying MRI images.

Limericks for Myocardial Recovery and Regeneration.

Limericks are an easy, casual, and entertaining way to have fun with the English language. Creating them can be an engaging pastime to assist in memorizing important anatomic relationships necessary for being an interventional cardiologist or simply an intellectual exercise that provides respite after a hectic day in the cardiac catheterization laboratory, surgical suite, outpatient clinic, or intensive care unit. Interest in this form of poetry often dates back to when we, as children, were taught the simplistic rhyming pattern of a traditional limerick or learned one during adolescence. As we age, our limericks often became more humorous, personal, and bawdy. That evolution is the beauty of this poetic form. For this edition of Poet's Pen, we invited Dr. Marshall S. Flam, a noted dabbler in the limerick world, to pen "Limericks for Myocardial Recovery and Regeneration" to accompany the theme of this issue.

Pancreatic Pseudocyst in A Child: About A Case, in the Hospital of the District of the Commune IV of Bamako

The pseudocyst of the pancreas is rarely diagnosed and treated in our hospital, we report this first case of a 10-year-old child with no particular medical-surgical history with a history of impact trauma from the handlebars of his bicycle during a walk in the village. A week later, progressive abdominal pain appeared associated with an increase in the volume of the abdomen. A month after the trauma the signs of gastric and biliary compression settled type of nausea, postprandial vomiting, weight loss, anorexia, jaundice. After clinical, biological and radiological examinations, we retained the diagnosis of a pseudo cyst of the symptomatic pancreas. The treatment consisted in making an internal surgical bypass Kystogastric. Cytobacteriological examination of the collection of the contents of the pancreatic cyst revealed a multiresistant gram-negative bacterium «Achromobacter dentrificans», antibiotic therapy adapted to the germs was administered. The surgical suites were simple.

Abstract B001: Impedance based biomarker for “smart ROSE” pancreatic cancer detection: Initial results from an ongoing clinical trial with nsCanary

Abstract Pancreatic cancer (PC) accounts for half a million new cases and 4.7% of cancer-related deaths globally in 2020. Endoscopic ultrasound (EUS) guided fine needle biopsies (FNB) are the current standard for confirming suspicious lesions, although their diagnostic accuracy remains below 70% with a non-diagnostic rate of the first procedure as high as 40%. Rapid on-site evaluation (ROSE) was introduced to improve diagnostic accuracy via on-site pathology assessment. However, ROSE availability is often limited due to resource constraints. NovaScan has developed the nsCanary, a ”smart ROSE” device, which uses a bioimpedance spectroscopy biomarker based on the Cole Relaxation Frequency (CRF) to detect cancer in biopsy samples in real-time and on-site. The aim of this study is to present initial results from a clinical trial that validates the nsCanary’s ability to detect PC in biopsy samples. Data were collected with the nsCanary device in an IRB approved double-blind study including a cohort of 44 patients (20 males, 24 females; average age of 63 years; 66% White, 22% African American, 12% Hispanic) undergoing EUS procedures with FNB sampling for suspected PC at the Texas International Endoscopy Center in Houston, TX. The nsCanary is a small desktop instrument that performs spectral bioimpedance analysis to extract the CRF based biomarker in less than 30 seconds without altering the biopsied tissue. A touch panel user interface allows for the user to input information and start the measurement. Obtained biopsy samples were flushed in a disposable strainer in order to drain any excess fluid. A circular disposable electrode, consisting of an interdigitated array with alternating polarities was placed in contact with the sample to perform measurements of complex bioimpedance in the 1 kHz - 10 MHz frequency range. The design of the electrode allows it to sense the signal from samples as small as FNB cores. Samples with CRF value below 1 MHz for every scan were considered noncancerous. Samples with at least one CRF value above 1MHz or absence of CRF reading (i.e., CRF out of range) were considered cancerous. PC assessment provided by nsCanary was validated against histopathology outcomes for each biopsy sample. Pathology results indicated that out of the cancerous lesions observed, there were 7 cases of pancreatic adenocarcinoma, 2 cases of invasive adenocarcinoma, 1 case of ductal adenocarcinoma, and 1 case of metastatic renal cell carcinoma. Findings showed a sensitivity of 81.8%, specificity of 84.8%, PPV of 64.3% and NPV of 93.3% for a total of n=44 patients. The device is low cost, portable, and can be used in the surgical suite without interfering with the standard workflow or affecting the sample for following pathological assessment. The implementation of the nsCanary device into the clinic will adjunctively support the decision-making process by providing immediate feedback on cancer detection and sample adequacy. This will enable endoscopists to diagnose PC on the first biopsy procedure, ultimately facilitating prompt treatment of patients. Citation Format: Federica Dibennardo, Martina Guidetti, Onur Fidaner, Daniel S. Gehrke, Donato Ceres, Margaret C. John, Constantine H. Bovalis, Isaac Raijman, Les Bogdanowicz. Impedance based biomarker for “smart ROSE” pancreatic cancer detection: Initial results from an ongoing clinical trial with nsCanary [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B001.

Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project

Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021–March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.

Guidelines in Practice: Design and Maintenance of the Surgical Suite.

Hospital construction and renovation is an ongoing occurrence in the health care setting. The recently updated AORN "Guideline for design and maintenance of the surgical suite" provides perioperative nurses with information on the layout design and maintenance of perioperative spaces; safety measures to use during construction and renovation; monitoring and maintenance of the heating, ventilation, and air conditioning; and how to respond to unintended utility failures. This article provides an overview of the guideline and discusses recommendations for the interdisciplinary team, planning and designing the surgical suite, construction-related environmental contamination, ORs, and OR maintenance. It also includes a scenario describing specific concerns associated with the construction of an additional OR. Perioperative nurses should review the guideline in its entirety and apply the recommendations when participating in perioperative construction and renovation projects.

Estimating the carbon emissions from a resource-limited surgical suite in Papua New Guinea: The climate change potential.

The upscale of surgical service delivery in low to middle income countries will increase health sector greenhouse gas emissions globally. Understanding surgical greenhouse gas emissions from surgical suite activities can direct decarbonization strategies and achieve local, and global climate change objectives. A prospective surgical suite carbon foot print study was conducted at the Alotau Provincial Hospital from the 28th March 2022 to the 28th of May 2022. The total carbon emission for the surgical suite in APH over the study period was 2,665.8 kgCO2e. The average carbon emission per surgical case within the boundary of the surgical suite was 8.4 kgCO2e. Scope one emissions (anaesthetic gases) accounted for 44.7% (1171.3 kgCO2e) of all carbon emissions. If no action is taken, carbon emissions in the western pacific region will continue to increase from surgical suites. Therefore, proactive efforts to reduce greenhouse gas emissions must be prioritized.

External validation of the M-CARS score for mortality risk in coronary intensive care units

Abstract Background The M-CARS (Mayo-CICU Admission Risk Score) score was recently developed and validated for coronary intensive care units (CICU) for the estimation of mortality risk at admission. Most existing scores were developed and validated for general intensive care unit patients with a distinct profile, and need a myriad of both clinical and laboratory data from the first 24 hours after admission and constant updates. The M-CARS is based on only 7 data points collected at admission: the presence of cardiac arrest, respiratory failure and/or any type of shock, the Branden score, blood urea nitrogen > 23mg/dL, anion gap > 14 and red blood cell distribution width (RDW) > 14.3. The scale varies from zero to 10 points and three risk categories were described: low (0 to 2 points), intermediate (from 2 to 4), and high (>4 points). Purpose To provide external validation of the M-CARS score. Methods Retrospective cohort of patients admitted to two CICUs in the same academic hospital. One is linked to the emergency ward and mainly admits acute cardiac care patients. The second one is linked to the cardiology clinical and surgical wards, the outpatient care center, and the interventional and surgical suites. Demographic, clinical, and laboratory data were collected during admission to obtain the M-CARS score. Our primary endpoint was death within 30 days of admission to CICU. Readmissions for the same time interval were also evaluated. Statistical analysis used parametric and non-parametric tests as needed to describe the data and for comparison between groups. P-value < 5% was established as significant. Results A total of 408 consecutive patients were included: 60% men, 81% white and the median age was 64 years. The mean stay duration was 6±6 days. The total mortality at 30 days was 9.8% (40 patients), with no age (62.4±14,6years - alive vs 66.4 ± 17.0years - dead; p=0.10), gender (p=0.31), and CICU location (10.9%- CICU linked to the emergency ward vs 8.3% - CICU linked to cardiology wards; p=0.38) differences. The M-CARS score was obtained in 363 patients, and the lack of blood chloride levels needed for anion gap calculation was the reason for the 45 patients not being included in this analysis. Within this group, 38 (10.5%) patients died. The M-CARS score was significantly higher in the group of patients who died within 30 days (4.4±2.6 vs 2.0±1,6; p<0.0001). Considering the risk categories, mortality was significantly distinct between all mortality risk categories (Low = 3.4%, Intermediate = 10.2%, and High =40.5%; p<0.0001, and P<0.0001 for all Bonferroni post-tests). Readmissions with 30 days had similar M-CARS score (P=0.64).CONCLUSIONS: The M-CARS score was adequate in identifying the mortality risk category in CICUs from outside the country it was developed. It could not predict readmissions. It may be incorporated into the admission proceedings and be used to guide medical care and instruct relatives about the risks of the patient.

