Robot, Pass Me the Scissors! How Robots Can Assist Us in the Operating Room

  • Juan P. Wachs
Part of the Lecture Notes in Computer Science book series (LNCS, volume 7441)


The inclusion of robotics and automation to support and augment surgical performance offers the promise of shorter operating times, higher accuracy and fewer risks compared with traditional, human-only surgery. This paper discusses current research in the area of surgical robotics and human-robot collaboration. A multimodal robotic scrub nurse (Gestonurse) for the operating room (OR) is presented as a case study. Gestonurse assists the main surgeon by passing surgical instruments, thereby releasing the surgical technician to perform other tasks. Such a robotic system has the potential to reduce miscommunication and compensate for understaffing. The implications of the introduction of surgical robots, as assistants rather than autonomous agents, are discussed in terms of the societal and technological requirements. Quantitative and qualitative findings are presented as evidence to support the guidelines discussed.


Gesture recognition operating room human computer interaction 


  1. 1.
    Buerhaus, P.I., Auerbach, D.I., Staiger, D.O.: The Recent Surge In Nurse Employment: Causes And Implications. Health Affairs 28(4), 657–668 (2009)CrossRefGoogle Scholar
  2. 2.
    The Effect of Health Care Working Conditions on Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD, Summary, Evidence Report/Technology Assessment: Number 74 AHRQ Publication No. 03-E024 (2003)Google Scholar
  3. 3.
    Needleman, D.J., Buerhaus, P., Pankratz, V.S., Leibson, C.L., et al.: Nurse staffing and inpatient hospital mortality. New England Journal of Medicine 364(11), 1037–1045 (2011)CrossRefGoogle Scholar
  4. 4.
    McHugh, M.D., Brooks Carthon, M., Wu, E., Kelly, L., Sloane, D., Aiken, L.H.: Impact of nurse staffing mandates on safety-net hospitals: Lessons from California. The Milbank Quarterly 90, 160–186 (2012)CrossRefGoogle Scholar
  5. 5.
    Firth-Cozens, J.: Why communication fails in the operating room. Qual. Saf. Health Care 13(5), 327 (2004)CrossRefGoogle Scholar
  6. 6.
    Lingard, L., Espin, S., Whyte, S., et al.: Communication failures in the operating room: an observational classification of recurrent types and effects. Qual. Saf. Health Care 13, 330–334 (2004)CrossRefGoogle Scholar
  7. 7.
    Healey, A.N., Undre, S., Vincent, C.A.: Defining the technical skills of teamwork in surgery. Qual. Saf. Health Care 15, 231–234 (2006)CrossRefGoogle Scholar
  8. 8.
    Carthey, J., de Laval, M.R., Wright, D.J., et al.: Behavioural markers of surgical excellence. Safety Science 41, 409–425 (2003)CrossRefGoogle Scholar
  9. 9.
    Taylor, R.H., Stoianovici, D.: Medical Robotics in Computer-Integrated Surgery. IEEE Transactions on Robotics and Automation 19(5) (2003)Google Scholar
  10. 10.
    Borenstein, J., Koren, Y.: A mobile platform for nursing robots. IEEE Transactions on Industrial Electronics (2), 158–165 (2007)Google Scholar
  11. 11.
    Bedem, V.L.: Realization of a demonstrator slave for robotic minimally invasive surgery. Ph.D. dissertation, Technische Universiteit Eindhoven (2010)Google Scholar
  12. 12.
    Agovic, A., Levine, S., Papanikolopoulos, N., Tewfik, A. (2010) Haptic interface design considerations for scrub nurse robots in microsurgery. 18th Mediterranean Conference on Control & Automation (MED), 2010 , pp.1573-1578. Google Scholar
  13. 13.
    Intuitive Surgical, da Vinci Surgical System, OnlineGoogle Scholar
  14. 14.
    Kochan, A.: Scalpel please, robot: Penelope’s debut in the operating room. Industrial Robot: An International Journal 32(6), 449–451 (2005)CrossRefGoogle Scholar
  15. 15.
    Carpintero, E., Perez, C., Morales, R., et al.: Development of a robotic scrub nurse for the operating theatre. In: 2010 3rd IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob), pp. 504–509 (2010)Google Scholar
  16. 16.
    Nathan, C., Chakradeo, V., Malhotra, K., D’Agostino, H., Patwardhan, R.: The Voice-Controlled Robotic Assist Scope Holder AESOP for the Endoscopic Approach to the Sella. Skull Base 12, 123–132 (2006)CrossRefGoogle Scholar
  17. 17.
    Yoshimitsu, K., Miyawaki, F., Sadahiro, T., et al.: Development and evaluation of the second version of scrub nurse robot (SNR) for endoscopic and laparoscopic surgery. In: Intelligent Robots and Systems, IROS 2007, pp. 2288–2294 (2007)Google Scholar
