Keywords: HCI, AI, RL, Skill acquisition, Music, Rehabilitation

More information: here

Fig.1(Top) Classic Minimally Invasive Surgery in gynecology. Fig.1(Top Left) Classic Minimally Invasive Surgery operating room diagram. The patient lies on a table in the center of the room. One, or eventually two or more, surgeons stand next to the patient table on one side. On the other side stands one Bedside Assistant. On the lower part of the table, where the patient's feet lie, another Bedside Assistant stands. The anaesthesiologist stands on the upper part of the table, behind monitors. Fig.1(Top Center) Classic Minimally Invasive Surgery operating room picture from the field study. In two callouts: first, the proximal end of a laparoscopic tool called forcep, second, the distal end of the tool. The tool is grabbed by the surgeon as one usually grabs a scissor. There are only two degrees of freedom, opening and closing the tool (by opening and closing the fingers like with a scissor), and rotating the tool (through a knob). Fig.1(Top Right) Ports inserted on the patient's abdomen, with severe tools going through them. Fig.1(Bottom) Robotic-Assisted Minimally Invasive Surgery in gynecology. Fig.1(Bottom Left) Robotic-Assisted Minimally Invasive Surgery operating room diagram. The patient lies on a table in the center of the room. A Bedside Assistant surgeons stand next to the patient table on one side. On the lower part of the table, where the patient's feet lie, another Bedside Assistant stands. The anaesthesiologist stands on the upper part of the table, behind monitors. One, or eventually two, consoles to operate the robot are placed on the top-right corner of the room. A surgeon sits in front of the console to operate it. Eventually, a second surgeon can operate the second console. The Patient Cart robot has four arms. It is placed next to the patient table, opposite to one of the bedside assistants. The arms have laparoscopic tools attached, which go inside the patient. They are controlled by the surgeon operating the console. Fig.1(Bottom Center) Robotic-Assisted Minimally Invasive Surgery operating room picture from the field study. In two callouts: first, the joysticks surgeons manipulate in the console of the robotic system, second, the distal end of the robotic tool. The tool is grabbed by the surgeon as one usually grabs eating chopsticks. There are six degrees of freedom, mainly opening and closing the tool tip, rotating the tool tip and rotation about the end of the tool (similar to how a hand rotates with respect to the arm about the wrist). The tool tip mimics the surgeon's hand movement, it is highly dexteric) Fig.1(Bottom Right) A closeup of the robotic arms and the console. The robotic arms have laparoscopic tools already inserted. The surgeon sits at the console where s/he controls the tools.

People Involved

Ignacio Avellino, Sorbonne Université
Gilles Bailly, Sorbonne Université
Geoffroy Canlorbe, Hôpital Pitié Salpêtrière & Sorbonne Université
Jérémie Belghiti, Hôpital Pitié Salpêtrière
Guillaume Morel, Sorbonne Université
Marie-Aude Vitrani, Sorbonne Université

Abstract

Robotic-assisted Minimally Invasive Surgery (MIS) is adopted more and more as it overcomes the shortcomings of classic MIS for surgeons while keeping the benefits of small incisions for patients. However, introducing new technology oftentimes affects the work of skilled practitioners. Our goals are to investigate the impacts of telemanipulated surgical robots on the work practices of surgical teams and to understand their cause. We conducted a field study observing 21 surgeries, conducting 12 interviews and performing 3 data validation sessions with surgeons. Using Thematic Analysis, we find that physically separating surgeons from their teams makes them more autonomous, shifts their use of perceptual senses, and turns the surgeon’s assistant into the robot’s assistant. We open design opportunities for the HCI field by questioning the telemanipulated approach and discussing alternatives that keep surgeons on the surgical field.

Main Findings

Robotic assistance to Minimally Invasive Surgery is realized today through a telemanipulated approach. We identify three unintended impacts of Telemanipulation in Robotic Assisted Surgery:

1) The Autonomous but Withdrawn Surgeon

The surgeon gains autonomy, as the telemanipulation console lets her control all the complex operations of the robot independently, however, overloading her cognition which can lead to errors in manipulating the robotic interface.

Sitting at the console withdraws the surgeon, reducing situational awareness of other team member’s actions as well as social interaction with the team.

2) Shifting the Use of Perceptual Senses

The telemanipulation console removes haptic feedback and isolates the surgeon’s attention, limiting visual contact with the team.

3) From Surgeon Assistant to Robot Assistant

The surgical assistant’s tasks shift from assisting the surgeon (holding a tissue, cutting) to assisting the robot (untangling arms, changing tools).

 

In conclusion, robots bring enormous benefits to surgery, but their interface design can cause even greater drawbacks. Telemanipulation is one approach but not the only one. We encourage future HCI research to explore the continuum Surgeon-to-Patient distance as a design dimension, bringing the surgeon closer to the patient and her team, and thus making surgery minimally invasive not only for the patient but also for the surgeon.

Fig.2 Exploring the surgeon--patient design dimension for Robotic-Assisted Minimally Invasive Surgery. The continuum goes from left to right and it is divided into two, non-robotic surgery and robotic-assisted surgery. First, Non-robotic surgery. 1) Open Surgery: the surgeon uses his/her hand to operate. 2) Laparoscopic surgery: the surgeons manipulates a tool that goes inside the body. Second, robotic-assisted surgery. 1) Comanipulation: both the surgeon and a robot comanipulate the laparoscopic tool 2) Sterile Field Telemanipulation: the surgeon operates robotic arms remotely from a portable console he/she is grabbing, this portable console can be taken into the sterile field. 3) Operating Room Telemanipulation: the current situation for robotic-assisted surgery, where the surgeon sits at a console about a meter away from the patient and controls a cart with robotic arms next to the patient. 4) Remote Telemanipulation: same situation as before, except the surgeon is far away from the patient, for example in another country.