On-line computer system to minimize laser injuries during surgery: Preliminary system layout and proposal of the key features

Abstract

The aim of this paper is to investigate some new user interface ideas and related application packages which aim to improve the degree of safety in an operating room during surgical operations in which an invasive laser beam is deployed. The overall value of the proposition is that a means is provided which ensures the successful completion of the surgical case while minimizing the risk of thermal and mechanical injuries to healthy tissues adjacent to the surgical field. According to surgeons operating with a variety of CO2 lasers available at both the National Cancer Institute in Milan, Italy, and the Sackler School of Medicine, Tel Aviv University, Israel, each laser device presents different cutting and coagulation properties. In order to identify which ‘ideal’ procedure might corroborate the subjective impression of each surgeon and also to provide one common tool to ensure procedures with a high level of safety, the author has worked for several months with surgeons and technicians of both Institutions to define the general design of a new on-line surgical operation planning and design system to be used during the pre-operative briefing activities and also as a consultation tool during operation. This software package will be developed and tested on both ‘C’ and FORTRAN compilers running on a commercially available PC which is driving a continuous wave (CW) CO2 laser device via its Instrument-Bus interface. The present proposal describes the details of a software package called LCA (Laser-beam Controller and Adviser) which performs several controls in parallel on the key output parameters of a laser beam device during its utilization in delicate surgical operations. The required performances of this device needed during a given surgical operation are pre-simulated and compared against the well-known safety limits, which are stored in the computer's mass storage. If the surgeon's decision about the laser device set-up are considered to be too close to the required physiological safety limits, then the SW alerts the surgeon and proposes alternatives based on other combinations of both HW and SW configurations. An additional application of LCA uses this SW as a warning tool during the operation itself. If a wrong set-up of the laser device is accidentally used, an alarm will be generated and the laser beam automatically switched-off prior to an ‘incident report’ printout. The operation will continue only when the surgeon validates the choices that the SW suggests for implementation. If necessary, the surgeon can switch off the device and continue to operate it manually. In this case, the surveillance mode will be totally excluded.