The Digital Overall Operating Room System ecosystem links upstream component supply, midstream integration, and downstream clinical use. Upstream suppliers provide sensors, displays, and instrument interfaces that constitute the hardware base. Midstream actors—OEMs, software developers, and system integrators—assemble these inputs into interoperable platforms delivering imaging, robotics, and workflow orchestration. Downstream, hospitals and ambulatory surgery centers purchase, install, and run the solutions, while service firms ensure ongoing performance. Value is captured through hardware sales, software licensing, integration fees, and recurring service contracts, each stage relying on the previous for functional delivery.