This AI-Powered “Black Box” Could Make Surgery Safer

A new smart monitoring system could help doctors avoid mistakes—but it’s also alarming some surgeons and leading to sabotage.

The first time Teodor Grantcharov sat down to watch himself perform surgery, he wanted to throw the VHS tape out the window.

“My perception was that my performance was spectacular,” Grantcharov says, and then pauses—“until the moment I saw the video.” Reflecting on this operation from 25 years ago, he remembers the roughness of his dissection, the wrong instruments used, the inefficiencies that transformed a 30-minute operation into a 90-minute one. “I didn’t want anyone to see it.”

This reaction wasn’t exactly unique. The operating room has long been defined by its hush-hush nature—what happens in the OR stays in the OR—because surgeons are notoriously bad at acknowledging their own mistakes. Grantcharov jokes that when you ask “Who are the top three surgeons in the world?” a typical surgeon “always has a challenge identifying who the other two are.”

But after the initial humiliation over watching himself work, Grantcharov started to see the value in recording his operations. “There are so many small details that normally take years and years of practice to realize—that some surgeons never get to that point,” he says. “Suddenly, I could see all these insights and opportunities overnight.”

There was a big problem, though: it was the ’90s, and spending hours playing back grainy VHS recordings wasn’t a realistic quality improvement strategy. It would have been nearly impossible to determine how often his relatively mundane slipups happened at scale—not to mention more serious medical errors like those that kill some 22,000 Americans each year. Many of these errors happen on the operating table, from leaving surgical sponges inside patients’ bodies to performing the wrong procedure altogether.

While the patient safety movement has pushed for uniform checklists and other manual fail-safes to prevent such mistakes, Grantcharov believes that “as long as the only barrier between success and failure is a human, there will be errors.” Improving safety and surgical efficiency became something of a personal obsession. He wanted to make it challenging to make mistakes, and he thought developing the right system to create and analyze recordings could be the key.[…]

A new smart monitoring system could help doctors avoid mistakes—but it’s also alarming some surgeons and leading to sabotage.

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