Analysis of disruptive events and precarious situations caused by interaction with neurosurgical microscope

BackgroundDevelopments in micro-neurosurgical microscopes have improved operating precision and ensured the quality of outcomes. Using the stereoscopic magnified view, however, necessitates frequent manual adjustments to the microscope during an operation.MethodThis article reports on an investigation of the interaction details concerning a state-of-the-art micro-neurosurgical microscope. The video data from detailed observations of neurosurgeons’ interaction patterns with the microscope were analysed to examine disruptive events caused by adjusting the microscope.ResultsThe primary findings show that interruptions caused by adjusting the microscope handgrips and mouth switch prolong the surgery time up to 10 %. Surgeons, we observed, avoid interaction with the microscope’s controls, settings, and configurations by working at the edge of the view, operating on a non-focused view, and assuming unergonomic body postures.ConclusionsThe lack of an automatic method for adjusting the microscope is a major problem that causes interruptions during micro-neurosurgery. From this understanding of disruptive events, we discuss the opportunities and limitations of interactive technologies that aim to reduce the frequency or shorten the duration of interruptions caused by microscope adjustment.

[1]  G. Heinemann,et al.  Team performance in health care : assessment and development , 2002 .

[2]  Hu Shen,et al.  Some collected principles of microneurosurgery: simple and fast, while preserving normal anatomy: a review. , 2005, Surgical neurology.

[3]  Kutluay Uluç,et al.  Operating microscopes: past, present, and future. , 2009, Neurosurgical focus.

[4]  A Schweikard,et al.  Motorization of a surgical microscope for intra‐operative navigation and intuitive control , 2010, The international journal of medical robotics + computer assisted surgery : MRCAS.

[5]  C. Ware,et al.  An evaluation of an eye tracker as a device for computer input2 , 1987, CHI '87.

[6]  Karen Holtzblatt,et al.  Contextual design , 1997, INTR.

[7]  Toomas Timpka,et al.  Situated cognition in clinical visualization: The role of transparency in GammaKnife neurosurgery planning , 2009, Artif. Intell. Medicine.

[8]  Peter Cuyvers,et al.  Social perspectives: emote control , 1999, INTR.

[9]  E. Coiera When conversation is better than computation. , 2000, Journal of the American Medical Informatics Association : JAMIA.

[10]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[11]  Anatole Lécuyer,et al.  Using an Eye-Tracking System to Improve Depth-of-Field Blur Effects and Camera Motions in Virtual Environments , 2008 .

[12]  Lorelei Lingard,et al.  Team Communications in the Operating Room: Talk Patterns, Sites of Tension, and Implications for Novices , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[13]  Akio Morita,et al.  Master–slave robotic platform and its feasibility study for micro‐neurosurgery , 2013, The international journal of medical robotics + computer assisted surgery : MRCAS.

[14]  P Sourdille,et al.  Eye-controlled microscope for surgical applications. , 1991, Developments in ophthalmology.

[15]  Colin Ware,et al.  An evaluation of an eye tracker as a device for computer input2 , 1987, CHI 1987.

[16]  Andrew T Duchowski,et al.  A breadth-first survey of eye-tracking applications , 2002, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[17]  Allan Kuchinsky,et al.  Turning away from talking heads: the use of video-as-data in neurosurgery , 1993, INTERCHI.

[18]  Chao-Hsu Tsai,et al.  A three‐dimensional stereoscopic monitor system in microscopic vascular anastomosis , 2012, Microsurgery.

[19]  J. Hindmarsh,et al.  The Tacit Order of Teamwork: Collaboration and Embodied Conduct in Anesthesia , 2002 .

[20]  Markku Tukiainen,et al.  Gaze behaviour of expert and novice microneurosurgeons differs during observations of tumor removal recordings , 2012, ETRA '12.

[21]  Roman Bednarik,et al.  The potentials for hands-free interaction in micro-neurosurgery , 2014, NordiCHI.

[22]  T. C. Kriss,et al.  History of the operating microscope: from magnifying glass to microneurosurgery. , 1998, Neurosurgery.

[23]  Tommy Strandvall,et al.  Eye Tracking in Human-Computer Interaction and Usability Research , 2009, INTERACT.

[24]  Ken Hinckley,et al.  Passive real-world interface props for neurosurgical visualization , 1994, International Conference on Human Factors in Computing Systems.

[25]  Helena M. Mentis,et al.  Imaging the body: embodied vision in minimally invasive surgery , 2013, CHI.

[26]  Jan Van Looy,et al.  Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery , 2013, 2013 7th International Conference on Pervasive Computing Technologies for Healthcare and Workshops.