Abstract 18890: Outcomes for Patients With STEMI vs NTEMI in COVID-19: A Contemporary National Insight

Introduction: The COVID-19 pandemic posed significant challenges to cardiovascular care. Previous studies have shown that patients with NSTEMI type II have worse outcomes than those with NSTEMI type I or STEMI. In 2020, STEMI incidence was disproportionately high compared to NSTEMI. Since there are no ICD 10 codes to differentiate NSTEMI types I and II, we sought to compare patients with COVID-19 admitted for STEMI vs NSTEMI using the NIS database. Hypothesis: Given the initial pandemic response, we expect outcomes for STEMI to be worse than NSTEMI in COVID-19 patients. Methods: A retrospective analysis was completed utilizing the National Inpatient Sample (2020). Patients were identified based on ICD-10 codes corresponding to those with COVID-19 and STEMI vs. patients with COVID-19 and NSTEMI. Primary outcomes were mortality, length of stay (LOS) and total hospital charge (TOTHC). Secondary outcomes were analyzed using multivariate analysis. Results: 1,685,745 patients had COVID-19, of which 39,246 had a STEMI, and 5,818 had a NSTEMI. Average age was 62.. When comparing COVID-19, patients with STEMI vs. NSTEMI, the mortality odds ratio (OR) was 2.5 (95% CI 2.28-3.75, p < 0.001) and LOS was -1.27 days. Primary and secondary outcomes are described in Table 1. Conclusions: STEMI was significantly associated with increased mortality in the setting of COVID-19. This may explain the lower LOS and lack of difference in TOTHC between the two groups. This may be related to the initial pandemic response of strict isolation protocols with closing of catheterization and surgical suites. Patients with STEMI and COVID-19 most likely were medically managed or diagnosed late leading to increased mortality. Intubation, cardiogenic shock and cardiac arrest were all significantly associated with increased mortality, LOS and TOTHC. Future studies may show reversal of these outcomes given a return to standard operations with respect to cardiac catheterization and surgical intervention.

A-390 Implementation of the New GEM Hemochron 100 Point-of-care Coagulation System for Heparin Monitoring During Cardiopulmonary Bypass Procedures

Abstract Background The Ohio State University Wexner Medical Center has monitored the administration of unfractionated heparin (UFH) during cardiopulmonary bypass (CPB) procedures with the activated coagulation time test, using the Hemochron Signature Elite (Elite) instrument (Werfen) with the ACT+ cartridge. An assessment was conducted to evaluate the performance of the newest Hemochron model, the GEM Hemochron 100 (Werfen), to upgrade current instruments. Methods Precision and Methods Comparison studies were conducted with nine GEM Hemochron 100 systems. Each GEM Hemochron 100 instrument was analyzed with two levels of directCHECK liquid quality control, five replicates, over four days. The Method Comparison study compared the results from one Elite system's result, against the average result reported from one to three GEM Hemochron 100 systems. This methodology was repeated in multiple groups, using different Elite and GEM Hemochron 100 systems. All tests were performed with the ACT+ assay, which is sensitive to UFH from 1–6 IU/mL. Results Precision: All nine GEM Hemochron 100 instruments yielded: Level 1 CV ≤ 9.5%, and Level 2 CV ≤ 2.5%. Method Comparison: Total datasets 66; range 94–902 seconds; estimated bias at the 300, 420, and 480 second ACT+ clinical decision points were 1.6, 3.2, 4.1 seconds respectively; correlation (r) 0.97; slope 1.01; average CV across GEM Hemochron 100 systems 6.0%. Conclusion The performance of the new GEM Hemochron 100 system demonstrated acceptable agreement compared to the Elite system during CPB, maintaining existing ACT+ procedural target times. Results of system performance were consistent with the manufacturer's package insert, as well as previously published data. Based on the clinical performance, GEM Hemochron 100 systems have been implemented into our surgical suites.

