“Black Box” Recorder Monitors Operating Rooms

A “black box,” similar to that used in the airline industry, could improve patient safety and outcomes by identifying where errors occur in the operating room (OR) and teaching surgeons how to prevent them.

Developed at St. Michael’s Hospital (Toronto, ON, Canada), in collaboration with Air Canada (Montreal, Canada) the “black box” records almost everything that is happening in the OR, such as vital signs, a video of the OR, a video feed from the endoscope used in the surgical procedure, conversations among health care workers, room temperature, and decibel levels. Based on the PESA (Huntsville, AL, USA) X-stream multipath streaming media recorder, the technology is currently being used for minimally invasive surgery (MIS), but could be expanded for open surgeries as well.


Patients must give their consent before the black box is used during their surgery, as do members of the surgical team, including theater nurses. In a preliminary review of the data recorded on the device, the researchers have found that 84% of errors during gastric bypass MIS procedures occurred during the same two stages - suturing and grafting the bowel. The device has been in use at St. Michael’s since April 2014, and is also being tested at two hospitals in Copenhagen (Denmark), with more international sites to be involved soon.

“We want to see where errors happen in surgery so that we can understand how errors lead to adverse events and develop training curricula to prevent these errors from ever happening again,” said device developer surgeon Teodor Grantcharov, MD. “It doesn’t mean that we will have perfect surgeries, because we are not perfect. But it means we will learn from our errors, which will make us safer. We will train future surgeons better because we can show them what the most critical situations are and how to avoid them.”

“For surgeons, we will have data that will allow better coaching and improvements, and therefore better patient care. We will reduce the risk and complications and show how to make the OR more efficient, which will also allow us to save money and do more cases,” added Dr. Grantcharov. He also added that he hoped his black box would bring more transparency to the OR for patients, and help change the “blame-and-shame” culture that traditionally has made doctors and nurses reluctant to report mistakes.

Related Links:
St. Michael’s Hospital
Air Canada
PESA