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  • The operating room (OR) Black Box simultaneously captures audiovisual data, physiologic data from the patient and members of the surgical team, and data from instrumentation and sensors.

  • During enhanced morbidity and mortality conferences, the OR Black Box can provide objective, quantifiable data from the OR to stakeholders to not only ensure they present accurate and granular data to attendees, but also so they can perform detailed root-cause analyses to identify often opaque or overlooked intraoperative factors that may have impacted the clinical outcome.


In the mid-1950s, the United Kingdom airline de Havilland Comet was involved in multiple airplane crashes. David Warren, an Australian inventor, recognized that something had to be changed. He subsequently created a device that could record pilots’ voices as well as cockpit instrument usage. Warren posited that by collecting such data, explanations for why planes were crashing could be quantified. Furthermore, with such information, airlines could better predict and prevent planes from crashing in the future.1 Warren’s airplane black box has become a hallmark of aviation cockpit safety, allowing airlines to learn from mistakes and saving the lives of many.

Similar to aviation, safety in the operating room (OR) is essential. Despite this, errors occur regularly in the OR.2 Surgical errors such as miscommunication and tension between surgical team members, equipment being used incorrectly or failing, breaks in sterility, and most devastatingly, wrong-sided surgeries are not uncommon.3,4 The surgical community needed a way to adequately record data in the OR to identify errors in an objective way, learn from these errors, and improve. Analogous to Warren’s black box in aviation, the OR Black Box (Surgical Safety Technologies, Toronto, Canada) is an all-encompassing data collection platform for the intraoperative phase of care in surgery.5 The OR Black Box system simultaneously records audiovisual data, physiologic data from the patient and members of the surgical team, and data from instrumentation and sensors. Video data are captured from both the wide-angle room camera and the laparoscopic/robot camera. The implications of the OR Black Box platform include improving patient safety, surgical training, quality, and surgical efficiency. This chapter will focus on how the OR Black Box captures data and uses novel technology to make these data meaningful for surgeons, surgical trainees, and patients alike.


Surgical data science is an emerging and innovative field.6 In ORs around the world, different modalities of data collection are used, such as safety checklists and procedural records. Despite the frequency and necessity of effective data collection in the OR, the current methods used can be subjective, inefficient, and lacking important data.7

From an education perspective, gathering surgical trainees’ OR data is imperative to provide effective feedback and promote improvement. Many surgical training programs use the Objective Structured Assessment of Technical Skills ...

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