Skip to main content

Advertisement

Springer Nature Link
Log in

Teamwork enables remote surgical control and a new model for a surgical system emerges

  • Original Article
  • Published:
Cognition, Technology & Work Aims and scope Submit manuscript

Abstract

Technology has revolutionised surgery in minimising anatomical invasiveness and increasing the range of surgical interventions available. However, modern remote and robot assisted surgery places unorthodox demands on surgeons and on all those involved in surgical operations in the operating theatre/room. This system of work is of vital importance to surgical success. However, research for developing surgical technique focuses mainly on the surgeon’s interface with the operative site, neglecting the operating room system supporting that technique. Furthermore, there is yet no agreement on the framework for regularly organising this vital system and for optimising its design for interprofessional work. By expanding on the conventional human–machine interface, we develop a model depicting the surgeon controlling surgical action through the media and technology of the operating room system. We show how the operating room team mediate the control of the surgical operation. By viewing control and communication in the operating room as a property of a distributed or joint cognitive system, we emphasise the potential for the team, their media and technology to either impair or enhance surgical performance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  • Aggarwal R, Undre S, Moorthy K, Vincent C, Darzi A (2004) The simulated operating room: comprehensive training for surgical teams. Qual Saf Health Care 13(Suppl 1):i27–i32

    Article  Google Scholar 

  • Awad SS, Fagan SP, Bellows C, Albo D, Green-Rashad B, De la Garza M, Berger DH (2005) Bridging the communication gap in the operating room with medical team training. Am J Surg 190:770–774

    Article  Google Scholar 

  • Alarcon A, Berguer R (1996) A comparison of operating room crowding between open and laparoscopic operations. Surg Endosc 10:916–919

    Article  Google Scholar 

  • Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234(4):549–559

    Article  Google Scholar 

  • Bann S, Khan M, Hernandez J, Munz Y, Moorthy K, Rockall T, Darzi A (2003) Robotics in surgery. J Am Coll Surg 196(5):784–795

    Article  Google Scholar 

  • Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207

    Article  Google Scholar 

  • Cao CGL, Milgram P (2000) Disorientation in minimal access surgery: a case study. In: Proceedings of the IEA 2000/HFES 2000 Congress

  • Cao CGL, Taylor H (2004) Effects of new technology on the operating room team. In: Khalid HM, Helander MG, Yeo AW (eds) Working with computing systems, pp 309–312

  • Carthey J, de Leval MR, Reason JT (2001) The human factor in cardiac surgery: errors and near misses in a high technology medical domain. Ann Thorac Surg 72:300–305

    Article  Google Scholar 

  • Carthey J, de Leval MR, Wright DJ, Farewell VT, Reason JT (2003) Behavioural markers of surgical excellence. Saf Sci 41:409–425

    Article  Google Scholar 

  • Catchpole KR, Giddings AE, de Leval MR, Peek GJ, Godden PJ, Utley M, Gallivan S, Hirst G, Dale T (2006) Identification of systems failures in successful paediatric cardiac surgery. Ergonomics 49(5–6):567–588

    Article  Google Scholar 

  • Christian C, Gustafson M, Roth E, Sheridan T, Gandhi T, Dwyer K, Zinner M, Dierks M (2006) A prospective study of patient safety in the operating room. Surgery 139(2):159–173

    Article  Google Scholar 

  • Coiera E, Tombs V (1998) Communication behaviours in a hospital setting: an observational study. BMJ 316:673–676

    Google Scholar 

  • Cook RI, Woods DD (1996) Adapting to new technology in the operating room. Hum Factors 38(4):593–613

    Article  Google Scholar 

  • de Leval M, Carthey J, Wright D, Farewell V, Reason J (2000) Human factors and cardiac surgery: a multicentre study. J Thorac Cardiovasc Surg 119:661–672

    Article  Google Scholar 

  • den Hartog FTH, Schmidt JR, de Vries A (2006) On the potential of personal networks in hospitals. Int J Med Inform 7(5):658–663

