Decoding the OR Black Box and Similar Technologies and Considerations in Otolaryngologic Surgery

To introduce the concept and provide a unifying framework for multimodal intraoperative data-capturing technologies and to describe their role in otolaryngology.

This narrative review synthesizes the current evidence and developments on intraoperative data-gathering technologies. It introduces the framework of Multimodal Operating-room Data Acquisition and Leveraging (MODAL) systems, which integrate data from surgical equipment, physiologic monitors, electronic health records, and ambient audiovisual sources.

Emerging multimodal data-capturing technologies are now enabling systematic collection and analysis of OR data to improve safety, quality, and efficiency in surgery. Otolaryngology is particularly well suited to adopt MODAL systems, given its large volume of video-based procedures such as endoscopic sinus surgery, most forms of ear surgery, airway surgery, and transoral robotic surgery. MODAL technologies have demonstrated value in intraoperative checklist compliance, surgical education, and postoperative safety analysis. There is also growing potential for real-time decision support through computer vision and artificial intelligence integration. Despite the growing adoption of these technologies, the terminology, implementation methods, and governance frameworks are not well standardized. The implementation of MODAL systems also requires attention to patient and physician privacy, data governance, technical infrastructure, and collaboration among providers, informaticists, and institutional leaders.

While the current scope of MODAL systems is limited, their capabilities are evolving. Within otolaryngology, these technologies hold the most promise for video-intensive subspecialties. However, realizing their full benefits will require carefully planned institutional policy, governance, and continued refinement.

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