  18. 18.
    McCulloch, P., Mishra, A., Handa, A., Dale, T., Hirst, G., Catchpole, K.: The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. British Medical Journal 18(2), 109 (2009)Google Scholar
  19. 19.
    Mitchell, L., Flin, R.: Non-technical skills of the operating theatre scrub nurse: literature review. Journal of Advanced Nursing 63(1), 15–24 (2009)CrossRefGoogle Scholar
  20. 20.
    Purdy, E.: The Increasing Role of Robots in National Security. In: Greig, J.M. (ed.) Defense AT&L, vol. XXXVII (2008)Google Scholar
  21. 21.
    King, H., Low, T., Hufford, K., Broderick, T.: Acceleration compensation for vehicle based telesurgery on earth or in space. In: The International Conference on Intelligent Robots and Systems, IROS IEEE/RSJ 2008, pp. 1459–1464 (2008)Google Scholar
  22. 22.
    Garcia, P., Rosen, J., Kapoor, C., Noakes, M., Elbert, G., Treat, M., Ganous, T., Hanson, M., Manak, J., Hasser, C., Rohler, D., Satava, R.: Trauma pod: A semi-automated telerobotic surgical system. International Journal of Medical Robotics and Computer Assisted Surgery 5(2), 136–146 (2009)CrossRefGoogle Scholar
  23. 23.
    Treat, M.R., Amory, S.E., Downey, P.E., Taliaferro, D.A.: Initial clinical experience with a partly autonomous robotic surgical instrument server. Surg. Endoscopy 20 (2006)Google Scholar
  24. 24.
    Jacob, M.G., Li, Y., Wachs, J.P.: A Gesture Driven Robotic Scrub Nurse. In: Proceedings of the 2011 IEEE International Conference on Systems, Man, and Cybernetics, Anchorage, Alaska, October 9-12 (2001)Google Scholar
  25. 25.
    Fulchiero, G.J., Vujevich, J.J., Goldberg, L.H.: Nonverbal hand signals: a tool for increasing patient comfort during dermatologic surgery. Dermatol Surg. 35(5), 856–857 (2009)CrossRefGoogle Scholar
  26. 26.
    Phillips, N., Berry, E., Kohn, M.: Berry & Kohn’s operating room technique. Mosby Inc. (2004)Google Scholar
  27. 27.
    Pezzella, A.: Hand Signals in Surgery. AORN Journal 63(4), 769 (1996)CrossRefGoogle Scholar
  28. 28.
    CMU Sphinx: Open source toolkit for speech recognition. Carnegie Mellon University (2011)Google Scholar
  29. 29.
    Wachs, J.P., Jacob, M., Li, Y., Akingba, G.: Does a robotic scrub nurse improve economy of movements? In: SPIE Medical Imaging, Image-Guided Procedures, Robotic Interventions, and Modeling Conference, San Diego, California USA, February 4-9 (2012)Google Scholar
  30. 30.
    Jacob, M., Li, Y.T., Wachs, J.P.: Gestonurse: A Multimodal Robotic Scrub Nurse. In: Proc. of the7th ACM/IEEE Intl Conf. on Human Robot Interaction (HRI 2012), Boston, Massachusetts, March 5-8 (2011)Google Scholar
  31. 31.
    Jacob, M., Li, Y.T., Akingba, G., Wachs, J.P.: ’Gestonurse’ a robotic surgical nurse for handling surgical instruments in the operating room. Journal of Robotic Surgery, 1–11 (2011) ISSN: 1863-2483Google Scholar
  32. 32.
    Wasen, K.: Replacement of Highly Educated Surgical Assistants by Robot Technology in Working Life: Paradigm Shift in the Service Sector. I. J. Social Robotics 2(4), 431–438 (2010)CrossRefGoogle Scholar
  33. 33.
    Freedy, A., DeVisser, E., Weltman, G., Coeyman, N.: Measurement of trust in human-robot collaboration. In: Proc. Int. Symp. Collaborative Technologies and Syst., Orlando, FL, pp. 106–114 (2007)Google Scholar
  34. 34.
    Parasuraman, R., Riley, V.: Humans and automation: Use, misuse, disuse, abuse. Human Factors 39(2), 230–253 (1997)CrossRefGoogle Scholar
  35. 35.
    Adams, B.D., Bruyn, L.E., Houde, S., Angelopoulos, P.: Trust in automated systems literature review. Defense Research and Development Canada Toronto No. CR-2003-096 (2003)Google Scholar
  36. 36.
    Desai, M., Stubbs, K., Steinfeld, A., Yanco, H.: Creating trustworthy robots: Lessons and inspirations from automated systems. In: Proc. Artificial Intelligence and Simulation of Behaviour Conv.: New Frontiers in Human-Robot Interaction, Scotland (2009)Google Scholar
  37. 37.
    Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., et al.: Patient safety, satisfaction, and quality of hospital care: Cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal (2012)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Juan P. Wachs
    • 1
  1. 1.Purdue UniversityWest LafayetteUSA

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