    Google Scholar 

  • Dion YM, Gaillard F (1997) Visual integration of data and basic motor skills under laparoscopy: influence of 2-D and 3-D video-camera systems. Surg Endosc 11(10):995–1000

    Article  Google Scholar 

  • Dismukes RK, Loukopoulos LD, Jobe KK (2001) The challenges of managing concurrent and deferred tasks. In: Jensen R (ed) Proceedings of the 11th international symposium on aviation psychology. Ohio State University, Columbus

    Google Scholar 

  • Dunn D, Nair R, Fowler S, AL ET (1994) Laparoscopic cholecystectomy in England and Wales: results of an audit by the Royal College of Surgeons of England. Ann R Coll Surg Engl 76:269–275

    Google Scholar 

  • Einstein GO, McDaniel MA, Williford CL, Pagan JL, Dismukes RK (2003) Forgetting of intentions in demanding situations is rapid. J Exp Psychol Appl 9(3):147–162

    Article  Google Scholar 

  • Emam TA, Hanna G, Cuschieri A (2002) Comparison of orthodox versus off-optical axis endoscopic manipulations: importance of monitor display angles. Surg Endosc 16:401–405

    Article  Google Scholar 

  • Etchells E, O’Neil C, Bernstein M (2003) Patient safety in surgery: error detection and prevention. World J Surg 27:936–942

    Article  Google Scholar 

  • Greenberg CC, Roth EM, Sheridan TB, Gandh TK, Gustafson ML, Zinner MJ, Dierks MM (2006) Making the operating room of the future safer. Am Surg 72(11):1102–1108

    Google Scholar 

  • Guerlain S, Turrentine FE, Bauer DT, Calland JF, Adams R (2008) Crew resource management training for surgeons: feasibility and impact. Cogn Technol work: special issue on enhancing surgical systems. doi:10.1007/s10111-007-0091-y

  • Hanna GB, Shimi SM, Cuschieri A (1998) Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg 227(4):481–484

    Article  Google Scholar 

  • Hazelhurst B, Mcmullen C, Gorman P (2004) Getting the right tools for the job; distributed planning in cardiac surgery. IEEE Trans Syst Man Cybern A Syst Hum 34:708–717

    Article  Google Scholar 

  • Healey AN (2008) Speculation on the neuropsychology of teleoperation: implications for presence research and minimally invasive surgery. Presence: teleoperators and virtual environments, vol 17. MIT Press, cambridge, pp 199–211

  • Healey AN, Vincent CA (2007) The systems of surgery. Theor Issues Ergon Sci 1:1–15

    Google Scholar 

  • Healey AN, Undre S, Vincent CA (2004) Developing observational measures of performance in surgical teams. Qual Saf Health Care 13(Suppl 1):i33–i40

    Article  Google Scholar 

  • Healey AN, Sevdalis N, Vincent CA (2006a) Measuring intraoperative interference from distraction and interruption observed in the operating theatre. Ergonomics: special issue on patient safety 49:589–604

    Google Scholar 

  • Healey AN, Undre S, Vincent CA (2006b) Defining the technical skills of teamwork in surgery. Qual Saf Health care 15:231–234

    Article  Google Scholar 

  • Healey AN, Primus CP, Koutantji M (2007) Quantifying distraction and interruption in urological surgery. Qual Saf Health Care 16:135–139

    Article  Google Scholar 

  • Healey AN, Olsen S, Davies R, Vincent CA (2008a) A method for measuring work-interference in surgery. Cogn Technol Work, special issue: enhancing surgical systems. doi:10.1007/s10111-007-0088-6

  • Healey AN, Catchpole K, Yule (2008b) Editorial: enhancing surgical systems. Cogn Technol Work, special issue: enhancing surgical systems. doi: 10.1007/s10111-007-0090-z (Online July 2007)

  • Hodge B, Thompson JF (1990) Noise pollution in the operating theatre. Lancet 335:891–894

