Science fiction comes to the OR

AORN Journal,  Sept, 2007  by Nancy J. Girard

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I admit it. I grew up reading science fiction, probably because that is what my father read and the house was full of his books. Through the years, I have come to value that early reading, because it helped me stretch my imagination, open my mind, and look for ways to do the improbable.

The merging of science and fiction led to huge jumps in creative thought in the early twentieth century. In many science fiction stories, the use of very advanced technology was depicted in healing and medical situations. For example, I remember reading a story in the 1960s in which a physician scanned a patient using a handheld instrument that allowed him to visualize the disease and diagnose it easily. It has taken nearly 50 years to reach a time when such technology is possible, but much of that early fiction, based on science, is now reality.

COMING EVENTS

Mankind's drive to imagine, develop, and invent seemingly impossible technology to provide medical and surgical care is ongoing. What will new scientific developments bring to the OR, and what will perioperative nurses of the future need to know?

ENHANCED VISUALIZATION. The invention of the scope revolutionized surgery, providing surgeons with the ability to perform minimally invasive surgery. The advent of endoscopic surgery created a permanent paradigm shift; however, many believe that endoscopic surgery techniques have come as far as they can and the next shift will be a strong merger between surgery and radiology. (1) Increased visualization of surgical sites will give physicians the ability to see through tissue without invasion, see objects in three dimensions, and see behind and around organs. (1) This will result in micro-invasive surgery. Biopsies will be replaced with imaging and high-intensity ultrasound that will immediately eradicate a tumor. (2) Surgery could move out of the OR entirely.

BIOTECHNOLOGY. Tiny computer chips implanted in the body will repair damaged biological functions. For example, research has shown that 2-mm computer chips surgically imbedded in the retinas of cats that went blind from retinitis pigmentosa function like the normal eye to recognize light and pass the signals along the optic nerve to the brain, allowing vision. (3) All senses could be treated this way in the future, allowing patients to regain sight, smell, speech, hearing, and touch.

NANOSURGERY. The development of nanorobots that can travel through the body to repair damage will precipitate the next generation of surgery. These nanorobots could search out and destroy cancer and arterial atheromatous plaques, fix strictures, repair trauma to tissue and bones, and even repair or exchange whole chromosomes. Research groups are already working on "cytobots" and "karyobots" that will work via wireless computer directions to perform intracellular and intranuclear surgery. (4)

SMART FABRICS. Fabrics are being created that incorporate computers within the strands of the material. (5,6) Patches, pockets, and decorations will contain the components to transmit wireless information into the computer with the touch of a finger. Smart materials could adapt to cold and heat or glow as a warning to indicate something is wrong. (6)

VIRTUAL REALITY TRAINING. The use of virtual, real-life simulations will change training and testing for health care providers. Skills can be learned through simulated, hands-on practice that incorporates holographic, three-dimensional technology and uses special glasses and haptic gloves (ie, gloves that allow tactile feeling and finger manipulation) to enable real-time practice and testing. This technology is already available in computer games.

Advanced computer simulations will be able to tell if the learner is experienced or a novice, detect the accuracy of hand-eye coordination, and identify the learner's physiological problems. For example, the software in virtual training will be able to tell if the surgeon or nurse is taking a controlled substance or is under the influence of alcohol. (7) It also will be able to tell when a surgeon or a nurse should retire or at least stop participating in detailed surgeries. (7) This technology will change training and will ensure competency of skills. Board certification could be automatic when a computer deems that the practitioner is competent in all the required skills, and a certificate could be automatically processed directly to the employee's file.

IMPLICATIONS FOR PERIOPERATIVE NURSING: A VISION OF THE FUTURE

The nurses of tomorrow will study informatics, software management, radiology, technology management, and physics in addition to their routine coursework. They may be required to work for a year in the intensive care unit before becoming perioperative nurses because of the skills needed to maintain and monitor the patient using high-tech machines. They will learn skills and become competent in a simulated environment rather than in a clinical area. Special training will be needed to learn to control machines through eye and hand movement, as well as thought.