Current Practice Trends in Knee Arthroplasty in India Among ISHKS Members: ISHKS Annual Meeting 2019.

To assess the current practice trends in knee arthroplasty in Indiaamong ISHKS members. Literature review on 12 areas of key interest in total knee arthroplasty was conducted. Twenty-eight questions pertaining to these key areas in total knee arthroplasty surgery were presented to the delegates for a physical voting with audience response system (ARS) at ISHKS meeting, Bangalore, 2019. The members who could not attend the meeting voted by an online monkey survey. All questions were given three responses: a. Agree, b. Disagree, and c. Abstain. 310 delegates participated and 295 voted in the physical meeting and 110 voted online. Consensus was reached for 28 statements representing five domains on the best practices. Overall, 92% of statements reached unanimous or strong consensus. The statements that achieved strong majority (> 90%) were the factors on pre-operative skin preparations, administration of antibiotics 30min prior skin incision, and current practices of bilateral TKR. Furthermore, there was strong consensus approval on the role of aspirin for prophylaxis of DVT, lack of benefit on use of drain, considerations for pre-emptive analgesia, and neuraxial anesthesia. Finally, there were disparate views and weak consensus on use of laminar airflow theaters and use of surgical space suits, length of antibiotic administration postoperatively, and linking of DVT with PE and death. This study gives the surgeon practice preferences in knee arthroplasty in India and assists in clinical decision-making for all healthcare professionals.

Breast tissue analysis using a clinically compatible combined time-resolved fluorescence and diffuse reflectance (TRF-DR) system.

This work aims to develop a clinically compatible system that can perform breast tissue analysis in a more time efficient process than conventional histopathological assessment. The potential for such a system to be used in vivo in the operating room or surgical suite to improve patient outcome is investigated. In this work, 80 matched pairs of invasive ductal carcinoma and adjacent normal breast tissue were measured in a combined time-resolved fluorescence and diffuse reflectance (DA) system. Following measurement, the fluorescence intensity of collagen and flavin adenine dinucleotide (FAD); the fluorescence lifetime of collagen, nicotinamide adenine dinucleotide (NADH), and FAD; the DA; absorption coefficient; and reduced scattering coefficient were extracted. Samples then underwent histological processing and H&E staining to classify composition as tumor, fibroglandular, and/or adipose tissue. Statistically significant differences in the collagen and FAD fluorescence intensity, collagen and FAD fluorescence lifetime, DA, and scattering coefficient were found between each tissue group. The NADH fluorescence lifetime and absorption coefficient were statistically different between the tumor and fibroglandular groups, and the tumor and adipose groups. While many breast tissue analysis studies label fibroglandular and adipose together as "normal" breast tissue, this work indicates that some differences between tumor and fibroglandular tissue are not the same as differences between tumor and adipose tissue. Observations of the reduced scatter coefficient may also indicate further classification to include fibro-adipose may be necessary. Future work would benefit from the additional tissue classification. With observable differences in optical parameters between the three tissue types, this system shows promise as a breast analysis tool in a clinical setting. With further work involving samples of mixed composition, this combined system could potentially be used intraoperatively for rapid margin assessment.

Hybrid Operating Room Suites


 This Horizon Scan summarizes information related to hybrid operating room suites for surgical procedures beyond thoracic surgery, neurosurgery, and emergency vascular surgery, including a list of some of the hybrid operating rooms in Canada, a description of some related published studies, and a summary of some important considerations, such as patient and provider experiences and facility planning.
 Hybrid operating rooms combine medical imaging and conventional surgical suites into 1 treatment space and can be used for both minimally invasive and open surgical procedures. They allow surgeons to perform imaging, biopsy, diagnosis, and surgery all in the same room and remove the need to move a patient between an imaging suite and an operating room.
 Evidence suggests that the use of hybrid operating rooms can result in improved patient outcomes and decreased procedure times. Radiation safety for both providers and patients is an important consideration when implementing the use of hybrid operating rooms.
 The use of hybrid operating rooms is well established for thoracic surgery, neurosurgery, and emergency vascular surgery; and is emerging for surgeries such as gynecological, urological, and orthopedic.

