Presentation
Scalpel, Please: How Do Surgeons Communicate and Interact With Robotic Scrub Nurses During Instrument Handoffs in Intraoperative Care
SessionRobotics Summit - Session 2
DescriptionIntroduction: The implementation of robots into healthcare systems is nothing new. Robotic assisted surgery (RAS), one of the most salient examples of robotics in healthcare, has been on a steady and aggressive rise. However, RAS is but a single promising example of what robotics in healthcare has to offer. A systematic review conducted in 2024 shines a light on the ways robots are being used to fill in as nurses in a hospital setting (Babalola et al., 2024). The paper covers uses for robotic nurses ranging from medication delivery and monitoring vitals to assisting with administrative duties; that said, one particular setting they do not report on and acknowledge as needing further research is the use of nurses in the operating room (OR). With this in mind, we set out to determine how robotic scrub-nurses (RSN) are being utilized to fill in for their human counterparts in the OR.
The driving motivator for our research is the ongoing global nursing shortage. The World Health Organization estimates a nursing shortage of 4.8 million nurses globally by the year 2030 (WHO, 2024). Included in that count are scrub nurses who serve in an auxiliary role in the operating room. They provide assistance to the surgeon by managing tasks such as handing over surgical instruments to keep the flow of surgery fast and efficient. The well structured and repetitive nature of this role is well suited for a robot and thus, the widespread adoption of RSNs can be one approach to ease the growing labor shortage in nursing.
In addition to reducing the strain on healthcare systems, RSNs represent an opportunity to improve patient safety. The consistent and often multimodal communication-interactions afforded by robots have the potential to improve patient outcomes in the OR by allowing for reliable channels of communication that are not at risk of easily breaking down. Breakdowns of communication are one of the main contributors of errors in the OR with one study suggesting 30% of exchanges in the OR involve a communication failure, one third of which go on to jeopardize patient safety (Lingard et al., 2004).
Objectives: In this paper we take a look at robotic scrub-nurse systems. Our aim is to determine what communication and interaction methods are used by robotic scrub-nurses and surgeons to interact with each other. We hope that our work will provide a base that can inform the development of future RSNs by exploring how they are currently being developed and tested as well as how their communication and interaction modalities affect the surgeon.
Approach: Our scoping review of this topic followed the PRISMA guidelines in order to establish a comprehensive base of knowledge for this relatively unexplored intersection of human-robot interaction and healthcare. We collected a mixture of seven articles and conference proceedings from a total of four databases after screening them according to curated exclusion criteria.
Findings: The selected papers included four experiments and three papers that were observational in nature or were validating a design. The amount of participants in the selected papers ranged from 1-36. Papers recruited participants including lay people (2), medical professionals (4), or were left unstated (1). Various set-ups were used in these papers that spanned a large range of realism ranging from dry-lab analysis of human and robot data all the way to an ex-vivo resection of a pig colon.
All papers detailed a system in which the surgeon was capable of communicating with the RSN but only a portion of papers outlined a system in which the RSN was capable of communicating with the surgeon. Communication from surgeon to RSN took the form of either gestures, speech, gaze, haptics, other body language, or a combination of modalities; communication from RSN to surgeon took the form of either auditory feedback, light-based feedback, haptic feedback, or some combination of modalities. Surgeons responded positively when RSNs were capable of two way communication. The various RSN’s ability to accurately detect the relevant modality of communication was consistently high but there was a large amount of variation in regard to how they affect total instrument delivery time. The instrument handoff interactions afforded by RSNs led to less variability of handoff location. Most RSNs utilized a gripper-type end effector (6) and there was consensus that end-effectors equipped with force/torque sensors (2) led to more natural handoffs.
Upon viewing the current research as a cohesive whole, we found that RSNs perform similarly to human scrub nurses based on qualitative, quantitative, and mixed methods measurements. Notably RSNs were perceived mostly positively by both surgeons and nurses. The fact that they do not jeopardize quality or efficiency of care makes their apparent benefits all the more salient. We found hand gestures were the most common, most preferred, and best performing communication method. Gestures appear to be widely chosen and utilized due to being easily and accurately detected by RSNs, their intuitive and familiar nature to surgeons, as well as the impact they have on reducing instrument handoff request and delivery times compared to other modalities. That said, it was often stated by surgeons that RSNs should be capable of multimodal communication.
Regarding robot interactions, the improved efficiency of surgeon movement provided by RSNs proves to be a promising benefit that can protect surgeons from compromising motions and limit potential injuries or inefficiencies. Furthermore, the design of the end-effector on RSNs seems to be an area of great importance to the quality of handoffs.
