When one hears the words digital surgery the first image that comes to mind...

may be one of a surgical robot hovering above an operating table in a cool blue theatre room, working hand in hand with the operating team. This is as far as popular imagination usually goes. Zooming into the scene, though, one would see that every so often the surgeon casts a furtive eye toward a nearby screen, which displays in real time the effect of each millimetric movement she makes inside the patient’s body, so that she can react instantaneously if a delicate resection may be cutting too close to a critical tissue. The patient being operated on is receiving the undivided attention of a flesh-and-bone surgeon and her surgical team, their every movement tracked and enhanced by robotic-assisted technology with digital vision and precision.

This vignette is not a scene from a futuristic movie – it is becoming the reality for many surgeons who are looking to a hybrid mode of operating that brings together the best of human and digital capabilities. COVID-19 has served to accelerate even further the adoption of digital technologies and processes in healthcare – a welcome development for patients, physicians, and health systems alike. With redesigned, more intuitive, and more efficient care made possible by novel digital tools, medical interventions can accomplish health outcomes that were previously unreachable because of the invasive nature of conventional surgery, while at the same time not compromising the patient’s recovery. Yet despite these advances, the surgery landscape today remains fragmented and much of the progress resides in silos that often do not communicate and connect well enough with one another.

To avoid such gaps, Johnson & Johnson Medical Devices Companies are advancing a holistic vision of a digital surgery ecosystem that goes beyond robotic-assisted systems and reimagines the entire care pathway. Leveraging its cross-sector expertise and creative global footprint, the company is bringing together the power of next-generation robotics, world class instrumentation, advanced imaging and visualization, data and analytics, and artificial intelligence and machine learning.

“We want to shape a future where medical intervention is smarter, less invasive and more personalized for patients, so that they can have more confidence in their procedures and recovery,”

-Celine Martin, Company Group Chairman of Ethicon Digital Surgery, part of the Johnson & Johnson family of companies

Martin emphasizes that the group’s renewed vision is designed not only to meet the immediate clinical needs of surgery patients, but also to provide continuous care and support throughout their functional and psychological journey as they prepare for and recover from surgery. “Advancements in machine learning and artificial intelligence are enabling the creation of digital solutions that connect the patient journey before, during, and after a procedure.”

To achieve that vision, Johnson & Johnson is partnering closely with hospitals, health systems, and leading technology companies to build a smart, connected, digital ecosystem that aims to improve efficiencies, advance insights, and promote collaboration.

“We believe the transformative promise of digital surgery lies in capturing the learnings surgeons have gained from performing countless procedures and transferring that knowledge through data analytics and insights into technologies. Those technologies can be leveraged across the continuum of care for more informed decision making and better connectivity with the patient pre- and post-operatively,” says Sharrolyn Josse, Worldwide President of VELYS™ Digital Surgery, DePuy Synthes, the orthopaedics company of Johnson & Johnson.

For example, in orthopaedics Johnson & Johnson is taking bold steps to bring disruptive innovations to the market through a connected and personalized digital platform. Those innovations inform every step before, during, and after surgery through technologies that connect care teams with their patients by using action plans, education, direct feedback, and a companion mobile app.

These improvements will ultimately lead to an integrated, user-centered care model that meets patients where they are and wraps itself around their healthcare needs and circumstances.

To reach this goal, the suite of digital surgery platforms will look beyond individual instrumentation systems and toward achieving seamless connectivity among every aspect of the human and technological elements involved in creating successful surgical outcomes.

The result is technologies linked through meticulously designed, intuitive interactions along all levels of the care continuum to ensure positive patient outcomes.

Connecting the Continuum of Care: Before, During and After a Procedure

As Johnson & Johnson develops this holistic new digital surgery ecosystem, there are three main stages of clinical workflow across which the integrated platforms will assist physicians with achieving optimal patient outcomes. Each of them focuses on transforming surgery from an isolated event to a connected, data-driven endeavor that begins before the patient enters the operating theater and lasts long after they have left it.

Planning & Pre-Op:

To optimally prepare care teams for complex procedures, Johnson & Johnson is deploying an arsenal of data and analytics, augmented reality (AR), and virtual reality (VR) tools that can enhance training and procedure planning with high-fidelity patient-specific simulation, providing surgeons with a clearer roadmap for surgery.

“I believe we can make procedures more predictable and enable new clinical frontiers by offering surgeons novel capabilities and insights that will provide demonstrable benefits to patients,” says Frederic Moll, M.D., Chief Development Officer of Johnson & Johnson Medical Devices Companies. “As our technology advances, I can imagine entirely new procedures and new approaches to treating disease.”

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Intra-Op:

The execution of a surgical plan depends on the unique characteristics of each patient. These characteristics can be influenced by obesity, inflammation, and prior surgery, and can lead to difficult surgical dissection or difficulty in the identification of critical structures. To address these issues, it is critical to create a platform based upon intra-operative imaging and intelligent instrumentation that provides real-time surgical navigation of critical structures.

Making this vision reality, Johnson & Johnson’s state-of-the-art technologies help operators carry out delicate maneuvers and avert damage to adjacent tissues and organs. In orthopaedics, the company’s robotic-assisted solution aims to give surgeons the control they are used to and help them execute more accurate cuts. As a result, surgeons may experience reduced complexity, reduced operating room time, increased operating room turnover, all within a footprint that is designed to serve both ambulatory surgical centers and specialty hospital settings.

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Post-Op & Learning:

To provide surgeons with continuous learning opportunities and support for their patients, Johnson & Johnson is working to integrate solutions such as sensors for post-operative patient monitoring and rehabilitation. Throughout every step of the process, insights will fuel a system that will meet surgeons where they are in their workflow and patients where they are in their healthcare journey.

“Our vision includes sensors to monitor how patients heal from the comfort of their home using advanced technologies to wirelessly share data with their healthcare professional. And it includes ongoing data collection to drive stronger insights, support evidence generation, and help improve outcomes,” says Aldo Denti, Company Group Chairman of DePuy Synthes. “It is a system that becomes smarter with time, learning as it captures real-time data, generating actionable insights, and informing each step of the surgical approach to optimize outcomes.”

For example, one of the system’s modalities is aimed at reducing surgical variability by sharing use cases on surgical methodologies through an online network and providing the option to pair junior surgeons from any part of the world with more experienced mentors.

It’s an exciting time for digital surgery, one that is bursting with opportunities to radically transform how we design, organize, and deliver services – with the goal of creating the best possible health outcomes and experiences for patients.

“When we think about our journey in robotics, we are looking at the next five, ten and twenty years, and how we can continue to drive innovation that will make a clinical difference,” says Martin. “This is just the beginning of a new era of treatment options driven by technology, and we’re excited to help bring the benefits of digital surgery to more patients.”

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