Guideline for Design and Maintenance of the Surgical Suite.

AORN JournalVolume 117, Issue 6 p. P4-P6 Guideline First Look Guideline for Design and Maintenance of the Surgical Suite Lisa Croke, Lisa Croke Managing EditorSearch for more papers by this author Lisa Croke, Lisa Croke Managing EditorSearch for more papers by this author First published: 26 May 2023 https://doi.org/10.1002/aorn.13942Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume117, Issue6Special Focus Issue: AORN Post‐ConferenceJune 2023Pages P4-P6 RelatedInformation

A Reflection on Nursing in Neurosurgery

Around the world in many countries, May is “Nurses Month” and May 12, International Nurses Day (Florence Nightingale's birthday). Thinking about this a few months ago led me to think how little we spend in the pages of this journal and others, on the value of nursing in neurosurgery. The cover this month highlights the partnership of nurses and neurosurgeons from years past and the present. My dear friend Dan Leksell shared this image of his father Lars Leksell performing air ventriculography, while his nurse assists with the imaging. Can we even think about the performance of neurosurgery without nursing support, whether in the office, the research environment, the operating room, the hospital wards, or the rehabilitation centers that often help our patients in their recoveries? Do we just take for granted that complex and challenging surgeries will be followed by excellent nursing care that lasts all night, the next day, and the day after that? Nurses talk to our patients when we are not there, reiterate our messages, and clarify and answer patient's questions. They become as familiar with new surgical techniques as we do, to understand their indications and potential outcomes. Then they work to make those outcomes possible. In the surgical suite, they must become familiar with new devices and do so expeditiously to meet our high standards. It is truly a wonder how over the course of their own career they evolve as we evolve, as our field evolves. Neurosurgical nursing is its own calling. As for any of us, the path is different from person to person. To become involved in the care of patients with challenging and debilitating neurological disorders, in one or more different clinical settings, is a commitment toward excellence. I personally think of our work as more a vocation than a career. We are so fortunate to have nurses in the practice setting who help us bring patients and families to an understanding of their own medical challenges and to help them navigate what is assuredly an anxious time. Their calm, unhurried demeanor can help them through a potentially frustrating interaction with the health care system, lessening worry and sleepless nights, at least to some degree. Nurses on the hospital wards provide the surgical aftercare of recovery, hopefully to a prompt return home, but sometimes toward an extended care stay that may develop into more personal contacts with patients, friends, and family. The hands-on, personal interactions involved are truly special and go far beyond the expectations of a “job.” In the surgical suite, our nurses have the same commitment to professionalism, communication, care, and error reduction as we do. This is displayed time and again, each time a new patient enters the room. And last, a personal note. Many years ago now, I married a neurosurgical nurse who had worked on the neurosurgery floor at the Toronto General Hospital and then in the operating room there. She later worked in the OR at the University of Pittsburgh Medical Center. She understood the field, the disorders we treat, and the personalities involved. Her nursing skills were also crucial to our family, including structure, planning, fearlessness, and tenderness. As my dear friend John Golfinos would say, “you can't spell neurosurgery without n-u-r-s-e.” I encourage you to think about the nurses you work with, in any of the different settings, and know that the wonderful science in these journal pages could not have happened without them. Douglas Kondziolka, MD, MSc Editor-in-Chief, Neurosurgery Publications New York, New York, USA

Eponyms in Otology: A Historical Narrative of Commonly Used Surgical Instruments.

Numerous eponymous instruments are regularly used in the otology surgical suite. This manuscript uses a tympanoplasty to highlight 10 frequently used instruments and the remarkable surgeons behind their creation. Many of these names will be familiar, but we hope our readers will gain an appreciation of these landmark figures that have transformed the practice of otology.

Associations of Surgical Team Communication With the Layout of Physical Space: A Network Analysis of the Operating Room in a Military Medical Center.

