LETTERS TO EDITOR
Year : 2019 | Volume
| Issue : 4 | Page : 390-391
Triton sponge and canister app for estimating surgical blood loss
Abhijit S Nair, Vibhavari Naik, Narahari Busa, Basanth K Rayani
Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
Dr. Abhijit S Nair
Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad - 500 034, Telangana
Source of Support: None, Conflict of Interest: None
|Date of Web Publication||5-Sep-2019|
|How to cite this article:|
Nair AS, Naik V, Busa N, Rayani BK. Triton sponge and canister app for estimating surgical blood loss. Saudi J Anaesth 2019;13:390-1
Conventionally gravimetric method and visual estimations are used to quantify intraoperative blood loss. In gravimetric method, soaked mops are weighed and difference in grams is estimated as blood loss in ml. In visual estimation, loss is estimated by the amount seen in drains and mops after which a rough quantification is done after enquiring about the saline wash used intraoperatively or the body fluids which is drained. Both methods are inconsistent in determining surgical blood loss. The loss is underestimated in major surgeries which involves excessive blood loss and overestimated in otherwise minimal blood loss.
The Triton system (Gauss Surgical, Inc., Palo Alto, CA) is a mobile monitoring system that uses mobile computing with Gauss “'Feature Extraction Technology” (FET). The application can be downloaded on an iPad from the App Store on Macintosh platform by searching “Triton Sponge” [Figure 1]a. The application helps by directly assessing Hb mass (mHb) absorbed by surgical sponges from an image. The software works using algorithms, which can automatically filter out nonsanguineous components such as saline used for wash, body fluids like ascites, urine, pleural fluid that is absorbed by the mops. Triton system got US-FDA approval as an “'Image Processing Device For Estimation Of External Blood Loss' with an 510(K) number: K163507.
|Figure 1: (a) Figure shows Triton Sponge App as available on App Store. (b) Figure shows Triton Canister App as available on App Store|
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Later, Gauss Surgical, Inc. launched 'Triton Canister' app, which used FET to estimate blood loss in canisters and other suction containers used to collect intraoperative losses [Figure 1]b. The app can be found on App store by typing “Triton Canister v2”. In this app also the image of suction containers and canisters needs to be uploaded, which is then processed and an accurate estimate of blood loss is then provided by the app after excluding other fluids in the canisters. The canister app also received US-FDA approval in 2015 under device classification “Image Processing Device For Estimation Of External Blood Loss” with 510(K) Number: K142801.(8)
After the FDA approval, several studies have been conducted involving major laparotomies, orthopedic surgeries (spine, arthroplasties), cesarean deliveries ,,,, [Table 1]. Konig et al. conducted an in vitro study to assess the accuracy and performance of the app on surgical laparotomy sponges and later on suction canisters across various range of ambient light conditions, sponge saturation, saline contamination, and initial blood Hb and found it very accurate. Although the sample size of the studies published till date is small, respective authors felt that this algorithm based app was much better and reliable in estimating intraoperative blood loss, thereby helping the clinicians to take decisions judiciously.
|Table 1: Table shows currently published papers which used the Triton Sponge and Canister App for estimation of intra-operative blood loss|
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To conclude, the Triton system-based estimation of intraoperative blood loss in sponges and canisters is a simple and reasonably accurate way of estimating blood loss. It is easy to learn and understand. Presently, the app is available for free download on Macintosh platform only although the user's needs to purchase the license to use the app. The app can be used on an iPad once installed with a functional internet connection. Being a regulated medical product, the app is available for use in a country if the product is cleared by local regulating bodies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Holmes AA, Konig G, Ting V, Philip B, Puzio T, Satish S, et al
. Clinical evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg 2014;119:588-94.
Sharareh B, Woolwine S, Satish S, Abraham P, Schwarzkopf R. Real time intraoperative monitoring of blood loss with a novel tablet application. Open Orthop J 2015;9:422-6.
Doctorvaladan SV, Jelks AT, Hsieh EW, Thurer RL, Zakowski MI, Lagrew DC. Accuracy of blood loss measurement during cesarean delivery. AJP Rep 2017;7:e93-100.
Konig G, Waters JH, Javidroozi M, Philip B, Ting V, Abbi G, et al
. Real-time evaluation of an image analysis system for monitoring surgical hemoglobin loss. J Clin Monit Comput 2018;32:303-10.
Nowicki PD, Ndika A, Kemppainen J, Cassidy J, Forness M, Satish S, et al
. Measurement of intraoperative blood loss in pediatric orthopaedic patients: Evaluation of a new method. J Am Acad Orthop Surg Glob Res Rev 2018;2:e014.
Konig G, Waters JH, Hsieh E, Philip B, Ting V, Abbi G, et al
. In vitro
evaluation of a novel image processing device to estimate surgical blood loss in suction canisters. Anesth Analg 2018;126:621-8.
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