    Article  Google Scholar 

  • Holden JG, Flach JM, Donchin Y (1999) Perceptual-motor coordination in an endoscopic surgery simulation. Surg Endosc 13:127–132

    Article  Google Scholar 

  • Hollnagel E, Woods DD (2005) Joint cognitive systems: foundations of cognitive systems engineering. CRC Press/Taylor & Francis, Boca Raton

    Google Scholar 

  • Huber JW, Taffinder N, Russell RCG, Darzi A (1993) The effects of different viewing conditions on performance in simulated minimal access surgery. Ergonomics 46(10):999–1016

    Article  Google Scholar 

  • Jett QR, George JM (2003) Work interrupted. A closer-look at the role of interruptions in organisational life. Acad Manage 28(3):494–508

    Google Scholar 

  • Kimura T, Amerada Y, Matsumoto S (2000) Laparoscopic cholecystectomy performed by a single surgeon using a visual field tracking camera. Surg Endosc 14:825–829

    Article  Google Scholar 

  • Lasome CEM, Xiao Y (2001) Large public display boards. A case study of an OR board and design implications. Proc AMIA Symp 349–352

  • Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334

    Article  Google Scholar 

  • Lingard L, Espin S, Rubin B, Whyte S, Colmenares M, Baker GR, Doran D, Grober E, Orser B, Bohnen J, Reznick R (2005) Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care 14(5):340–346

    Article  Google Scholar 

  • Lingard L, Whyte S, Espin S, Baker GR, Orser B, Doran D (2006) Towards safer interprofessional communication: constructing a model of “utility” from preoperative team briefings. J Interprof Care 20(5):471–483

    Article  Google Scholar 

  • Lu Y, Xiao Y, Sears A, Jacko JA (2005) A review and a framework of handheld computer adoption in healthcare. Int J Med Inform 74(5):409–422

    Article  Google Scholar 

  • Mahawar KK (2003) Too much talk in theatre. Lancet 361(9368):1570

    Article  Google Scholar 

  • Makary MA, Sexton JB, Freischlag JA et al (2006) Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 202(5):746–752

    Article  Google Scholar 

  • Martin JA, Regehr G, Reznick R et al (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273–278

    Article  Google Scholar 

  • Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327(7422):1032–1037

    Article  Google Scholar 

  • Moorthy K, Munz Y, Adams S, Pandey V, Darzi A (2005) A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann Surg 242(5):631–639

    Article  Google Scholar 

  • Nemeth CP (2008) Improving healthcare team communication. Ashgate Publishing, Aldershot

  • Nyssen S (2004) Integrating cognitive and collective aspects of work in evaluating technology. IEEE Trans Syst Man Cybern Syst Human 34(6):743–748

    Article  Google Scholar 

  • Pennel I, Ferrel C, Coello Y, Orliaguet JP (2002) Sensorimotor control in teleoperation: theoretical and ergonomic considerations. Travail Humain 65(1):29–58

    Article  Google Scholar 

  • Perkins N, Starkes JL, Lee TD, Hutchison C (2002) Learning to use minimal access surgical tools and 2-D remote visual feedback: how difficult is it for novices? Adv Health Sci Educ 7:117–131

    Article  Google Scholar 

  • Reinhardt-Rutland AH, Annett JM (1999) Depth perception and indirect viewing: reflections on minimally invasive surgery. Int J Cogn Ergonomics 3(2):77–90

    Article  Google Scholar 

  • Roth EM, Christian CK, Gustafson M, Sheridan TB, Dwyer K, Ghandi TK, Zinner MJ, Dierks MM (2004) Using field observations as a tool for discovery: analysing cognitive and collaborative demands in the OT. Cogn Tech Work 6:148–157

    Article  Google Scholar 

  • Ruurda JP, Draaisma WA, van Hillegersberg R et al (2005) Robot-assisted endoscopic surgery: a four-year single-center experience. Dig Surg 22(5):313–320

    Article  Google Scholar 

  • Sinclair MA (2007) Ergonomic issues in future systems. Ergonomics 50(12): 1957–1986

