How One Startup Is Working to Reduce Surgical Variability & Bring Transparency to the OR

Palo Alto-based health technology company Theator was founded in 2018 with a mission to address variability and disparities in surgical care. Since then, the company has built a platform for the routine capture of surgical video data. I recently spoke with the startup’s CEO, Tamir Wolf, to learn more about Theator’s technology and its ability to help providers understand the high level of variability in outcomes among common surgical procedures.

There is “tremendous variability” in the field of surgery because it lacks a standardized method of adhering to best practices, Wolf said. Much of this problem has to do with the fact that department heads don’t have much insight into how other surgeons are conducting procedures in operating rooms.

“There’s very limited visibility into whether or not safety practices are adhered to,” Wolf pointed out.

To address this issue, Theator created technology that captures surgical video data and analyzes it with AI. The company doesn’t add any cameras to operating rooms — it leverages cameras that surgeons already use to perform minimally invasive procedures, Wolf said.

In a recent research effort, the startup set out to determine why there is so much variability in outcomes among hysterectomies, which is the most common gynecologic procedure conducted in the U.S. This variability exists not only in different parts of the country, but also even within the same hospital, Wolf declared.

Theator analyzed hundreds of laparoscopic hysterectomy surgical videos across different surgeons and hospitals. Wolf said that he can’t reveal the names of the hospitals but they’re major providers in the U.S.

When analyzing these hundreds of unstructured videos, Theator wanted to identify key moments within the intraoperative performance. By doing this, the startup was able to figure out a reason why patients suffer injuries to the ureter, a serious complication that can stem from gynecological surgery. The reason was that many surgeons weren’t taking a deliberate look at the ureter during surgery. This may seem simple, but Wolf said there isn’t really a standardized set of best practices that all gynecological surgeons adhere to that tells them that they must take this step during laparoscopic hysterectomies.

“We asked the chair of the department ‘In which percentage of cases do your surgeons take a deliberate view of the ureter during the hysterectomy?’ And without waiting too much, they said ‘Close to 100%.’ Then we went to see whether or not that was actually accurate. We have an algorithm that automatically identifies whether or not the action of deliberate view of the ureter is being performed,” Wolf explained.

Across a hospital’s entire gynecological surgery department and over a period of several months, Theator found that there was significant variability when it comes to surgeons taking a deliberate view of the ureter. The company’s video analysis showed that there were surgeons that never took a deliberate look at it, and there were surgeons that took a deliberate look some of the time, Wolf said.

“For the first time, we were able to show objective data that provides department heads with insight into what is actually being done in the operating room. Because otherwise they would need to be with every surgeon in every single case, and that’s obviously not something that is possible,” he declared.

Having these insights allows department heads to establish standardized safety practices for their surgeons, Wolf said. Standardization not only improves patient outcomes, but it can also save surgeons time, he declared.

Performing procedures in a standardized way helps optimize surgical flow because fewer significant events happen during surgeries. Surgical procedures are huge revenue generators for hospitals, so there’s a push to do more and more. But it’s not wise to do more surgeries if they’re going to be performed in a manner that lacks safety and standardization, Wolf argued.

“You’re churning patients through OR, you’re doing a lot of procedures and your volume is very high. But then after discharging the patient and sending them home, there’s a high percentage of patients that bounce back into the hospital because of complications. Then what are we really doing here?” he said.

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