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

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.

[1]  L. Way,et al.  Causes and Prevention of Laparoscopic Bile Duct Injuries: Analysis of 252 Cases From a Human Factors and Cognitive Psychology Perspective , 2003, Annals of surgery.

[2]  Yan Xiao,et al.  Large public display boards: a case study of an OR board and design implications , 2001, AMIA.

[3]  Charles Vincent,et al.  Systems Approaches to Surgical Quality and Safety: From Concept to Measurement , 2004, Annals of surgery.

[4]  J.W. HUBER,et al.  The effects of different viewing conditions on performance in simulated minimal access surgery , 2003, Ergonomics.

[5]  Nick Sevdalis,et al.  Teamwork in the operating theatre: cohesion or confusion? , 2006, Journal of evaluation in clinical practice.

[6]  J. Jakimowicz,et al.  Ergonomic problems encountered by the medical team related to products used for minimally invasive surgery , 2003, Surgical Endoscopy And Other Interventional Techniques.

[7]  R Flin,et al.  Development of a rating system for surgeons' non‐technical skills , 2006, Medical education.

[8]  M. Bernstein,et al.  Patient Safety in Surgery , 2009 .

[9]  Thomas B. Sheridan,et al.  Using field observations as a tool for discovery: analys ing cognitive and collaborative demands in the operating room , 2004, Cognition, Technology & Work.

[10]  Peter Fu-Ming Hu,et al.  Opportunities and challenges in improving surgical work flow , 2008, Cognition, Technology & Work.

[11]  R. Strong,et al.  Iatrogenic bile duct injury: The scourge of laparoscopic cholecystectomy , 2002, ANZ journal of surgery.

[12]  S Undre,et al.  Developing observational measures of performance in surgical teams , 2004, Quality and Safety in Health Care.

[13]  David T. Bauer,et al.  Crew resource management training for surgeons: feasibility and impact , 2008, Cognition, Technology & Work.

[14]  A. Cuschieri,et al.  Comparison of orthodox versus off-optical axis endoscopic manipulations , 2001, Surgical Endoscopy And Other Interventional Techniques.

[15]  Karen D Horvath,et al.  Surgeon Information Transfer and Communication: Factors Affecting Quality and Efficiency of Inpatient Care , 2007, Annals of surgery.

[16]  Yan Xiao,et al.  A review and a framework of handheld computer adoption in healthcare , 2005, Int. J. Medical Informatics.

[17]  Frank T. H. den Hartog,et al.  On the potential of personal networks for hospitals , 2006, Int. J. Medical Informatics.

[18]  Mervyn Gifford,et al.  Depth Perception and Indirect Viewing: Reflections on Minimally Invasive Surgery , 1999 .

[19]  Caprice K. Christian,et al.  A prospective study of patient safety in the operating room. , 2006, Surgery.

[20]  M Koutantji,et al.  Quantifying distraction and interruption in urological surgery , 2007, Quality and Safety in Health Care.

[21]  S. Fagan,et al.  Bridging the communication gap in the operating room with medical team training. , 2005, American journal of surgery.

[22]  A. Darzi,et al.  The simulated operating theatre: comprehensive training for surgical teams , 2004, Quality and Safety in Health Care.

[23]  C. Daniel Smith,et al.  Bile Duct Injury During Laparoscopic Cholecystectomy: Results of a National Survey , 2001, Annals of surgery.

[24]  Brian Hazlehurst,et al.  Getting the right tools for the job: distributed planning in cardiac surgery , 2004, IEEE Transactions on Systems, Man, and Cybernetics - Part A: Systems and Humans.

[25]  Timothy D Lee,et al.  Learning to Use Minimal Access Surgical Instruments and 2-Dimensional Remote Visual Feedback: How Difficult is the Task for Novices? , 2002, Advances in health sciences education : theory and practice.

[26]  Warren D. Smith,et al.  Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery , 2001, Surgical Endoscopy.

[27]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[28]  Y. Dion,et al.  Visual integration of data and basic motor skills under laparoscopy , 1997, Surgical Endoscopy.

[29]  Lorelei Lingard,et al.  Paradoxical effects of interprofessional briefings on OR team performance , 2008, Cognition, Technology & Work.

[30]  Ara Darzi,et al.  Robotics in surgery , 2002, BMJ.

[31]  Richard I. Cook,et al.  SPECIAL SECTION: Adapting to New Technology in the Operating Room , 1996, Hum. Factors.

[32]  S Undre,et al.  Defining the technical skills of teamwork in surgery , 2006, Quality and Safety in Health Care.

[33]  E. Etchells,et al.  Patient Safety in Surgery: Error Detection and Prevention , 2003, World journal of surgery.

[34]  Erik Hollnagel,et al.  Joint Cognitive Systems: Foundations of Cognitive Systems Engineering , 2005 .

[35]  Caroline G. L. Cao,et al.  Effects of New Technology on the Operating Room Team , 2004 .