    Google Scholar 

  • Slater K, Rw Strong, Wall Dr, Lynch SV (2002) Iatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy. ANZ J Surg 72:83–88

    Article  Google Scholar 

  • Stassen HG, Dankelman J, Grimbergen CA (1999) Open versus minimally invasive surgery: a man-machine system approach. Trans Inst Meas Control 21(4–5):151–162

    Article  Google Scholar 

  • Stassen HG, Grimbergen CA, Dankelman J (2005) Introduction to minimally invasive surgery. In: Dankelman J, Grimbergen CA, Stassen HG (eds) Engineering for patient safety: issues in minimally invasive procedures. Lawrence Erlbaum Associates, London 2005

  • Tendick F, Jennings R, Tharp G, Stark L (1993) Sensing and manipulation problems in endoscopic surgery: experiment, analysis and observation. Presence Teleoperators Virtual Environ 2(1):66–81

    Google Scholar 

  • Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA (2006) Teamwork in the operating theatre: cohesion or confusion. J Eval Clin Pract 12(2):182–189

    Article  Google Scholar 

  • Van Veelen M, Nederlof E, Goossens C, Schot C, Jakimwicz J (2003) Egonomic problems encountered by the medical team related to products used for minimally invasive surgery. Surg Endosc 17:1077–1081

    Article  Google Scholar 

  • Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW (2004) Systems approach to surgical quality and safety: from concepts to measurements. Ann Surg 239:475–482

    Article  Google Scholar 

  • Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469

    Article  Google Scholar 

  • Webster JL, Cao CGL (2006) Lowering communication barriers in operating room technology. Hum Factors 48(4):747–758

    Article  Google Scholar 

  • Welty G, Schippers E, Grablowitz V, Lawong AG, Tittel A, Schumpelick V (2002) Is laparoscopic cholecystectomy a mature technique? Surg Endosc 16:820–827

    Article  Google Scholar 

  • Whyte S, Lingard L, Espin S, Baker G, Bohnen J, Orser BA, Doran D, Reznick R, Regehr G (2008) Paradoxical effects of interprofessional briefings in OR team performance. Cogn Tech Work. doi:10.1007/s10111-007-0086-8

  • Williams Reed G, Silverman RJD, Schwind C, Fortune JB, Sutyak J, Van Horvath KD, Eaton EG, Azzie G, Potts JR, Boehler M, Dunnington GL (2007) Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Ann Surg 245(2):159–169

    Article  Google Scholar 

  • Xiao Y, Hu P, Moss J, Winter Jd, Venekamp D, Mackenzie CF, Seagull FJ, Perkins S (2008). Opportunities and challenges in improving surgical work flow. Cogn Technol Work: special issue on enhancing surgical systems. doi:10.1007/s10111-007-0087-7

  • Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D (2006) Development of a rating system for surgeons’ non-technical skills. Med Educ 40:1098–1104

    Article  Google Scholar 

  • Zheng B, Swanstrom LL, MacKenzie CL (2007) A laboratory study on anticipatory movement in laparoscopic surgery: a behavioral indicator for team collaboration. Surg Endosc 21:935–940

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Andrew N. Healey was funded by The Engineering and Physical Sciences Research Council, UK (http://www.epsrc.ac.uk/default.htm). Dr. Jonathan Benn was funded by The Health Foundation, UK (http://www.health.org.uk).

Author information

Authors and Affiliations

  1. Human Factors, Atomic Weapons Establishment (AWE), Aldermaston, Reading, Berkshire, RG7 4PR, UK

    Andrew N. Healey

  2. Imperial College London, London, UK

    Jonathan Benn

Authors
  1. Andrew N. Healey
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Jonathan Benn
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Andrew N. Healey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Healey, A.N., Benn, J. Teamwork enables remote surgical control and a new model for a surgical system emerges. Cogn Tech Work 11, 255–265 (2009). https://doi.org/10.1007/s10111-008-0125-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10111-008-0125-0

Keywords