September 30, 2021
3 min read
Stryker has acquired Gauss Surgical, which produces the Triton artificial-intelligence platform for monitoring blood loss during labor, surgery and other medical procedures.
The Triton system works as a computer vision app on Apple iPhones and iPads, using the devices’ cameras to visually measure blood loss by capturing images of sponges, canisters and towels. Its algorithms can distinguish between blood and non-sanguineous fluids in these items and then calculate the blood volume via the captured images. The app also can calculate blood volume of weighed items. Triton then integrates custom hemorrhage protocols and triggers alerts notifying providers of excessive blood loss.
According to Gauss Surgical, the Mount Sinai Hospital increased hemorrhage recognition during cesarean sections and vaginal deliveries by factors of two to four. Delayed interventions to control bleeding also declined by 34%, and the hospital realized $209,000 in annualized cost avoidance from unnecessary transfusions and lab tests.
Healio spoke with Siddarth Satish, MS, founder and CEO of Gauss Surgical, to find out more about the technology.
Healio: What prompted the development of the app?
Satish: We spent considerable time in the operating room in graduate school for various projects. When observing surgery, it was apparent to the Gauss founders that despite major advances in such fields as surgical robotics and patient monitoring, surgical workflow was still largely inefficient. Of note, some operating rooms still manually tally surgical sponges and instruments, and blood loss is largely visually estimated by providers — a practice that is notoriously inaccurate and imprecise. Triton was developed with the goal of estimating blood loss with a high degree of accuracy and precision, using computer vision technology to overcome limitations of human visual acuity.
Healio: Could you briefly describe the technology and how it works?
Satish: Triton is an iPhone app that uses computer vision to accurately assess surgical blood loss on sponges and in canisters, despite the presence of confounding fluids such as irrigation. Triton also uses a Bluetooth smart scale to quantify blood loss on pads and other items that only hold blood. Once pre-defined thresholds of blood loss are met, Triton can send automated notifications to [operating room] staff and to other clinicians on call, enabling them to activate a stage-based hemorrhage protocol in a timely manner.
Healio: Could you describe step–by–step how a doctor or nurse would use the app during delivery?
Satish: In the operating room during c-sections, nurses simply hold up blood-soaked sponges to the iPhone during their routine sponge counting process. The Triton app recognizes the sponge, captures an image and uses computer vision algorithms to accurately assess blood loss in a matter of seconds. Similarly, the Triton app captures a panoramic photo of the suction canister and accurately estimates blood loss inside the canister. In labor and delivery and postpartum settings, the app uses a Bluetooth smart scale integrated with the app to quantify blood loss by weight.
Healio: What are Triton’s current advantages over other methods for monitoring and calculating blood loss?
Satish: Blood loss is still largely visually estimated in surgical care. Recently in labor and delivery settings, there has been a renewed focus on estimating blood loss more accurately. However, these methods, which rely solely on gravimetric assessment (ie, weighing of sponges and pads), are inaccurate and imprecise due to the presence of confounding fluids such as irrigation or amniotic fluid. They also are highly cumbersome, requiring the manual operation of weighing scales and calculators/spreadsheets. Triton brings accuracy and precision to blood loss estimation using computer vision technology, and radically improves workflow by integrating seamlessly into the sponge-counting process.
Healio: The company has studied Triton’s effectiveness. What kinds of results have you seen?
Satish: Several studies, published in peer-reviewed journals, have described the improvement in early intervention, clinical outcomes and cost when Triton was implemented. Notably, a 2019 study published in the International Journal of Obstetric Anesthesia concluded that the use of the Triton system to monitor maternal blood loss during labor and delivery was associated with improved patient outcomes and cost savings.
Researchers at Mount Sinai Hospital in New York City studied more than 7,600 deliveries and concluded that the systematic monitoring of blood loss with Triton was associated with improved recognition of postpartum hemorrhage, earlier intervention to control bleeding and cost savings when compared with visual estimation of blood loss.