Toronto's Dr Teodor Grantcharov has developed new technology, a "black-box" similar to those in aviation, which records all aspects of a surgical procedure to improve performance of all members of the team.
Photo Credit: CBC

Toronto surgeon develops “black-box” for operating rooms


Flying an aircraft with its complex systems requires a high degree of safety.  Long ago, the industry developed flight recorders, that collected data and cockpit voices so that in the event of an accident, investigators could determine what may have gone wrong.

Now a doctor in Toronto has developed a similar “black box” system for the operating room.

Dr Teodor Grantcharov is an associate professor of surgery at the University of Toronto, and a staff surgeon at St Michael’s Hospital who specializes in minimally invasive procedures


Dr Grantcharov says his system records all aspects of an operation, through cameras microphones, and includes other parameters like room temperature, and patient conditions.

He says it notes even minor deviations from the perfect situation, adding, that no operation is perfect.

Dr Teodor Grantcharov, staff surgeon St Michael’s Hospital, Toronto © Mr. Karthik Raj

He says surgery is a high performance, high risk profession and “we’re all human, and we can all improve”.  All OR staff can see and reflect upon their performance and actions throughout the operation, where someone has made an error, or simply where an action can be done in a better way as surgery is a team effort, not just that of the surgeon.

He says that it could become a great teaching tool as well

The advantage of his black-box concept is that the whole operation and all aspects of it can later be reviewed carefully by analysts and the surgical team.  He points out that the hospital research team has people who are experts in analysis of technical skills and team performance.  They can analyze other things like the safety of equipment and human factors.

During such assessment errors, lapses, or deficiencies are pointed out. They could be as minor as a surgeon momentarily losing sight of a suturing needle. Or they could be as major as grasping a bowel too hard and causing a perforation.

However, the black box also shows where things are being done efficiently and to best practices so that those can be observed and later practiced by others.

Its important to get the message out that this technology is not to find blame, but rather so that people can improve.

He notes that as part of a pilot project he has been recording his own surgeries and finds that it has helped him improve.

Other medical professionals  have expressed interest in the concept although there has been some concern about the idea of being monitored might put O.R. staff under added stress, and there are questions about litigation that have to be discussed. “

Like black boxes in aircraft, and in other transport industries like trains, they could also be used to assess what went wrong after an accident, which in hospitals is known as a “major adverse event.”

“It can help tell us what went wrong. Was it a human error? Was it technological malfunction? What information can we give the manufacturers to make it safer next time?” he explains.

Dr Grantcharov  plans to publish results of the pilot project in a peer-reviewed medical journal next year, and in a few weeks he will describe how it works to contemporaries at the American College of Surgeons conference in Washington, D.C.

He notes that further trials with the prototype of his “black box” technology will take place in a hospital in Copenhagen starting in October.  Eventually, he thinks it could become standard procedure in all hospitals and surgeries.

Categories: Health, Internet, Science and Technology

Do you want to report an error or a typo? Click here!

@*@ Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

 characters available

Note: By submitting your comments, you acknowledge that Radio Canada International has the right to reproduce, broadcast and publicize those comments or any part thereof in any manner whatsoever. Radio Canada International does not endorse any of the views posted. Your comments will be pre-moderated and published if they meet netiquette guidelines.

Netiquette »

When you express your personal opinion in an online forum, you must be as courteous as if you were speaking with someone face-to-face. Insults and personal attacks will not be tolerated. To disagree with an opinion, an idea or an event is one thing, but to show disrespect for other people is quite another. Great minds don’t always think alike—and that’s precisely what makes online dialogue so interesting and valuable.

Netiquette is the set of rules of conduct governing how you should behave when communicating via the Internet. Before you post a message to a blog or forum, it’s important to read and understand these rules. Otherwise, you may be banned from posting.