Takeaways: Robotic scrub-nurses are an emerging but promising technology. They stand to aid in the growing nursing shortage and improve outcomes in the OR for patients and surgeons alike. As a field just making its debut, designers should be encouraged to explore innovative and varied approaches when developing RSNs but keep in mind the design elements surgeons want to see such as multimodal communication, natural handoffs, and even the ability to predict surgeon actions. We hope our research expands the field’s understanding of robotic scrub-nurse systems and shines a light on the path ahead for designers.
The driving motivator for our research is the ongoing global nursing shortage. The World Health Organization estimates a nursing shortage of 4.8 million nurses globally by the year 2030 (WHO, 2024). Included in that count are scrub nurses who serve in an auxiliary role in the operating room. They provide assistance to the surgeon by managing tasks such as handing over surgical instruments to keep the flow of surgery fast and efficient. The well structured and repetitive nature of this role is well suited for a robot and thus, the widespread adoption of RSNs can be one approach to ease the growing labor shortage in nursing.
In addition to reducing the strain on healthcare systems, RSNs represent an opportunity to improve patient safety. The consistent and often multimodal communication-interactions afforded by robots have the potential to improve patient outcomes in the OR by allowing for reliable channels of communication that are not at risk of easily breaking down. Breakdowns of communication are one of the main contributors of errors in the OR with one study suggesting 30% of exchanges in the OR involve a communication failure, one third of which go on to jeopardize patient safety (Lingard et al., 2004).
Objectives: In this paper we take a look at robotic scrub-nurse systems. Our aim is to determine what communication and interaction methods are used by robotic scrub-nurses and surgeons to interact with each other. We hope that our work will provide a base that can inform the development of future RSNs by exploring how they are currently being developed and tested as well as how their communication and interaction modalities affect the surgeon.
Approach: Our scoping review of this topic followed the PRISMA guidelines in order to establish a comprehensive base of knowledge for this relatively unexplored intersection of human-robot interaction and healthcare. We collected a mixture of seven articles and conference proceedings from a total of four databases after screening them according to curated exclusion criteria.
Findings: The selected papers included four experiments and three papers that were observational in nature or were validating a design. The amount of participants in the selected papers ranged from 1-36. Papers recruited participants including lay people (2), medical professionals (4), or were left unstated (1). Various set-ups were used in these papers that spanned a large range of realism ranging from dry-lab analysis of human and robot data all the way to an ex-vivo resection of a pig colon.
All papers detailed a system in which the surgeon was capable of communicating with the RSN but only a portion of papers outlined a system in which the RSN was capable of communicating with the surgeon. Communication from surgeon to RSN took the form of either gestures, speech, gaze, haptics, other body language, or a combination of modalities; communication from RSN to surgeon took the form of either auditory feedback, light-based feedback, haptic feedback, or some combination of modalities. Surgeons responded positively when RSNs were capable of two way communication. The various RSN’s ability to accurately detect the relevant modality of communication was consistently high but there was a large amount of variation in regard to how they affect total instrument delivery time. The instrument handoff interactions afforded by RSNs led to less variability of handoff location. Most RSNs utilized a gripper-type end effector (6) and there was consensus that end-effectors equipped with force/torque sensors (2) led to more natural handoffs.
Upon viewing the current research as a cohesive whole, we found that RSNs perform similarly to human scrub nurses based on qualitative, quantitative, and mixed methods measurements. Notably RSNs were perceived mostly positively by both surgeons and nurses. The fact that they do not jeopardize quality or efficiency of care makes their apparent benefits all the more salient. We found hand gestures were the most common, most preferred, and best performing communication method. Gestures appear to be widely chosen and utilized due to being easily and accurately detected by RSNs, their intuitive and familiar nature to surgeons, as well as the impact they have on reducing instrument handoff request and delivery times compared to other modalities. That said, it was often stated by surgeons that RSNs should be capable of multimodal communication.
Regarding robot interactions, the improved efficiency of surgeon movement provided by RSNs proves to be a promising benefit that can protect surgeons from compromising motions and limit potential injuries or inefficiencies. Furthermore, the design of the end-effector on RSNs seems to be an area of great importance to the quality of handoffs.
Takeaways: Robotic scrub-nurses are an emerging but promising technology. They stand to aid in the growing nursing shortage and improve outcomes in the OR for patients and surgeons alike. As a field just making its debut, designers should be encouraged to explore innovative and varied approaches when developing RSNs but keep in mind the design elements surgeons want to see such as multimodal communication, natural handoffs, and even the ability to predict surgeon actions. We hope our research expands the field’s understanding of robotic scrub-nurse systems and shines a light on the path ahead for designers.
Event Type
Robotics Workshop Submission
TimeSunday, March 3011:15am - 11:45am EDT
LocationHarbour A/B