To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication. Understanding the complex association between surgical team communication and the OR's spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors. We employed a cross-sectional, quantitative, case study, and network-centric study design. We studied the population of 204 clinicians in a large military medical center (36 perioperative nurses, 34 surgical technicians, 62 anesthesia providers, and 72 surgeons), focusing on surgical teams with cases completed within duty hours. Data were collected from December 2020 to June 2021 using an electronic survey. Spatial network analysis was done using electronic floor plans. Statistical analysis was done with descriptive statistics and linear regressions. The outcomes were general and task-specific communication, and team-level variables were aggregated from scores for all team members. Spatial effects were assessed with network centrality (degree, Laplacian, and betweenness). The individual-level survey response rate was 77% (157 of 204). Data were collected on 137 surgical teams. On a 5-point scale, general and task-specific communication ranged from 3.4 to 5.0 and 3.5 to 5.0, respectively (for both, median = 4.7). Team size ranged from 4 to 6 individuals (median = 4). Surgical suites with higher network centralities were associated with significantly lower communication scores. The OR's spatial network location has important impacts on surgical team communication. Our findings have design and workflow implications for ORs and even surgical care in combat zones.

Office-based kidney stone management with new ultrasound technologies

Despite the growing incidence of urinary stones, the fundamental interventions for urinary stones have remained the same for several decades. However, technical innovations in ultrasound have enabled new strategies for stone management. Our team aims to employ these methods to establish a new paradigm to treat stones in an office or clinic rather than a surgical suite. Technologies include new imaging methods to detect and characterize stones, burst wave lithotripsy to fragment stones using focused ultrasound rather than shock waves, and ultrasonic propulsion to promote clearance of fragments, all using a single ultrasound platform. This presentation will describe the principles and development of these technologies, as well as the fruitful partnerships between teams of basic scientists, engineers, physicians, and industry that have enabled rapid development of these concepts to successful clinical trials. [Work supported by NIDDK P01 DK043881 and the Focused Ultrasound Foundation.]

The 20-year paradigm shift toward organ recovery centers: 2500 donors at Mid-America Transplant and broader adoption across the United States

On March 1, 2001, Mid-America Transplant, the organ procurement organization (OPO) located in St Louis, Missouri, performed the first organ recovery of a brain-dead donor in a hospital-independent, free-standing, organ recovery center (ORC), with successful transplantation of a liver. This was the inception of a paradigm shift in donor management and organ procurement, moving away from the traditional method of using the donor hospital. In the last 20 years, many advances have occurred in the ORC. Brain-dead donors are moved within hours of authorization to fully equipped intensive care units. Some ORCs are equipped with computed tomography scanners, portable radiography, laboratory facilities, bronchoscopy, and a cardiac catheterization laboratory. ORCs have dedicated surgical suites, and operating time is frequently during the day and is rarely delayed. Donor management in an ORC is more consistent, efficient, and effective than that in a donor hospital, and studies have demonstrated increased organ yield. Multiple studies have demonstrated a cost benefit of an ORC as well as providing an ideal environment for donor research studies. Currently, there are 24 of 57 OPOs that are using an independent or hospital-based ORC to manage their donors. We review the history and describe the current state of ORCs.

Long-term capacity planning for obstetric surgical suites using quantile linear regression.

Obstetric surgical suites differ from most inpatient surgical suites, serving one specialty, and often small. We evaluated long-term capacity planning for these operating rooms. The retrospective cohort study included all caesarean births in three operating rooms over 28 years, 1994 through 2021, plus all other obstetric procedures over the latter 19 years. We calculated the obstetric anaesthesia activity index, 0.5 × neuraxial labour analgesia placement + 1.0 × caesarean births. Annual caesarean births from one year to the next had a Pearson linear correlation coefficient of 0.993. Therefore, linear regression can be used for long-term capacity planning. However, the difference between 0.9 and 0.1 quantiles in weekly caseloads was greater than tenfold larger than the annual rate of growth in births per week. Therefore, clinicians likely would be unable to distinguish, by experience, between growth versus being busy due to variability, suggesting value of the modelling. Over 19 years, the fraction of the obstetric workload from caesarean births was unchanging, Pearson correlation coefficient of 0.04. Therefore, use of the obstetric anaesthesia activity index to judge changes in workload was appropriate. The annual total for the index increased linearly, Pearson correlation coefficient of 0.98, supporting validity of the finding that long-term capacity can be planned with linear regression. The difference between 0.9 and 0.1 quantiles in weekly totals of the index exceeded annual rate of growth, supporting validity of the finding that variability week to week is very large relative to growth. These results help decision-makers ensure that operating rooms and staff meet referring hospitals' needs.