[36]  K. Catchpole,et al.  Identification of systems failures in successful paediatric cardiac surgery , 2006, Ergonomics.

[37]  Carole Ferrel,et al.  Contrôle sensori-moteur en situation de téléopération : données théoriques et perspectives ergonomiques , 2002 .

[38]  Lawrence W. Stark,et al.  Sensing and Manipulation Problems in Endoscopic Surgery: Experiment, Analysis, and Observation , 1993, Presence: Teleoperators & Virtual Environments.

[39]  N. Sevdalis,et al.  Measuring intra-operative interference from distraction and interruption observedin the operating theatre , 2006, Ergonomics.

[40]  T. Kimura,et al.  Laparoscopic cholecystectomy performed by a single surgeon using a visual field tracking camera , 2000, Surgical Endoscopy.

[41]  G R Baker,et al.  Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR , 2005, Quality and Safety in Health Care.

[42]  Andrew N. Healey,et al.  Speculation on the Neuropsychology of Teleoperation: Implications for Presence Research and Minimally Invasive Surgery , 2008, PRESENCE: Teleoperators and Virtual Environments.

[43]  R. Reznick,et al.  Communication failures in the operating room: an observational classification of recurrent types and effects , 2004, Quality and Safety in Health Care.

[44]  Andrew N. Healey,et al.  A method for measuring work interference in surgical teams , 2008, Cognition, Technology & Work.

[45]  M A Sinclair,et al.  Ergonomics issues in future systems , 2007, Ergonomics.

[46]  A. Darzi,et al.  Objective assessment of technical skills in surgery , 2003, BMJ : British Medical Journal.

[47]  Ara Darzi,et al.  A Human Factors Analysis of Technical and Team Skills Among Surgical Trainees During Procedural Simulations in a Simulated Operating Theatre , 2005, Annals of surgery.

[48]  J. G. Holden,et al.  Perceptual-motor coordination in an endoscopic surgery simulation , 1999, Surgical Endoscopy.

[49]  M R de Leval,et al.  The human factor in cardiac surgery: errors and near misses in a high technology medical domain. , 2001, The Annals of thoracic surgery.

[50]  Caroline G. L. Cao,et al.  Lowering Communication Barriers in Operating Room Technology , 2006, Hum. Factors.

[51]  M. McDaniel,et al.  Forgetting of intentions in demanding situations is rapid. , 2003, Journal of experimental psychology. Applied.

[52]  M. Makary,et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. , 2006, Journal of the American College of Surgeons.

[53]  Thomas B Sheridan,et al.  Making the Operating Room of the Future Safer , 2006, The American surgeon.

[54]  Enrico W. Coiera,et al.  Communication behaviours in a hospital setting: an observational study , 1998, BMJ.

[55]  Jenny Dankelman,et al.  Introduction to Minimally Invasive Surgery , 2004 .

[56]  J. F. Thompson,et al.  Noise Pollution in the Operating Theatre , 1990 .

[57]  R. Berguer,et al.  A comparison of operating room crowding between open and laparoscopic operations , 1996, Surgical Endoscopy.

[58]  P. Hale,et al.  Laparoscopic cholecystectomy in England and Wales: results of an audit by The Royal college of Surgeons of England. , 1995, Annals of the Royal College of Surgeons of England.

[59]  Jenny Dankelman,et al.  Open versus minimally invasive surgery: a man-machine system approach , 1999 .

[60]  Caroline G. L. Cao,et al.  Disorientation in Minimal Access Surgery: A Case Study , 2000 .

[61]  K. R. Catchpole,et al.  Enhancing surgical systems , 2007, Cognition, Technology & Work.

[62]  Anne-Sophie Nyssen,et al.  Integrating cognitive and collective aspects of work in evaluating technology , 2004, IEEE Transactions on Systems, Man, and Cybernetics - Part A: Systems and Humans.

[63]  Ivo A.M.J. Broeders,et al.  Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience , 2006, Digestive Surgery.

[64]  J. George,et al.  Work Interrupted: A Closer Look at the Role of Interruptions in Organizational Life , 2003 .

[65]  James T. Reason,et al.  Behavioural markers of surgical excellence , 2003 .

[66]  A. Cuschieri,et al.  Task performance in endoscopic surgery is influenced by location of the image display. , 1998, Annals of surgery.

[67]  C. MacKenzie,et al.  A laboratory study on anticipatory movement in laparoscopic surgery: a behavioral indicator for team collaboration , 2007, Surgical Endoscopy.

[68]  J. Reason,et al.  Human factors and cardiac surgery: a multicenter study. , 2000, The Journal of thoracic and cardiovascular surgery.

[69]  L. Lingard,et al.  Towards safer interprofessional communication: Constructing a model of “utility” from preoperative team briefings , 2006, Journal of interprofessional care.

[70]  A N Healey,et al.  The systems of surgery , 2007 .