  1.’s online forums are not anonymous. Users must register, and give their full name and place of residence, which are displayed alongside each of their comments. reserves the right not to publish comments if there is any doubt as to the identity of their author.
  2. Assuming the identity of another person with intent to mislead or cause harm is a serious infraction that may result in the offender being banned.
  3.’s online forums are open to everyone, without regard to age, ethnic origin, religion, gender or sexual orientation.
  4. Comments that are defamatory, hateful, racist, xenophobic, sexist, or that disparage an ethnic origin, religious affiliation or age group will not be published.
  5. In online speak, writing in ALL CAPS is considered yelling, and may be interpreted as aggressive behaviour, which is unpleasant for the people reading. Any message containing one or more words in all caps (except for initialisms and acronyms) will be rejected, as will any message containing one or more words in bold, italic or underlined characters.
  6. Use of vulgar, obscene or objectionable language is prohibited. Forums are public places and your comments could offend some users. People who use inappropriate language will be banned.
  7. Mutual respect is essential among users. Insulting, threatening or harassing another user is prohibited. You can express your disagreement with an idea without attacking anyone.
  8. Exchanging arguments and opposing views is a key component of healthy debate, but it should not turn into a dialogue or private discussion between two users who address each other without regard for the other participants. Messages of this type will not be posted.
  9. Radio Canada International publishes contents in five languages. The language used in the forums has to be the same as the contents we publish. The usage of other languages, with the exception of some words, is forbidden. Messages that are off-topic will not be published.
  10. Making repetitive posts disrupts the flow of discussions and will not be tolerated.
  11. Adding images or any other type of file to comments is forbidden. Including hyperlinks to other websites is allowed, as long as they comply with netiquette. Radio Canada International  is in no way responsible for the content of such sites, however.
  12. Copying and pasting text written by someone else, even if you credit the author, is unacceptable if that text makes up the majority of your comment.
  13. Posting any type of advertising or call to action, in any form, to Radio Canada International  forums is prohibited.
  14. All comments and other types of content are moderated before publication. Radio Canada International  reserves the right to refuse any comment for publication.
  15. Radio Canada International  reserves the right to close a forum at any time, without notice.
  16. Radio Canada International  reserves the right to amend this code of conduct (netiquette) at any time, without notice.
  17. By participating in its online forums, you allow Radio Canada International to publish your comments on the web for an indefinite time. This also implies that these messages will be indexed by Internet search engines.
  18. Radio Canada International has no obligation to remove your messages from the web if one day you request it. We invite you to carefully consider your comments and the consequences of their posting.


4 comments on “Toronto surgeon develops “black-box” for operating rooms
  1. Avatar Dr. Barry Gilliland says:

    I have operated since 1978 and during those years I have operated with other surgeons in other centers many times, usually to teach others as well as learn new techniques. I found I often learned helpful things from others even when I was teaching them. I’ve also taught dozens of Residents in training. There is a dramatic difference in their abilities at the end of their training But they all get the same degree or credentials. Some form of “black box” would be tremendous for the learner as well as the experienced surgeon. I completely support this concept for learning as well as credential follow up. Terrific concept!

  2. Avatar Catnapper says:

    What happens when there’s medical malpractice involved? Could the information within that black box be held as evidence?

    My opinion, for what it’s worth — probably not! Doctors aren’t in the habit of squealing on each other.

  3. Avatar David Gerrior says:

    I can imagine there will be doctors who will be very unhappy to have this technology installed because they will no longer be able to hide mistakes. But perhaps this will eliminate some of the poor surgeons out there who should not be in an operating room in the first place.

    However, I think you can expect some push back from surgeons who will feel this is an intrusion and not appreciate “someone”looking over their shoulders. But given time, the system will be almost invisible and not noticeable. It will be interesting to see if this technology plays a part in finding doctors who take short cuts or if it will be allowed into the courtroom in the event of a trial. Lets hope it’s used for the purpose it’s designed for – to use as a teaching tool. It can be an excellent diagnostic as well as teaching tool.