Collaboration with future robots in the OR? Insights from observations with experienced su

HCC Research presented at the MuC 2022:

Six key findings from our six observations of robotic-assisted surgeries at the Charité Berlin indicate required features for semi-autonomous robots in the operating room [1]:

• Extensive technical, medical and patient-specific knowledge.

• Ensure intraoperative situational awareness of the process, team, patient and their environment.

• Provide understanding of the system's capabilities (and their limitations) to the team at all times.

• Enable and encourage surgeons to reflect on decisions about the process and the patient intraoperatively.

• Communicate alternative decisions by asking questions instead of giving instructions.

• Recognize and respect hierarchy in taking and carrying out instructions.

Image of a common robotic-assisted surgery setup as usually observed at the Charité [1]. This article refers to the first bedside assistant. The second bedside assistant usually played a minor role.

Backrgound

A general understanding in robotic-assisted surgery is that robots should become as intelligent and autonomous as possible, at least for many parts of the processes. Exactly which and how much of this is still in the infancy of research. Somewhat "simpler" stitching of tissue together are the first promising results of such research.

When it comes to human-computer interaction (HCI), there are ethnological studies (consisting of observations and interviews) that sometimes make questionable design suggestions. This is mainly due to the observed assistants. The distanced surgeon-robot interaction is always assisted by a bedside assistant on the robot. Depending on the knowledge and experience of the assistants, they are more or less helpful to the surgeons at the console, and sometimes even considered as problem creators [2]. In the studies, they are, in the best case, specially trained resident nurse first assistants (RNFAs) who have relatively good medical and technical understanding or, in the worst case, trainees who do not even have the technical understanding and are hardly recognized hierarchically. Assistants are very important in this process because they expand the limited senses and situational awareness of the surgeons at the consoles. However, unawareness, misunderstandings and inability to act due to inexperience are some of the problems that arise.

Example of questionable new designs based on experienced problems

The Avellino et al. 2019 [2] paper is very insightful and recommended to anyone entering this field. Nevertheless, the proposed designs should be treated with caution because they are based on studies with inexperienced assistants. Why this aspect is so important becomes clear below, but this much is said that these design decisions are based on identified negative observations (i.e., problems) rather than positive observations. Therefore, this and similar studies conclude: A new HCI design is needed that does not require the assistant, because the communication between the experienced surgeon at the console and the inexperienced assistant at the robot regularly lead to problems. Accordingly, there should be more intelligent and autonomous robots that allow the surgeon to return to the sterile field and control it, e.g. with a tablet. Studies with RFNAs are more positive toward assistants, but focus their design proposals on supporting interaction between RFNA and a more situationally aware robot (cf. [3]).

Design possibilities based on positive experiences

In our study, we had the rare opportunity to meet very experienced senior surgeons in the role of assistants. These surgeons were very experienced both medically and technically (in terms of the robot) in five out of six procedures and additionally knew the patient case. Only in one observation was the assistant an experienced surgeon, but still new to robotic-assisted surgery. Accordingly, we had a similar experience with the one less experienced assistant as described above.

In the other five surgeries, we observed proactive, situationally aware, and communicative assistance that also provided the opportunity for reflection on medical and technical decisions. In short, the assistants were adequate proxies for the telemanipulator and thus represented a potential agency for future more autonomous surgical robots. At the beginning of this article are six key findings of our observation, but you are welcome to read our paper [1] that gives a more detailed content of the interaction and communication between the experienced surgeons.

Finally, senior surgeons as Robotic-assisted surgery assistants, but also RNFAs are probably rarely given [2]. Trainees and young surgeons are more likely to be given. An HCI design that integrates the collected findings could provide exactly the helpful capabilities regardless of the experience of the assistants and without erasing them, but supporting both, the surgeon at the console and the assistant. In the future, we need to broaden our view in research and prototyping, to every relevant actor in the room, the team, the other technologies, objects and their environment. In the next step, we will further investigate these findings through interviews. If you have any questions or feedback, you are welcome to comment on this or contact me.

[1] Cypko M. A., Timmermann L., Sauer I. M. & Müller-Birn C., (2022). Towards Human-Robotic Collaboration: Observing Teamwork of Experienced Surgeons in Robotic-Assisted Surgery. In: Pfleging, B., Gerling, K. & Mayer, S. (Hrsg.), Mensch und Computer 2022 - Tagungsband. New York:ACM. (S. 558-563). DOI: https://dl.acm.org/doi/10.1145/3543758.3549891 Currently, we experience some DOI issues, original article will be available from Monday. Abstract can be found here: https://dl.gi.de/handle/20.500.12116/39276

[2] Avellino I., Bailly G., Canlorbe G., Belgihti J., Morel G., and Vitrani M-A., (2019). Impacts of Telemanipulation in Robotic Assisted Surgery. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. 1–15. https://doi.org/10.1145/3290605.3300813

[3] Cheatle A., Pelikan H., Jung M., and Jackson S., (2019). Sensing(Co) Operations: Articulation and Compensation in the Robotic Operating Room. Proceedings of the ACM on Human-Computer Interaction 3, CSCW (2019), 1–26. https://doi.org/10.1145/3359327